A tough viral season is tough on children's ears: What family physicians should watch for

Healthcare practitioners should be on the lookout for recurrent ear infections or hearing impairments in children after the surge in RSV, flu, colds and COVID-19, experts suggest. “I think it is important to keep being alert and find out those children that do have hearing impairment after viral illnesses,” said Dr. Ran Goldman, a pediatrician at BC Children’s hospital and a professor of pediatrics at the University of British Columbia. “This has been always true but I think more so now that we have a surge for the last few months of multiple viruses, not to mention the ongoing pandemic with COVID.” Viral infections often temporarily effect hearing due to the accumulation of fluid, or effusion, in the ears. This is usually resolved once the child is no longer ill, but now that there are more children sick with viral infections, and some sick with multiple viruses, it’s a good idea to check for a lingering effect of the effusion and if their is hearing is impaired, Dr. Goldman said. “Hearing is the future of speaking for children and they need to have their hearing well." Read: QUIZ: Test your knowledge on healthy ears Children with ear infections should be treated following the Canadian Pediatric Society guidelines on management of otitis media. The guidelines suggest waiting to make sure the ear infection is bacterial before initiating antibiotic treatment. “In general, most of the ear infections are caused by viruses and are likely to resolve themselves,” he said. The Canadian Pediatric Society guidelines suggest that physicians guide the family “to hold off from antibiotics and wait and see what’s going to happen in the next 24-48 hours,” Dr. Goldman noted. A child who has a high fever, severe ear pain and has been significantly ill for 48 hours is more likely to have a bacterial infection, and should be treated with antibiotics immediately, the guidelines state. If an ear infection is diagnosed, it’s important to follow-up. Be sure to ask parents or guardians about repeated ear infections to determine if a hearing test is necessary. Of course, hearing loss may not be due to an infection. It could be due to a build-up of ear wax, or even inattention. Dr. Goldman advises a full examination to find out the cause of hearing loss or ear pain. Examining children's ears and identifying the tympanic membrane is not an easy task, he noted. First, children may not allow you to approach with an otoscope. Second, there may be obstacles in the way from seeing the tympanic membrane, such as wax and dry skin. Family physicians may not have the time to clear the ears at each visit, but they can advise parents or guardians to clear the child’s earwax before a visit by putting one drop a day of mineral oil in the ear for a few days before the appointment, Dr. Goldman said. Research from the United States suggests ear infections were less common during school closures due to the COVID-19 pandemic. A retrospective cohort study of otitis media in children who visited U.S. children’s hospitals showed a significant decrease in cases in April to December 2020 compared to cases seen in 2019. Cases increased again in 2021, according to the paper in the American Journal of Otolaryngology. Read: Get kids back to school sooner after concussion for a better recovery: new study The number of ear infections may rise after the surge in viral infections seen in Canada and the U.S. “As we get through this winter and look at data, we might see the number (of ear infections) even went higher proportionately because of the higher number of viral upper respiratory infections,” Dr. Ishminder Kaur, assistant professor of pediatrics in the division of infectious diseases at the University of California in Los Angeles’ David Geffen School of Medicine, told Today.com Bacterial complications might be seen more frequently than normal because of the prevalence of viral illnesses in children. “Because there are so many more kids getting infected, we're going to see more of these rare complications,” Dr. Aaron Milstone, a pediatric infectious disease specialist at the Johns Hopkins Children’s Center in Baltimore told Today.com. “We've definitely seen a couple more cases of mastoiditis in the last few months than we've seen in prior winters,” Dr. Milstone said, noting that this could be “just because we’re seeing more kids with respiratory illness who get complicated ear infections.” While there’s no evidence suggesting hearing loss in children due to COVID-19, there have been reports of accumulation of fluid in the ears, tinnitus and vertigo with a SARS-CoV-2 infection. These are similar to what is seen after other viral illnesses, Dr. Goldman said. The Canadian Pediatric Society guidelines for the management of otitis media are available on their website. It also has a resource about ear infections for parents and guardians. Choosing Wisely also has a handout about antibiotics and ear infections. Read: Answers to FAQs on COVID-19 subvariant XBB.1.5

A tough viral season is tough on children's ears: What family physicians should watch for

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