Ear Infections

Next to the common cold, an ear infection is the most common childhood illness. In fact, most children have at least one ear infection by the time they are 3 years old. Most of the time, ear infections clear up without causing any lasting problems.

An Overview of Ear Infections

In order to understand how ear infections occur, it’s helpful to know how our ears work. The ear has three parts:  the outer ear, middle ear and inner ear. A small tube (eustachian tube) connects the middle ear to the back of the nose. When a child has a cold, nose or throat infection, or allergy, the eustachian tube can become blocked, causing a buildup of fluid in the middle ear. If bacteria or a virus infects this fluid, it can cause swelling and pain in the ear. This type of ear infection is called acute otitis media.

Often after the symptoms of acute otitis media clear up, fluid remains in the ear. Acute otitis media then develops into another kind of ear problem called otitis media with effusion (middle ear fluid). This condition is harder to detect than acute otitis media because except for the fluid and usually some mild hearing loss, there are often no other noticeable symptoms. This fluid may last several months and, in most cases, disappears on its own. Hearing then returns to normal.

Symptoms Of An Ear Infection

Your child may or may not have symptoms during an ear infection. Talk with your pediatrician about the best way to treat your child’s symptoms.

Pain. The most common symptom of an ear infection is pain. Older children can tell you that their ears hurt. Younger children may only seem irritable and cry. You may notice this more during feedings because sucking and swallowing may cause painful pressure changes in the middle ear.

Loss of appetite. Your child may have less of an appetite because of the ear pain.

Trouble sleeping. Your child may have trouble sleeping because of the ear pain.

Fever. Your child may have a temperature ranging from 100F (normal) to 104F.

Ear drainage. You might notice yellow or white fluid, possibly blood-tinged, draining from your child’s ear. The fluid may have a foul odor and will look different from normal earwax (which is orange-yellow or reddish-brown). Pain and pressure often decrease after this drainage begins, but this doesn’t always mean that the infection is going away. If this happens it’s not an emergency, but your child will need to see your pediatrician.

Trouble hearing. During and after an ear infection, your child may have trouble hearing for several weeks. This occurs because the fluid behind the eardrum gets in the way of sound transmission. This is usually temporary and clears up after the fluid from the middle ear drains away.


Ear Infections: Common Risk Factors

Ear Infections occur for a number of reason. Some can be controlled by parents, others not. Here’s a look at the most common risk factors for developing childhood ear infections:


Infants and young children are more likely to get ear infections than older children. The size and shape of an infant’s eustachian tube makes it easier for an infection to develop. Ear infections occur most often in children between 3 months and 3 years of age. Also, the younger a child is at the time of the first ear infection, the greater the change he will have repeated infections.

Family history

Ear infections can run in families. Children are more likely to have repeated middle ear infections if a parent or sibling also had repeated ear infections.


Colds often lead to ear infections. Children in group child care settings have a higher chance of passing their colds to each other becasue they are exposed to more viruses from the other children. Allergies that cause stuffy noses can also lead to ear infections.

Tobacco Smoke

Children who breathe in someone else’s tobacco smoke have a higher risk of developing health problems, including ear infections.


Babies who are bottle-fed, especially while they are lying down, get more ear infections than breastfed babies. If you bottle-feed your child, hold his head above the stomach level during feedings. This helps keep the eustachian tubes from being blocked.

Three things you can do to help reduce your child’s risk of getting an ear infection are:

Breastfeed instead of bottle-feed. Breastfeeding may decrease the risk of frequent colds and ear infections.

Keep your child away from tobacco smoke, especially in your home or car.

Also, vaccines against bacteria (such as pneumococcal vaccine) and viruses (such as influenza vaccine) may reduce the number of ear infections in children with frequent infections.


Ear Infections: Complications or Problems

Although it’s very rare, complications from ear infections can develop, including the following:

  • An infection of the inner ear that causes dizziness and imbalance (labyrinthitis)
  • An infection of the skull behind the ear (mastoiditis)
  • Scarring or thickening of the eardrum
  • Loss of feeling or movement in the face (facial paralysis)
  • Permanent hearing loss

It’s normal for children to have several ear infections when they are young — even as many as two separate infections within a few months. Most ear infections that develop in children are minor. Recurring ear infections may be a nuisance, but they usually clear up without any lasting problems. With proper care and treatment, ear infections can usually be managed successfully. But, if your child has one ear infection after another for several months, you may want to talk about other treatment options with your pediatrician.

Because your child can have trouble hearing without other symptoms of an ear infection, watch for the following changes in behavior (especially during or after a cold):

  • Talking more loudly or softly than usual
  • Saying huh? or what? more than usual
  • Not responding to sounds
  • Having more trouble understanding language in noisy rooms
  • Listening with the TV or radio turned up louder than usual

If you think your child may have difficulty hearing, call your pediatrician. Being able to hear and listen to others talk helps a child learn speech and language. This is especially important during the first few years of life.

Ear Infections:  Pain and Treatment

Sometimes an ear infection isn’t to blame for your child’s ear pain. There are other reasons, such as the following, that cause your child’s ears to hurt.

