Ear Infection

An ear infection, known medically as acute otitis media, is a sudden infection in the middle ear. The middle ear is the area behind the eardrum and in front of the inner ear, containing the small bones that receive outside sound waves and propagate them to the inner ear by vibration.

Eustachian Tubes and Their Role:

Eustachian Tubes: These are slight canals that connect the middle ear with the back of the throat.
Purpose: They equalize pressure in the ear and prevent fluid accumulation in the middle ear.
If the tubes don’t work properly, the fluid can build up inside the middle ear and leave a child with a gray feeling or sensation. Infections that involve viruses or bacteria can also produce fluid in the middle of the ear. Typically, this will inflict some pain and impact an individual’s ability to hear.

How Common Are Ear Infections?

Ear infections themselves aren’t contagious, but the germs causing them are.

Prevalence in Children: Ear infections are very common in young children, especially between 6 months and 2 years of age. They are the most frequent childhood ailment, other than colds.
Older Children and Adults: While older children and adults can get ear infections, they are much less common than in young children.

Why Are Children More Prone to Ear Infections?

Children are more prone to ear infections compared with adults due to a number of factors:

Eustachian Tube Function: The eustachian tubes in children are not that functional in draining the fluid out. Immature Immune System: Their immune system is not fully developed.
Getting Sick: Children easily get infections from their playmates.

Causes of Ear Infections

Ear infections are caused by bacteria or viruses. They often follow a cold or upper respiratory infection:

Germ Spread: Germs travel from the throat to the middle ear through the eustachian tube, leading to inflammation and infection.

Risk Factors

Risk Factors Include:
- Age: Infants and young children are more at risk.
- Family History: Ear infections can run in families.
- Frequent Colds: Increased risk in children who are often exposed to colds.
- Chronic Conditions: Conditions like cystic fibrosis or asthma.
- Ethnicity: Higher incidence in Native American, Hispanic, and Alaska Native children.
- Environmental Factors: Exposure to pollution and secondhand smoke.

Symptoms

Symptoms often start after a cold and include:

Ear Pain: A common sign of infection.
Loss of Appetite: Children may not want to eat.
Trouble Sleeping: Discomfort can disrupt sleep.
Hearing Issues: A blocked ear can make hearing difficult.
Feeling of Fullness: A sensation of pressure in the ear.
Ear Drainage: Yellow, brown, or white fluid can indicate a ruptured eardrum. Avoid inserting anything into the ear if you see drainage.

For Infants and Young Children:

Ear Tugging: They might rub or pull at their ears.
Increased Crying: They may become unusually fussy.
Fever: A temperature between 100.5 and 104 degrees Fahrenheit.
Mouth Breathing: May indicate enlarged adenoids, which can be related to ear infections.
Feeding Difficulties: Swallowing can cause pain and reduce their desire to eat.

Diagnosis

Diagnosing an ear infection involves a combination of evaluating symptoms, conducting a physical examination, and, if necessary, performing additional tests. Here’s a breakdown of the process:

Initial Diagnosis

Symptom Assessment:
- Your healthcare provider will start by asking about your child’s symptoms, such as ear pain, fever, and any recent upper respiratory infections like colds.
Physical Examination:
- General Check: The provider will look for signs of a cold or other illnesses that could be associated with an ear infection.
- Ear Examination: Using an otoscope, a lighted instrument, the provider will inspect the eardrum. An inflamed, swollen, or red eardrum typically indicates an ear infection.
Pneumatic Otoscope:
- This special otoscope blows a puff of air onto the eardrum. The eardrum should move slightly with the puff of air. If fluid is present in the middle ear, the eardrum will not move as expected.

Additional Tests

If the initial examination is inconclusive or if the infection is persistent, your child may need further testing:

Tympanometry:
- This test uses varying air pressure to check for fluid in the middle ear. It helps determine how well the eardrum and middle ear are functioning.
Acoustic Reflectometry:
- This method uses sound waves to detect fluid in the middle ear. It measures how sound waves reflect back from the eardrum.
Tympanocentesis:
- In this procedure, a small needle is used to remove fluid from the middle ear. The fluid is then tested for viruses or bacteria. Tympanocentesis is generally considered if other treatments have not resolved the infection.
Hearing Tests:
- An audiologist may perform hearing tests to assess if there is any hearing loss. This is especially relevant if the ear infection has been long-lasting or recurrent, as persistent fluid in the middle ear can affect hearing.

Treatment

Treating an ear infection involves several considerations based on factors like the child’s age, the infection’s severity, and its duration. Here’s a detailed overview of the treatment options:

General Treatment Approach

Observation vs. Treatment: Many ear infections resolve on their own without medical intervention. Healthcare providers often monitor the infection to see if it improves naturally before prescribing antibiotics. Pain relief can be managed with medications while waiting for the infection to resolve.
When Treatment is Necessary: If the infection persists or is severe, antibiotics or surgery might be required. Pain relief can also be achieved with over-the-counter medications.

