by Paul M. Dake, M.D.

Q:  My children have had ear infections since they were less than a year old. Whenever we saw their doctor some years ago for this problem, I was given a prescription for a decongestant. Since we moved and they have a new doctor, decongestants have not been part of the treatment for their infections. Why the change?

A:  Pediatric ear infections are always a result of abnormal fluid collection (mucus) inside the middle ear chamber.  This mucus usually drains out of the chamber into the back of the throat though the Eustachian tube, with yawning, chewing, or blowing one’s nose. We don’t feel it because it’s only a fraction of a drop in an area that’s moist all the time anyway.

But when the throat area is swollen, the Eustachian tubes are easily blocked, preventing normal drainage of any fluid that collects there.

In the same way that decongestants tend to dry up nasal drainage, they also cause considerable thickening of any mucus trapped in the ear chamber, making it more difficult to clear it from the chamber.  This has been shown to prolong the infection and the child’s pain, hence decongestants are no longer recommended for ear infections in children.  This applies to adults, as well as children.

By the same token, if you are having upper respiratory infection (URI) symptoms, with scratchy throat, nasal stuffiness, and clear nasal drainage, and you notice your hearing is suddenly decreased, you have almost certainly begun to accumulate fluid in this chamber.  If left there long enough, it virtually always becomes infected.

Such infection can be completely prevented if you are able to push the fluid in the chamber out into the back of the throat.  This is best accomplished by taking a fairly deep breath, pinching your nose shut, closing your mouth tightly, and trying to push air out through your nose, building pressure in the entire upper throat area; keep bearing down until one or both of your ears ‘pops’, then stop and breathe normally for several minutes.  This may have to be repeated a number of times because the amount of fluid pushed out each time is small and, in an adult, there can be as much as a full teaspoon trapped in the chamber.  Children as young as 3-4 years old can be taught to do this.

Anyone with a history of middle ear infections should probably start ‘popping’ their ears as soon as URI symptoms begin, to prevent even the beginning of a buildup of fluid in the middle ear chambers.

Thanks to Crystal H. for this question.  To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website, where you can click on the Search box in the upper right corner of the website, and enter your topic of interest.

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