Doctors’ Notes

Ear Infections

As Dr. Wolynn explains in his Note on Colds, viruses that cause colds are everywhere, and for the most part you and your child are able to fight them off after a few days. But occasionally they persist. When they do, they can cause complications such as otitis media — more commonly known as an ear infection.

What Causes Ear Infections?

earclipart Ear infections usually result from a viral upper respiratory illness (or, as it’s more commonly known: a cold). Colds cause congestion and inflammation of the ears, nose, and throat. These viruses and the symptoms they cause commonly resolve in 7-10 days. If they persist, fluid settles in the middle ear (the area behind the ear drum), and bacteria grow. Once the bacteria settle in, your child will usually experience persistent pain, fever, and irritability.

Who is Most Commonly Affected?

Ear infections can affect anyone, but the peak age is usually between 6 months and 2 years. Children under age 7 are prone to ear infections due to the angle of their Eustachian tubes. The Eustachian tube connects the middle ear to the throat and is usually an air-filled filled that becomes inflamed as a result of the virus. As children grow, the angle of the tube increases, making them less prone to accumulating fluid.

What are Some Signs & Symptoms?

Persistent ear pain. (Once the infection settles, pain usually does not wax and wane.)

Tugging at the ears. (Many children do this due to discomfort.)

Fever. (It’s common, but it doesn’t have to be present.)

Pressure (Older children may describe this sensation due to buildup of fluid in the Eustachian tube.)

Decrease in hearing. (Due to fluid behind the drum.)

Cold symptoms. (Persistent cold symptoms can predispose a child to an ear infection.)

How are Ear Infections Treated?

Symptomatic treatment includes appropriate doses of acetaminophen or ibuprofen for pain control and warm or cold compresses to the affected side. Occasionally for older children, numbing drops can be used to help alleviate the pain, but they should not be used unless first seen by a physician and determined that there is no rupture of the ear drum.

Frequently we suggest symptomatic treatment for the first 48 hours to allow the body to fight the infection on its own. If after that your child is still experiencing pain or symptoms are worsening, he or she may need an antibiotic. Antibiotics are usually prescribed for 7-10 days. (You should finish the entire course.)

Your child should be reevaluated 3-4 weeks after completion of the medications to ensure the infection has resolved. Non-infected fluid may often persist following an infection. If the fluid is present for longer than 3 months, it may need to be drained.

What are the Complications?

Sometimes parents may see pus draining from the ear canal. This is caused by a rupture of the ear drum. After the ear drum ruptures, children often feel better, because the pressure has been released. The burst ear drum will heal within a few weeks. A child with drainage from the ear should be evaluated in the office for appropriate treatment.

For children with recurrent ear infections, more than 3 in a season or 4-5 in a 12-month period, a referral to an ear specialist is recommended to evaluate for possible placement of tympanostomy tubes. These tubes are inserted into the ear drum and allow the middle ear fluid that may accumulate to drain. Children with ear tubes may still experience ear infections, but not nearly as frequent as before. If an infection does develop, the tube allows the pus to drain, and topical antibiotics alone can be used to treat the infection.

How Can I Help Prevent Ear Infections?

Immunize. (Make sure your child is up to date, including a yearly flu vaccine. Vaccinated children have fewer ear infections.)

Good hygiene. (Stress the importance of washing hands frequently to help prevent the spread of germs which can lead to colds and subsequent infections.)

Stop smoking. (Children exposed to nicotine suffer from more ear infections than those without exposure.)

Breastfeed. (Breast milk has been shown to help protect your baby from illnesses.)

A Few Take-Home Points

Colds lasting longer than 7-10 days with ear symptoms should be evaluated by a doctor.

Antibiotics are not always required to treat ear infections.

Fluid may be present in the middle ear following infections for up to 3 months.

Children can typically experience 3-5 ear infections each year and not have later hearing problems.

Dr. Alicia Hartung, a proud Kids Plus Doc since 2001, is a shareholder in the practice.