Ear infections, also called otitis media, are a common problem in children. About 50% of infants have at least one ear infection by their first birthday. Ear infections can cause pain in the ear, fever, and temporary hearing loss and general signs such as loss of appetite and irritability. Some children get better without specific antibiotic treatment but most young infants benefit from use of an antimicrobial agent.
What is an Ear Infection?
Ear infection, also known as acute otitis media, is an infection of the middle section of the ear. This condition is particularly common in children and can cause symptoms such as ear pain, fever, and temporary hearing loss.
What Causes an Ear Infection?
Ear infections often develop after a viral respiratory infection, like a cold or the flu. These infections cause swelling of the mucous membranes in the nose and throat, impairing the Eustachian tube's ability to regulate ear pressure. This leads to fluid buildup in the middle ear, where bacteria and viruses can thrive, resulting in inflammation, increased pressure, and symptoms such as fever, pain, and fussiness.
Ear Infection Symptoms
Symptoms of an ear infection in adolescents and older children may include ear aching or pain and temporary hearing loss. These symptoms usually come on suddenly.
In infants and young children, symptoms of an ear infection can include:
- Fever (temperature higher than 100.4ºF or 38ºC)
- Pulling on the ear
- Fussiness or irritability
- Decreased activity
- Cough
- Lack of appetite or difficulty eating
- Vomiting or diarrhea
Diagnosing an Ear Infection
If you suspect that your child has an ear infection, call your doctor to see if and when the child should be examined. Although the exam is not painful, most infants and children do not like having their ears examined. The doctor will use an instrument (otoscope) to look inside the child’s ear to view the ear drum. Often cerumen (ear wax) will need to be removed so your doctor can get a good view of the ear drum. The doctor can tell if your child has an ear infection by looking at the ear drum (tympanic membrane) for the typical features of an ear infection.
Ear Infection Treatment
Treatment of an ear infection may include:
- Antibiotics
- Medicines to treat pain and fever
- Observation
- A combination of the above
The “best” treatment depends on the child’s age, history of previous infections, degree of illness, and any underlying medical problems.
Antibiotics
Antibiotics are usually given to infants who are younger than 24 months or who have high fever or infection in both ears. Children who are older than 24 months and have mild symptoms may be treated with an antibiotic or observed to see if they improve without antibiotics. Antibiotics can have side effects such as diarrhea and rash, and overusing antibiotics can lead to more difficult to treat (resistant) bacteria. Resistance means that a particular antibiotic no longer works or that higher doses are needed next time.
Observation
In some cases, your child’s doctor will recommend that you watch your child at home before starting antibiotics; this is called observation. Observation can help to determine whether antibiotics are needed. Observation may be recommended in these situations:
- If the child is older than 24 months
- If the child appears well to the doctor
- If ear pain and fever are not severe
- If the child is otherwise healthy
You can give pain-relieving medicines during observation to ease pain. If your child is being observed rather than treated with antibiotics, you will need to call or go back to the doctor’s office after 24 hours for follow-up. If your child’s pain or fever continues or worsens, antibiotics are usually recommended; observation may continue if the child is improving.
Pain Management
Pain-relieving medicines, including ibuprofen (like Motrin), acetaminophen (like Tylenol), or ear drops that contain a numbing medicine, may be used to reduce discomfort.
Humidifier or Shower Steam
Use a cool-air humidifier or shower steam to loosen mucus or fluid in the ear. Additionally, keeping the air moist can help soothe irritated nasal passages and improve overall comfort.
Not Recommended to Treat Ear Infections
Complementary and Alternative Medical Treatments
There are a wide variety of complementary and alternative medical (CAM) treatments advertised to treat ear infections. These may include homeopathic, naturopathic, chiropractic, and acupuncture treatments. There are few scientific studies of CAM treatments for ear infection, and even fewer studies that show CAM treatments to be effective. As a result, these treatments are not recommended for ear infections in children.
Decongestants & Antihistamines
Cough and cold medicines (which usually include a decongestant or antihistamine) have not been proven to speed healing or reduce complications of ear infections in children. In addition, these treatments have side effects that can be dangerous. Neither decongestants nor antihistamines are recommended for children with ear infections.
Follow-up
Your child’s symptoms should improve within 24 to 48 hours whether or not antibiotics were prescribed. If your child does not improve after 48 hours or gets worse, call your doctor for advice. Although fever and discomfort may continue even after starting antibiotics, the child should get a little better every day. If your child appears more ill than when seen by his or her health care provider, contact the provider as soon as possible.
