Advice by Pediatric Conditions: Ear Infections

There Are Two Common Types Of Ear Infections – External And Middle Ear Infections.

• External ear infections start after irritation of the ear canal. These usually occur after frequent swimming and are commonly called “swimmer’s ear infections.” For more information, please refer to the swimmer’s ear page.
• The second type is the middle ear infection. This usually occurs after the eustachian (or drainage) tube from the middle ear becomes blocked and the fluid which collects behind the eardrum becomes infected.
  • Since young (under 9 years of age) children usually do not spend enough time in water to have problems with external ear infections, it is the middle ear infection which causes the most problems in young children.

For the rest of this section we will discuss middle ear infections.

Middle ear infections are more common than all other infections in children except “colds”. While most ear infections begin as colds, most colds do not progress to ear infections. If an ear infection is going to occur, it usually takes several days to develop after the cold starts.

Ear pain and fever usually mean an ear infection is present. However, ear infections can be present when one or both of these signs are absent. Even when ear pain is present it may be difficult to detect, especially in young children.

Often the only signs of ear pain are crankiness or eating and sleeping problems. Sometimes there are no signs, at all.

Ear pulling is not a reliable sign of ear infection in infants.

Most infants older than three months pull, scratch or play with their ears when no infection is present, and most children with an ear infection do not manipulate their ears.

Complications

Mild hearing loss or distorted hearing is a frequent complication of ear infections. These hearing problems are almost always temporary. However, even mild hearing problems can interfere with your child’s learning and development, especially speech development. Therefore, appropriate treatment and follow-up ear rechecks are important for young children. Serious infections rarely complicate ear infections.

Treatment

Ear infections are usually caused by bacteria. Because antibiotics (like amoxicillin) are medicines which kill bacteria, they are the mainstay of treatment. However, over 80% of ear infections resolve just as quickly (or slowly) with antibiotics as without any antibiotic. In other words, antibiotics do not help over 80% of children with ear infections and most children get well quickly without any medication.

Since problems may result from the use of antibiotics, there are many situations when it is best to NOT treat an ear infection with antibiotics. For example, if your child has minimal symptoms (ie, is only slightly bothered by ear discomfort) it is not necessary to treat with antibiotics.

For many children (especially under age 3 years) with ear pain and/or fever in this country, an antibiotic is prescribed. You should always take the full course of antibiotics if one is prescribed. The most worrisome situation occurs when a child is “partially treated”, or given less than the full prescription. Even if your child seems completely well within a few days after starting an antibiotic, always finish the antibiotic.

In children older than 3 years of age, a common treatment strategy is to use pain medication for several days, and reserve antibiotic treatment for those children who do not get better during that time. Please feel free to discuss middle ear infection treatment with our physicians.

Middle ear pain can be relieved with Tylenol (Panadol, Tempra etc) or Motrin/Advil. The correct dose and frequency is the same as the dose and frequency used for fever control. Warmth (from a hot water bottle or heating pad) applied to the outside of the ear will also help soothe the discomfort. These measures are especially helpful when the pain arises at night. Ear infections are not serious medical problems and need not cause you to seek care in an emergency room or urgent care center.

Does Your Child Get Frequent Ear Infections?

There are several reasons that might explain why your child gets more ear infections than other children.

• Ear infections may run in your family because of an eustachian tube that frequently malfunctions.
• Smoking in the household irritates the eustachian tube and increases the likelihood of middle ear fluid accumulating.
• Children who drink from a bottle while lying flat on the back are prone to ear infections.
• Allergies can cause the eustachian tube to malfunction
• Frequent colds (brought home by an older brother or sister, or contracted from other children at the daycare center or pre-school) can predispose a child to frequent ear infections.
• Children that use a pacifier and attend daycare are at the highest risk for contracting ear infections.