Ear Infections in Your Child -- The Comprehensive Parental Guide to Causes and Treatments Kenneth Grundfast, MD, and Cynthia J. Carney Compact Books, 283 pp. $14.95
The words "middle ear infection" ("otitis media" in medical jargon) conjure up images of sleepless nights, crying children, expensive medications and frequent doctor visits in the mind of any parent whose child has suffered through this illness. These same images are also envisioned by the pediatrician or family practitioner who is responsible for treating children with this illness.
In their new book, "Ear Infections in Your Child -- The Comprehensive Parental Guide to Causes and Treatments," Kenneth Grundfast, MD, chairman of the Department of Otolaryngology at Children's Hospital National Medical Center, and Cynthia J. Carney, a Washington free-lance writer, try to make some sense of this medical dilemma. This problem is not a trivial one. Otitis media, even since the advent of antibiotics, remains a major public health problem. It has been estimated that up to 2 billion dollars annually are spent on treatment of this problem alone. It is the most common medical problem faced by children (except for self-limited viral upper respiratory infections). It is second only to well-baby visits as a reason for an office visit to the pediatrician. Thirty million visits per year to physicians are estimated to take place for the diagnosis and treatment of otitis media. By age 6, nearly 90 percent of children in the United States will have had at least one ear infection.
Otitis media, or middle ear infection, refers to inflammation or infection of the eardrum. Most of the time, this infection must be treated with antibiotics. Following successful treatment of an ear infection, fluid may persist behind the eardrum for up to three months. If the fluid persists for longer periods of time, hearing loss and/or delayed development may occur. To prevent these problems, ENT (ear, nose and throat) specialists often will insert tympanostomy tubes (small plastic or metal tubes placed in the eardrum to ventilate and drain fluid or pus from the middle ear cavity) if a child has frequent or complicated infections. Most ear infections occur in children 6 to 24 months of age. As children become older, the incidence of ear infections usually decreases.
Prior to the discovery of antibiotics, life-threatening and permanent complications frequently followed episodes of otitis media. With the arrival of antibiotics, life-threatening conditions decreased but a whole new Pandora's box of problems has been opened. With millions of dollars at stake, drug companies with new and more expensive antibiotics try to influence a physician's choice of medication. Some physicians overprescribe antibiotics. When, and if, to insert tympanostomy tubes is presently controversial in the medical literature. Controversies have also arisen over the length of treatment, which antibiotic to use, how to diagnose otitis media and when to refer to a specialist -- to name only a few. While many physicians remain confused and perplexed by this problem, most parents are inundated by conflicting reports from physicians, magazine articles and anecdotal experiences of friends or relatives.
In their book, Grundfast and Carney present a step-by-step approach to assist both parents and physicians. With copious diagrams and sharp, concise definitions, they unravel some of the mystique of otitis media. What is unique in this book is that the reader continually is presented with two points of view -- that of a physician and that of a parent.
Some parents may find its length intimidating, but if a parent has a child with recurrent episodes of otitis media, it may just be worth the effort. Its style is fluent, with frequent illustrations and pictures.
New ground is broken by this book in several areas. There is an excellent chapter on how to prepare a child for going to the hospital for surgical placement of ear tubes. It is written from a parent's perspective and is insightful. The questions-and-answers section at the end of many of the chapters is very practical for both parents and physicians. In fact, just reading these alone would answer all the questions most parents have. These sections do help to dispel many of the myths and misconceptions that continue to surround this illness.
The book considers all aspects of this illness fairly -- from both points of view. Physicians are not assumed to be money-grabbing, beeper-carrying golfers, and parents are not presumed to be innocent bystanders. The book encourages physicians to improve their diagnostic skills and to prevent financial considerations from influencing their treatment of this illness. Parents are ordered to stand up for their children and help them -- parents are to stop being medical wimps! There are very clear ways that parents can help prevent their children from getting ear infections -- by not propping up an infant's bottle during feeding, by not smoking and by breastfeeding. The increasing use of daycare centers has also been implicated as a factor for contributing to frequent episodes of otitis media.
Grundfast and Carney also very adroitly clear up many misunderstandings and misconceptions between physician and parent. For example, the book explains why doctors don't prescribe antibiotics over the phone even when parents "know" their child has an ear infection. (In one study, 30 percent of the children did not have an ear infection, even though their parents felt they did.)
While at times Grundfast and Carney go into too much detail, and though it is exhaustingly long, this book is a welcome addition to the library of child health -- for parents and physicians alike. This book should also be read by every pediatric or family practice resident prior to the completion of medical training.
This book is intended to assist parents in taking care of and managing their child's illness along with the pediatrician. With the writing of this book, Grundfast and Carney have gone a long way in showing parents and physicians how to work together as partners in solving the intricacies of this all too common childhood illness.Lawrence K. Epple Jr., MD, is a board-certified pediatrician. He is on the faculty of Thomas Jefferson Medical School in Philadelphia and the Underwood-Memorial Hospital Family Practice Residency Center in Woodbury, N.J.