The American Academy of Pediatrics has developed a guide-line for the diagnosis and treatment of ear infections. Michael B. Grosso, MD, Senior Vice President of Medical Affairs at Huntington Hospital, and a Fellow of the American Academy of Pediatrics, answered questions on the new guidelines and the reason for the AAP's focus on this common childhood condition.

Q: Why did the AAP issue guidelines on this condition at this time?

Dr. Grosso:
Ear Infection (otitis media, acute otitis media) is the most common infection for which children receive medical attention and the most frequent reason that physicians prescribe an antibiotic at any age. As such, their cost, impact on families, and effect on the health and well-being of children is very significant.

Q: What do the new guidelines say about diagnosis?

Dr. Grosso:
The most important insight is that we have to be careful not to over diagnose this condition. Studies indi-cate that when physicians think they see an ear infection, they may be wrong as much as half the time. In addition, we now know that ear infections clear up spontaneously in more than 80% of cases.

Q: What does this mean for treatment?

Dr. Grosso:
In light of this information, the Academy now recommends that pediatricians consider an "observation option" for some children with ear infections. This is especially helpful for those over 2 years of age with mild symptoms or when the diagnosis is unclear.

Q: Why consider delaying treatment if there's even a small chance that it will help?

Dr. Grosso:
We've always known that antibiotics are not harmless. At the very least, children may experience diarrhea or other annoying symptoms. If an allergy develops, reactions can sometimes be severe. More recently, we have also become much more concerned about drug-resistant bacteria, which are the direct result of our antibiotic use.

Q: "Observation" sounds like "no treatment." Is that reasonable for a child in pain?

Dr. Grosso:
No, it's not. That is why the guideline strongly emphasizes pain control. Antibiotics are not pain-relievers. When prescribed for an ear infection, they probably take a day or more to make a difference, if they help at all. Either way, something needs to be done to control the earache. That means medications like Motrin® or Tylenol®, possibly with codeine or a similar agent. Anesthetic ear drops are pretty good, but the pain relief doesn't last long.

Q: Is there anything else that parents can do?

Dr. Grosso:
As is so often the case, "an ounce of prevention" is best. Breastfeeding for the first year of life reduces ear infections; exposure to tobacco smoke increases them. And since most of these infections occur as complications of the common cold, good hand washing and hygiene really make sense, especially in the Fall and Winter months. Immunization with the pneumococcal vaccine called Prevnar® only reduces ear infections by about 6% overall in studies, but it seems to prevent the most severe ones, reduces recurrences and has brought about a significant decrease in the need for surgical procedures for chronic middle ear problems related to these infections.