  • An infection of the skin of the ear canal, often called swimmer’s ear
  • Blocked or plugged eustachian tubes from colds or allergies
  • A sore throat
  • Teething or sore gums

Because pain is often the first and most uncomfortable symptom of ear infection, it’s important to help comfort your child by giving her pain medicine. Acetaminophen or ibuprofen are over-the-counter pain medicines that may help decrease much of the pain. Be sure to use the right dosage for your child’s age and size. Don’t give aspirin to your child. It has been associated with Reye syndrome, a disease that affects the liver and brain. There are also ear drops that may relieve ear pain for a short time. Ask your pediatrician whether these drops should be used. There is no need to use over-the-counter cold medicines (decongestants and antihistamines), because they don’t help clear up ear infections.

Not all ear infections require antibiotics. Some children who don’t have a high fever and aren’t severely ill may be observed without antibiotics. In most cases, pain and fever will improve in the first one to two days.

If your child is younger than 2 years, has drainage from the ear, has a fever higher than 102.5F, seems to be in a lot of pain, is unable to sleep, isn’t eating, or is acting ill, it’s important to call your pediatrician. If your child is older than 2 years and your child’s symptoms are mild, you may wait a couple of days to see if she improves.

Your child’s ear pain and fever should go away within two to three days of their onset. If your child’s condition doesn’t improve within 2 days, call your pediatrician. Your pediatrician may wish to see your child and may prescribe an antibiotic, if one wasn’t given initially. If an antibiotic was already started, your child may need a different antibiotic. Be sure to follow your pediatrician’s instructions closely.

If an antibiotic was prescribed, make sure your child finishes the entire prescription. If you stop the medicine too soon, some of the bacteria that caused the ear infection may still be present and cause an infection to start all over again.

As the infection starts to clear up, your child might feel a popping in the ears. This is a normal sign of healing. Children with ear infections don’t need to stay home if they are feeling well, as long as a child care provider or someone at school can give them their medicine properly, if needed. If your child needs to travel in an airplane, or wants to swim, contact your pediatrician for specific instructions.

Middle Ear Fluid and Your Child

The middle ear is the space, usually filled with air, behind the eardrum. When a child has middle ear fluid (otitis media with effusion), it means that a watery or mucous-like fluid has collected in the middle ear. Otitis media means middle ear inflammation, and effusion means fluid.

Middle ear fluid is not the same as an ear infection. An ear infection occurs when middle ear fluid is infected with viruses, bacteria or both, often during a cold. Children with middle ear fluid have no signs or symptoms of infection. Most children don’t have fever or severe pain, but may have mild discomfort or trouble hearing. About 90 percent of children get middle ear fluid at some time before age 5.

There is no one cause for middle ear fluid. Often your pediatrician may not know the cause. Middle ear fluid could be caused by:

  • A past ear infection
  • A cold or flu
  • Blockage of the eustachian tube (a small tube that connects the middle ear to the back of the nose)

You can help your pediatrician find the cause of your child’s middle ear fluid. Just write down your child’s name, pediatrician’s name and number, date and type of ear problem or infection, treatment, and results. These clues and can lead to a cause of the fluid.

Many healthy children with middle ear fluid have little or no problems. They often get better on their own. Often middle ear fluid is found at a regular checkup. Ear discomfort, if present, is usually mild. Your child may be irritable, rub his ears or have trouble sleeping. Other symptoms include hearing loss, changes in behavior, loss of balance, clumsiness and repeated ear infections. You may notice your child sitting closer to the TV or turning the sound up louder than usual. Sometimes it may seem like your child isn’t paying attention to you.

Some children with middle ear fluid are at risk for delays in speaking or may have problems with learning or schoolwork. Children at risk may include those with:

  • Permanent hearing loss not caused by middle ear fluid
  • Speech and language delays or disorders
  • Developmental delay of social and communication skills disorders (for example, autism-spectrum disorders)
  • Syndromes that affect cognitive, speech and language delays (for example, Down syndrome)
  • Craniofacial disorders that affect cognitive, speech and language delays (for example, cleft palate)
  • Blindness or visual loss that can’t be corrected

If your child is at risk and has ongoing middle ear fluid, her hearing, speech and language should be checked out right away.

Some risk factors for ear infections and middle ear fluid can be avoided, some can’t. Studies have found that children who live with smokers, attend group child care, or use pacifiers have more ear infections. Because some children who have middle ear infections later get middle ear fluid, you may want to:

  • Keep your child away from tobacco smoke.
  • Keep your child away from children who are sick.
  • Throw away pacifiers or limit to daytime use (if your child is older than 1 year).

Since there are limited symptoms associated with middle ear fluid, there are two tests that can determine whether fluid exists: a pneumatic otoscope and tympanometry.

A pneumatic otoscope is the best test for middle ear fluid. With this tool, the pediatrician looks at the eardrum. Tympanometry is another test for middle ear fluid. Tympanometry shows how well the eardrum moves. An eardrum with fluid behind it doesn’t move as well as a normal eardrum. Your child must sit still for both tests; the tests are painless. Because these tests don’t check hearing level, a hearing test may be given, if needed. Hearing tests measure how well your child hears. Although hearing tests don’t test for middle ear fluid, they can measure if the fluid is affecting your child’s hearing level. The type of hearing test given depends on your child’s age and ability to listen.


(Adapted from American Academy of Pediatrics)

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