Ear Infections

Overview

How does the ear work?

A tube called the eustachian (say: “you-stay-shee-an”) 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 the eustachian tube, the tube gets swollen and fills with thick mucus. This keeps the ear from draining normally. Sometimes bacteria can grow in the fluid, increasing pressure in the middle ear behind a bulging eardrum and causing pain.

The vibration of the eardrum causes the tiny bones in the ear to move. This movement sends the sound waves to the inner ear.

What causes earaches?

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 the 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 also 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. When the tubes are blocked, even if there is no infection, air in the middle ear space is gradually absorbed and this creates a vacuum or negative middle ear pressure. This negative pressure also often creates an achy discomfort, and can lead to fluid (effusion) in the middle ear and reduced hearing. Doctors call this whole pattern “eustachian tube dysfunction.” Learn more about eustachian tube dysfunction here.

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.

Why are earaches so common in children?

Ear infections may be more common in children because their eustachian tubes are shorter and more narrow than those of adults. Most children will have at least 1 ear infection by their third birthday.

What are the types of ear infections?

Otitis media is a term that refers to an inflammation of the middle ear without indicating a specific cause of the condition. Conditions affecting the middle ear include acute otitis media and otitis media with effusion. Learn more about otitis media with effusion here.

Another type of ear infection involves the outer ear and ear canal. Swimmer’s ear or otitis externa is caused by water irritating the skin inside the ear. Learn more about otitis externa (swimmer’s ear) here.

Symptoms

What are the symptoms of ear infections?

The most common symptoms of an acute middle ear infection (otitis media) 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.

Causes & Risk Factors

Children may be at higher risk for ear infections if they:

  • Are around people who smoke.
  • Have had previous ear infections.
  • Have a family history of ear infections.
  • Attend day care (because they are exposed to more germs and viruses).
  • Were born prematurely or with a low birth weight.
  • Have frequent colds or other infections.
  • Are bottle-fed rather than breast-fed (only a factor in first few months).
  • Take a bottle to bed.
  • Use a pacifier.
  • Are male (boys tend to get more ear infections than girls).
  • Have nasal speech (caused by large adenoids that block the eustachian tube).
  • Have allergies with nasal congestion.

Treatment

What is the treatment for ear infections?

The treatment for ear infections may include any of the following:

  • If your doctor thinks the infection is caused by bacteria, he or she may prescribe an antibiotic (antibiotics don’t work for infections caused by viruses). Your doctor may defer antibiotics among children 2 to 12 years with mild symptoms when there is an option for the doctor to observe the child’s symptoms for 48 to 72 hours. It’s very important to follow the directions for giving your child the medicine.
  • Pain relievers like acetaminophen (brand names: Children’s or Infants’ Tylenol) and ibuprofen (brand names: Children’s Advil or Children’s Motrin) can help make your child feel better and reduce fever. Patients younger than 18 years should not take aspirin if they have or are recovering from a fever, flu symptoms, or the chicken pox because of the risk of a serious and sometimes fatal condition called Reye’s syndrome.
  • A warm (not hot) heating pad held over the ear can also help relieve pain from the earache.
  • Your doctor may also prescribe ear drops to relieve pain.

Will my child need antibiotics?

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.

Why not just try antibiotics right now?

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.

What if the fluid doesn’t go away on its own?

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.

What are ear tubes?

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.

How should I use eardrops?

Your doctor will tell you how long and how often to use your eardrops. Warm the bottle in your hands before putting the drops in your ear. Using warm eardrops 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.

Complications

Will earaches hurt my child’s hearing?

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.

Persistent ear infections can cause damage to the structures in the middle ear, which can result in permanent hearing loss. However, this is not common.

Prevention

How can I help prevent ear infections from returning?

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.

Bibliography

Questions to Ask Your Doctor

  • My ear hurts and itches. Could I have swimmer’s ear?
  • How can I make my child more comfortable?
  • When should I call my doctor?
  • If my child has frequent ear infections, will he/she have to have ear tubes?
  • If my child gets several ear infections, could he/she have trouble hearing?
  • Is there anything I can do to help my child hear better?
  • My child has allergies. Will he/she be more likely to get ear infections?
  • When will my doctor prescribe antibiotics for my child?
  • How often will my child need to see the doctor if he/she has frequent ear infections?
  • If fluid drains from my child’s ear, should I call the doctor right away?

FDA Warning

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.

Citations

  • Otitis media: diagnosis and treatment by Harmes KM, et al.(American Family Physician 10/01/13, http://www.aafp.org/afp/2013/1001/p435.html )
  • Acute otitis externa: an update. by Schaefer P, Baugh RF(American Family Physician 12/01/12, http://www.aafp.org/afp/2012/1201/p1055.html)