Antibiotics

Antibiotics are used to treat bacterial ear infections. Here’s when they are typically prescribed:

Children 6 Months and Older:
- Moderate to Severe AOM: If the infection has lasted for at least 48 hours or if the child has a fever of 102.2°F (39°C) or higher, antibiotics are recommended.
Children 6 Months to 23 Months:
- Both Ears, Mild AOM: For mild infections lasting less than 48 hours with a temperature below 102.2°F (39°C), antibiotics are recommended.
Children 6 Months to 23 Months:
- One Ear, Mild AOM: For mild infections lasting less than 48 hours with a temperature below 102.2°F (39°C), the choice is between antibiotics or observation. If observing, start antibiotics if the condition worsens or does not improve within 48 to 72 hours.
Children 24 Months and Older:
- One or Both Ears, Mild AOM: Similar to younger children, either antibiotics or observation can be chosen. If observing, antibiotics should be started if the condition worsens or does not improve within 48 to 72 hours.

Important: Even if symptoms improve, continue taking antibiotics as prescribed to prevent the infection from returning.

Pain-Relieving Medications

Over-the-Counter Options: Your healthcare provider may suggest medications like acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) to alleviate pain and reduce fever.
Ear Drops: Prescription ear drops may also help with pain relief.

Note: Avoid giving aspirin to children as it can lead to Reye’s syndrome, a serious and potentially life-threatening condition.

Ear Tubes (Tympanostomy Tubes)

Ear tubes might be necessary if a child has:

Frequent ear infections
Infections that don’t respond to antibiotics
Hearing loss due to fluid buildup

Procedure Details:

Tympanostomy: An ENT specialist performs a tympanostomy, a brief procedure (about 10 minutes) where a small tube is inserted into a tiny cut in the eardrum.
Myringotomy: This involves making a small incision to drain fluid from the middle ear.

Post-Procedure:

Tube Duration: The tube remains in place for 12 to 18 months and may fall out on its own. If not, a surgical procedure might be needed to remove it. The eardrum hole will heal and close once the tube is removed.

Prevention

Reduce Exposure to Colds and Respiratory Illnesses:
- To help avoid ear infections, especially in your child’s first year, focus on preventing colds. Teach children to wash their hands frequently and to cover coughs and sneezes with their elbow.
- Minimize sharing of food, drinks, or utensils.
- If possible, delay enrolling your child in large daycare centers until they are older, as they are often exposed to more germs.
Avoid Secondhand Smoke:
- Keep your child away from smoke-filled environments. Secondhand smoke can increase the risk of ear infections.
Breastfeed Your Baby:
- If you can, breastfeed your baby for the first six to twelve months. Breast milk contains antibodies that help fight off infections.
Proper Bottle-Feeding Technique:
- When bottle-feeding, hold your baby in an upright position. This helps prevent fluids from flowing back into the eustachian tubes, reducing the risk of infections.
Stay Current on Vaccinations:
- Ensure your child receives all recommended vaccines, including annual flu shots starting at 6 months old. Also, discuss with your pediatrician about vaccines for pneumococcal disease and meningitis.

Possible Complications

Most ear infections don’t lead to long-term problems, but potential complications include:

Hearing Loss: Temporary or permanent hearing issues can occur.
Speech and Language Delays: Prolonged hearing loss can delay speech development.
Torn Eardrum: About 5-10% of infections result in a small tear, which usually heals on its own but may need surgery if it doesn’t.
Spread of Infection: Rarely, infections can spread to the bone behind the ear (mastoiditis) or to the brain’s protective membranes (meningitis).

When to Consult a Healthcare Provider

Immediate Consultation:

If your child experiences any of the following, seek immediate medical attention:
- Stiff neck
- Severe sluggishness or unusual sickness
- Difficulty walking or balance issues
- Severe ear pain
- Fever above 104°F (40°C)
- Facial weakness (e.g., crooked smile)
- Blood or pus-filled fluid draining from the ear

During Office Hours:

Contact your healthcare provider if:
- Fever persists or returns more than 48 hours after starting antibiotics
- Ear pain does not improve after three days of antibiotic treatment

Outlook and Recovery

Self-Healing:
- Most ear infections resolve on their own without the need for antibiotics. In the meantime, pain relievers can help manage symptoms like ear pain.
Antibiotics and Ear Tubes:
- Depending on the infection’s severity, your child might need antibiotics. For persistent or frequent infections, or if fluid remains in the middle ear, ear tubes might be recommended. Follow your healthcare provider’s advice on treatment and care.
Returning to Daily Activities:
- Your child can go back to school or daycare once their fever is gone.

FAQS

Going Outside:
- You do not need to cover your child’s ears when going outside with an ear infection.
Swimming:
- Swimming is generally safe unless there is a tear in the eardrum or drainage from the ear.
Traveling:
- Air travel and high altitudes are usually fine. You might experience some discomfort during takeoff and landing. Drinking fluids or chewing gum can help alleviate the pain, and giving a pacifier to a small child can also ease discomfort.

Note: Contact your child’s pediatrician if symptoms do not improve within two to three days. Often, ear infections resolve on their own, but depending on symptoms and age, antibiotics or other treatments may be necessary. Your provider can also suggest pain relief options to manage the illness.

Sources

Clevland Clinic
Merck Manual, Consumer Version. Overview of Middle Ear Infections in Young Children
Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update)
Danishyar A, Ashurst JV. Acute Otitis Media. Treasure Island, FL: StatPearls Publishing; 2022 Jan-.
American Academy of Pediatrics (healthychildren.org). Middle Ear Infections

Ear Infections