Children who are younger than two years and those who have language or learning problems should have a follow-up ear exam two to three months after being treated for an ear infection. These children are at risk for delays in learning to speak. This follow-up helps to ensure that the fluid collection (which can affect hearing) has resolved.
Ear Infection Complications
While complications from ear infections in children are rare, they can be serious when they occur. Potential issues include persistent hearing loss and ruptured eardrums. Prompt medical treatment typically prevents these complications, ensuring most children make a full recovery.
Ruptured Ear Drum
One of the common complications of an ear infection is rupture of the ear drum, also known as the tympanic membrane. The tympanic membrane can rupture when fluid presses on the membrane, reducing blood flow and causing the tissue to weaken. It does not hurt when the membrane ruptures, and many children feel better because pressure is released. Fortunately, the tympanic membrane usually heals quickly after rupturing, within hours to days. Rupture of the ear drum is an indication for antibiotic treatment of an ear infection.
Hearing Loss
The fluid that collects behind the eardrum (called an effusion) can persist for weeks to months after the pain of an ear infection resolves. An effusion causes trouble hearing, which is usually temporary. If the fluid persists, however, it can interfere with the process of learning to speak. Effusions usually resolve without any treatment. However, if the effusion persists for more than three months, the child may need treatment with a surgical procedure. The decision to treat is based upon how much the effusion affects the child’s hearing and the child’s risk of speech problems.
Children who are not treated for an effusion should be monitored over time. This includes an ear exam and hearing testing every three to six months until the effusion goes away.
Preventing Ear Infections in Children
Some children develop ear infections frequently. Recurrent ear infections are defined as three or more infections in six months, or four or more infections within 12 months. In addition to receiving the pneumococcal and influenza vaccines, as recommended for all children, several interventions can help reduce the risk of recurrent infections. These include avoidance of tobacco smoke, breastfeeding, continuous low dose antibiotics, and/or surgical placement of tubes in the ears.
Ways To Lower The Risk Of Ear Infections In Children
- Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year.
- It is recommended that you vaccinate your child with the 20-valent pneumococcal conjugate vaccine (PCV20). The PCV20 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7 or PCV13. If your child already has begun PCV7 or PCV 13 vaccination, consult your physician about how to transition to PCV20. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated. The vaccine is strongly recommended for children in daycare.
- Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu.
- Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections.
- Never put your baby down for a nap, or for the night, with a bottle.
- Don’t allow sick children to spend time together. As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick.
Preventive Antibiotics
Children who have recurrent ear infections are sometimes treated with a preventive regimen of a daily antibiotic during the fall, winter, and early spring months. Although preventive antibiotics might help reduce the number of ear infections, it is still possible for the child to get an infection. There is also a risk that taking antibiotics for a long period of time can lead to bacteria that are resistant to standard antibiotics. Talk to your child’s doctor about the potential benefits and risks of this approach.
Surgery
Some studies show that having surgery to place tympanostomy tubes in the ears helps to prevent recurrent ear infections. Other studies show no benefit of tympanostomy tubes for prevention of recurrences. Talk to your child’s doctor about the risks and benefits of surgery.
Frequently Asked Questions
Middle ear infections often go away on their own within 2 or 3 days, even without any specific treatment.
Often, there’s fluid in the middle ear even after an infection clears up. If it’s there for longer than 3 months, more treatment might be needed.
Kids (especially in the first 2 to 4 years of life) get ear infections more than adults do for several reasons:
- Their shorter, more horizontal eustachian tubes let bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower, so more likely to get blocked.
- Their adenoids, gland-like structures behind the nose, are larger and can interfere with the opening of the eustachian tubes.
Other things that can put kids at risk include secondhand smoke and bottle-feeding. Ear infections are more common in boys than girls.
Finding a Pediatrician Near You
Choosing the right pediatrician is a crucial step in ensuring the health and well-being of your child. A good pediatrician provides essential care, support, and guidance as your child grows and develops, helping to address any health concerns along the way.
Are you looking for a trusted pediatrician to support your child's health journey? Look no further than Pediatric Affiliates of Hampton Roads. Our experienced and compassionate team is dedicated to providing personalized, high-quality care for children of all ages. Schedule an appointment today and give your child the excellent care they deserve. Book now and take the first step toward securing your child's bright and healthy future.