The ear works by receiving sound waves and sending messages to the brain. The outer ear includes the part of the ear you can see and the ear canal. The sound waves go through the ear canal and hit the eardrum and cause it to vibrate.
The vibration of the eardrum causes the tiny bones in the ear to move. This movement sends the sound waves to the inner ear.
A tube called the eustachian (say: "you-stay-shun") tube connects the middle ear with the back of the nose. Normally this tube lets fluid drain out of the middle ear. If bacteria or viruses infect the lining of your child’s eustachian tube, the tube gets swollen and fills with thick mucus. This keeps fluid in the ear from draining normally. Bacteria can grow in the fluid, increasing pressure behind the eardrum and causing pain.
The eustachian tubes can become blocked because of allergies, a cold or other infection. In other cases, the adenoids (glands near the ear) become enlarged and block the eustachian tubes.
Acute ear infections usually clear up within 1 or 2 weeks. Sometimes, ear infections last longer and become chronic. After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
Anatomy of the ear
This may be because children's eustachian tubes are shorter and more narrow than those of adults. Most children will have at least 1 ear infection by their third birthday.
Otitis media with effusion means that there is fluid (effusion) in the middle ear. The middle ear is the space behind the eardrum. Fluid in the middle ear usually doesn't bother children. It almost always goes away on its own in a few weeks to a few months. So, this kind of ear problem doesn't usually need to be treated with antibiotics, unless the fluid doesn't go away.
Swimmer's ear (also called otitis externa) is a type of ear infection. It is an infection of the outer ear and the ear canal. Because the canal is dark and warm, it can easily get infected with bacteria and fungus. Swimmer's ear is different from the kind of infection you get in the middle part of your ear. That kind of infection is called otitis media.
The most common symptoms of an acute ear infection are ear pain and fever. If your child is too young to tell you what hurts, he or she may cry or pull at his or her ear. Your child may also be irritable or listless, have trouble hearing, or not feel like eating or sleeping.
Children who have otitis media with effusion may have the following symptoms:
Sometimes, otitis media with effusion does not cause any symptoms.
Symptoms of swimmer's ear include:
If left untreated, the affected ear can become swollen and very painful to the touch. The fluid may become more pus-like and the muffled of decreased hearing may become worse.
Fluid may build up in the middle ear for several reasons. When a child has a cold, the middle ear may produce fluid just like the nose does. A tube called the eustachian (say: "you-stay-shun") connects the middle ear with the back of the nose. Normally, the eustachian tube lets fluid drain out of the middle ear. However, bacteria or viruses can infect the lining of your child’s eustachian tube causing it to swell. The adenoids (glands near the ear) can also become enlarged and block the eustachian tubes. It is also not a good idea to let your baby fall asleep with a bottle or to leave a bottle in the crib. Drinking while lying down may also block the eustachian tubes.
If the eustachian tubes are blocked, fluid in the ear cannot drain normally. If bacteria grow in the middle ear fluid, an effusion can become a middle ear infection (acute otitis). This will usually increase pressure behind the eardrum and cause a lot of pain. The eardrum will become red and bulging. If this happens, your child may need to be treated with antibiotics.
Children who have frequent ear infections can also develop otitis media with effusion after their infection is gone if the fluid stays in the middle ear.
Several things can make swimmer's ear more likely, including the following:
The treatment for ear infections may include any of the following:
The. U.S. Food and Drug Administration (FDA) advises against the use of ear candles. Ear candles can cause serious injuries and there is no evidence to support their effectiveness. For more information, please visit the FDA Web site.
If your child is older than 6 months of age and only has mild symptoms, the best treatment is to let the fluid go away on its own. You can give your child an over-the-counter pain reliever, such as acetaminophen, (one brand: Children's Tylenol) if he or she is uncomfortable. A warm, moist cloth placed over the ear may also help.
Usually the fluid goes away in 2 to 3 months, and hearing returns to normal. Your doctor may want to check your child again at this time to see if fluid is still present.
Your child may need antibiotics if fluid is still there after a few months and is causing hearing loss or problems in both ears. For this reason, your child's ears should be checked a few months after an ear infection. If the fluid is still there, a hearing test may be the next step. Your doctor may also recommend antibiotics if your child is under 6 months of age or gets frequent middle ear infections.
Giving your child unnecessary antibiotics can be harmful. After each course of antibiotics, the germs in the nose and throat are more likely to become resistant. Resistant germs can't be killed by the usual antibiotics. More expensive and powerful antibiotics have to be used. Some of these antibiotics must be given in the hospital and their side effects can be very unpleasant or even dangerous. Since fluid in the ears doesn't usually bother children, it's better to wait and only give antibiotics when they are necessary.
If the fluid stays for more than a few months, your doctor may want to check your child's hearing. Your doctor may recommend ear tubes (also called tympanostomy tubes) to drain the fluid. Ear tubes may also decrease the number of ear infections your child gets.
Ear tubes are tiny plastic tubes that help balance the pressure in your child's ears. They allow air into the middle ear so that fluid can drain out down the eustachian tube. They're put into the eardrum (which is also called the tympanic membrane) during surgery and stay in place for an average of 6 to 9 months.
The tubes are usually left in place until they fall out on their own or your doctor decides your child no longer needs them. Sometimes, another set of tubes may be needed.
Placing tubes in the ears requires an operation and has some risks. Your child will need general anesthesia when the tube is inserted. Your doctor will talk with you about the risks if he or she thinks your child needs ear tubes.
Your doctor will look in your ear canal and remove any drainage or pus. Your doctor will check your eardrum to make sure there's no other infection. Most swimmer's ear infections can be treated with ear drops that contain antibiotics to fight infection and medicine to reduce itching and swelling. You can also take an over-the-counter pain medicine to relieve pain, such as ibuprofen (some brands: Advil, Motrin).
Your doctor will tell you how long and how often to use your ear drops. Warm the bottle in your hands before putting the drops in your ear. Using warm ear drops may prevent discomfort when the drops go in. Moving the earlobe back and forth after putting the drops in will also help the medicine go deep into the ear canal.
Follow your doctor's directions carefully and use all of your medicine(s). Swimmer's ear can be hard to treat. Here are some things that will help you get better:
Symptoms are usually much better in 3 days. They should be completely gone in 10 days. If you're not better by then, call your doctor.
Middle ear infections and fluid in the ear are the most common causes of temporary hearing loss in children. Children who have ongoing problems with hearing may have trouble developing their speech and language skills. For this reason, it is important to talk with your doctor if your child has repeated ear infections.
Some children seem to get many ear infections. If your child has had 3 ear infections in 6 months or 4 in 1 year, your doctor may suggest that your child take a low dose of antibiotic every day, usually during the winter, when these infections are most common.
Your doctor may want to see your child a few times when he or she is taking the antibiotic to make sure another ear infection does not happen.
The best way to prevent swimmer's ear is to keep the ear canal's natural defenses against infection working well. Follow these tips:
Appropriate Use of Antibiotics for URIs in Children: Part I. Otitis Media and Acute Sinusitis by SF Dowell, M.D., M.P.H., B Schwartz, M.D., WR Phillips, M.D., M.P.H., and The Pediatric URI Consensus Team (American Family Physician October 01, 1998, http://www.aafp.org/afp/981001ap/dowell.html)
Otitis Externa: A Practical Guide to Treatment and Prevention by R Sander, M.D. (American Family Physician March 01, 2001, http://www.aafp.org/afp/20010301/927.html)
Written by familydoctor.org editorial staff