Ear Infection

An ear infection is commonly known medically as something called “otitis media” or inflammation of the middle ear. By one year, 60% of children will have been diagnosed with one ear infection. By the age of 7 years, between 65%-95% of children will have been diagnosed with at least one episode of otitis media.

Acute otitis media (AOM) or “ear infection” means that there is inflammatory fluid in the middle ear space accompanied by ear pain, ear discharge or a distortion of the middle ear. Fever and irritability may also be present.

Otitis media with effusion (OME) means that there is fluid only in the ear without ear pain, discharge or distortion of the middle ear. This requires no treatment but to observe for pain, discharge, fever, or irritability (signs that mean that AOM has now developed).    

What is the anatomy behind an ear infection?

A healthy middle ear must contain air at the same atmospheric pressure as the outside of the ear so all these structures can vibrate freely and function normally to transmit sound. Air enters the middle ear through the Eustachian tube which passes from the back of the nose up into the ear. When you yawn or swallow and hear a pop (or click) in your ear, that means your eustachian tube has just sent a tiny little bubble of air up into your middle ear to equalize the air pressure.  This happens automatically over 1,000 times a day. As viruses from a cold infect the nose and upper respiratory mucosa, they cause swelling in the eustachian tubes so that they cannot function to drain fluids or regulate pressure.  Inflammatory fluid, mucus and respiratory bacteria/viruses reflux into the middle ear space. Otitis media forms.

An overproduction of mucus from allergies can also occlude the Eustachian tube which may lead to otitis media as well.

What are symptoms of an ear infection?

Fever, crankiness, clinginess, decreased appetite, or vomiting with history of a recent upper respiratory infection are the main symptoms. Some children will not want to be laid down in their crib. Some older children may complain of ear pain or popping or sudden loss of hearing along with pain, or may be off balance (ear regulates balance).

What factors increase my child’s chances of having an ear infection?

1. Exposure to tobacco smoke

2. Attendance at day care centers or having multiple upper respiratory infections

3. Heredity- if either/both parents had more frequent ear infections or allergies

4. Having craniofacial abnormalities

Are ear infections caused by bacteria or viruses?

The majority of ear infections are caused by bacteria- about 60% of the time. The remainder are caused by viruses or something called Mycoplasma. Respiratory viruses such as respiratory syncytial viruses (RSV), and influenza viruses may also be the culprit.

How are ear infections treated?

If you suspect an ear infection, make an appointment to be seen at the office. Not all ear infections are treated with antibiotics. Pain relievers are important especially in the first 24 hours. See dosage tables for acetaminophen and ibuprofen use. Your medical provider may give you the option of observance with a “safety net” antibiotic prescription to be started in 24-72 hours if your child does not improve. Some children (those that are young, febrile, suffer from recurrent infection and/or are very uncomfortable) are given antibiotics because they will benefit most from earlier treatment. High dose amoxicillin is the drug of choice and will be prescribed for children that are not allergic to penicillin or its derivatives.  Your child will be monitored closely for signs that the ear infection has resolved regardless if it is treated or not. This will necessitate a follow up ear recheck visit.

What if my child is “pulling on his/her ear”?

This symptom alone is not a reliable indicator of ear infection. If your child is doing this and is 6-12 months old, does not have a cold or has not had a recent cold and is acting fine, eating, drinking and sleeping okay, it is most likely not an ear infection. Your child has simply “found” his/her ears and is now enjoying playing with them.

What if my child just has OME or only “fluid in the ear”?

Your child may have fluid in the middle ear space that most likely will resolve over time. This fluid will be monitored on a monthly basis to ensure that it is draining. It is possible that your medical provider will use a device called a tympanometer (painless test) to quantify and monitor how much fluid is present and how much sound is conducted to the middle ear space.

It is important to remember that because this fluid is present, your child is more at risk of having it turn into an ear infection or AOM , especially if your child develops a new upper respiratory infection. If your child develops symptoms of irritability, fever, clinginess when OME is diagnosed, make an appointment.

Are ear infections contagious?

No- only the colds and upper respiratory infections that precede them are contagious.

What if my child’s eardrum ruptures?

Occasionally a child with an ear infection experiences spontaneous rupture of the middle ear membrane. This actually will improve your child’s pain and sometimes you will see blood or a pus filled fluid coming from the ear. Call the office to see if you should schedule another appointment. Typically, an antibiotic ear drop will be prescribed and a follow up visit will be made to ensure that the membrane has healed-rest easy- it usually heals really fast!

What is swimmer’s ear?

Swimmer’s ear or otitis externa is an inflammation that involves the structures of the outer ear, most specifically the ear canal. Otitis externa can result from the presence of a foreign body, or from swimming or bathing, or from an infected hair follicle. Children’s symptoms are ear pain, pain with chewing or pain with manipulation of the ear itself. An antibiotic topical solution possibly with an ingredient to decrease swelling will be prescribed during the office visit. Otitis externa can be prevented by keeping the ear canal dry and free of extra occlusive debris (like extra ear wax). In some cases drops found over the counter may be used after swimming to ensure that the canal remains clean and dry- call the office before using these drops.

What are ear tubes? Does my child need them?

Ear tubes or pressure equalizing tubes are inserted into a very small incision in the tympanic (middle ear) membrane. This allows for a temporary opening to drain the middle ear if fluid is present. This procedure is very safe and is extremely effective for recurrent ear infections in children.

Your Pediatrician and Ear Nose and Throat (Otolaryngologist) Doctor will decide if ear tubes are indicated for your child, but these are some general guidelines.

1. Children with prolonged OME- usually longer than 12 weeks but sometimes as long as 4-6 months.

2. Children with recurrent AOM or ear infections. Children with at least 3 separate episodes in 6 months or 4 in 12 months. Sometimes the same ear infection is treated with multiple courses of antibiotics. These are not separate infections but counted as one infection.

 By the age of 5 years, most children have wider and longer eustachian tubes, allowing better drainage of fluids from the ear.