Otitis Media (ear infection)

What is an ear infection?

An ear infection, also called a middle ear infection, is one of the most common conditions among children. They shouldn’t be ignored. Untreated ear infections can lead to unnecessary pain and permanent hearing loss for your child. An ear infection occurs in the middle ear and is caused by a bacterial or viral infection. It creates pressure in the small space between the eardrum and the back of the throat called the Eustachian tube. Smaller Eustachian tubes are more sensitive to pressure, which causes the ear pain. A child’s adenoids (the little bits of tissue that hang above the tonsils at the back of the throat) can block the opening of Eustachian tubes because they are larger in young children.

Eustachian tubes do not work properly when filled with drainage from the nose or mucous from allergies, colds, bacteria, or viruses because the drainage presses on the eardrum, which is what causes the pain. A chronic ear infection can last for 6 weeks or more, but most go away on their own after 3 days. Children who are routinely exposed to illness from other kids (especially during the winter months), or second-hand smoke are more likely to get ear infections, as does bottle-feeding, because your baby is lying down while eating. Some ear pain is due to teething in babies, a buildup of earwax, or a foreign object your child may have put in their ears. When the pressure increases, it can cause your child’s eardrum to rupture or pop, leaving a hole in the ear. The initial pop hurts, but actually relieves the pressure and pain.

Symptoms of ear infections

Intense pain in your child’s affected ear is usually the first sign of an ear infection. Young children can tell you that their ear hurts, but babies may only cry. Your child may repeatedly pulls on the ear that hurts. The pain is usually worse at night and when your child is chewing, sucking a bottle, or lying down because that’s when the pressure is at its greatest. Other symptoms include a runny nose, cough, fever, vomiting, or dizziness, and hearing loss.

Chronic, frequent ear infections can cause permanent hearing loss. You might suspect your child has hearing loss if you have to talk louder to your child, your child turns up the volume of the TV or music, is not responding to softer sounds or is suddenly less attentive at school.

What causes ear infections?

Ear infections happen in the middle ear. They are caused by a bacterial or viral infection. The infection creates pressure in the small space between the eardrum and the back of the throat. This area is called the Eustachian tube. These tubes do not work properly when filled with drainage from the nose or mucous from allergies, colds, bacteria, or viruses.

How are ear infections diagnosed?

Your doctor will be able to check for an ear infection by using a small scope with a light to look into your child’s ear. The infection is not visible without that tool, called an otoscope. Your doctor will know if the eardrum is infected if it looks red and he or she sees fluid inside the ear, the eardrum ruptured, leaving a hole that is visible to your doctor, or if your child has related symptoms, such as a runny nose, cough, fever, vomiting, and dizziness.

Can ear infections be prevented or avoided?

Although an ear infection is not contagious, the bacteria or virus that causes it is often passed from person to person like most germs. It’s important to:

  • Vaccinate your child with a pneumococcal conjugate vaccine to protect against several types of pneumococcal bacteria. This type of bacteria is the most common cause of ear infections. Get your child’s vaccinations on time.
  • Practice routine hand washing and avoid sharing food and drinks, especially if your child is exposed to large groups of kids in day care or school settings.
  • Avoid second-hand smoke.
  • Breastfeed your baby exclusively for the first 6 months and continue breastfeeding for at least 1 year. Place your baby at an angle while feeding.
  • Common allergy and cold medicines do not protect against ear infections.

Ear infection treatment

Ear infections usually go away in a few days without the use of medicine and don’t require surgery. Doctors are cautious about prescribing antibiotics for ear infections unless they are chronic and frequent. Research shows that over prescribing antibiotics for ear infections is not effective. Doctors treat the pain and fever of an ear infection with over-the-counter (OTC) pain relievers or eardrops, and wait a few days to see if your child’s infection disappears on its own. They’ll ask you to bring your child in again if there’s no improvement. The doctor may prescribe an antibiotic at that point if it is a bacterial infection.

If your child has chronic and frequent ear infections, signs of hearing loss, or speech delays because of that hearing loss, your doctor might refer you to an ear, nose, and throat (ENT) specialist for ear tube surgery. An ENT surgically inserts tubes inside your child’s middle ear. The tubes relieve the pressure and allow the fluid to drain. Some children naturally have small Eustachian tubes, so this helps correct that problem. As your child’s ears grow and develop, the tubes fall out automatically and the ear infections are no longer a problem. Sometimes, the tubes fall out too soon and have to be replaced. For some children, they never fall out and eventually have to be surgically removed. The surgery is quick and does not require overnight hospitalization.

Your doctor may recommend ear tube surgery in certain instances, such as frequent ear infections, or if your child has Down syndrome, cleft palate or a weakened immune system. Never stick anything in your child’s ear to relieve the pain of an ear infection, to remove the tubes or remove a foreign object. See your child’s doctor to have it removed.

Living with ear infections

Young children are more likely to get ear infections than are older children or adults. They are one of the most common illnesses among children. If your child suffers from several ear infections each year, you’ll want to look out for symptoms every time he or she has a stuffy nose or congestion. Many times, an ear infection will clear up on its own within a week or two. If you can manage your child’s pain at home, the American Academy of Family Physicians recommends a wait-and-see approach for 48 hours before seeing a doctor and asking for an antibiotic. This is unless your child has pain in both ears, is less than 2 years old, and has a fever higher than 102.2°F.

Adapted from American Academy of Family Physicians