Ear Infections

General Overview:

Ear infections are the most common illness in children.  They occur when fluid builds up in the middle ear and then becomes infected. Ear infections are most common in children ages 6-24 months, but may occur at any age.

The medical term for ear infections is “otitis media,” which means inflammation of the middle ear.  The middle ear is a small space behind the eardrum that is normally filled with air and also contains the tiny ear bones known as ossicles. The middle ear is connected to the nose and throat by a narrow canal called the eustachian tube. Otitis media occurs when fluid builds up in the middle ear and then becomes infected. The fluid buildup occurs because of poor drainage through the eustachian tube.

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Risk Factors:

The biggest risk factor for ear infections is age.  Ear infections are caused by the swelling of the nose and throat, which prevents the eustacian tube from properly draining built up fluid.  For this reason, ear infections are most commonly the result of a cold or allergies.  Ear infections are also more common in children who attend daycares, are exposed to cigarette smoke and/or who bottle feed.  Ear infections are less common in breastfed infants.

Signs/Symptoms:

Common Signs and symptoms include, but are not limited to:

  • Pain
  • Fever
  • Poor appetite
  • Trouble sleeping
  • Decreased hearing
  • Drainage from the ear

A normal middle ear/An infected middle ear

Management:

  • Acetaminophen (Tylenol) or Ibuprofen (Motrin, Advil) help reduce the pain associated with ear infections.  Keep in mind pain medications take 30-45 minutes to see a benefit
  • Elevating the Head - Since the pain is caused by pressure in the ear, which is worse when a child lays down, propping the head up with extra pillows may be helpful
  • Antibiotics – although not all ear infections require antibiotics, those that do are often treated with amoxicillin.  This is because it is effective, tastes good, is easy to administer and is less expensive than many other antibiotics. A small percentage of ear infections will not respond to Amoxicillin. Antibiotics often take a few days to work, but if your child has not improved much after 2-3 days on medicine please call to speak with your doctor.
  • While ear infections that are caused by bacteria are treated with antibiotics, many are caused by viruses, such as the common cold, and resolve without treatment. This is why antibiotics are not always the treatment of choice for ear infections.Your Provider can help determine the likely cause and best treatment course for an ear infection.

Additional Information:

Ear infections are NOT CONTAGIOUS, although the colds that often accompany them are. If your child has an ear infection but no fever and is acting well, he or she is no more contagious than other children with colds, and can return to day care or school.

There is also no restriction on swimming with an ear infection. There is no relation between getting ears or hair wet and typical middle ear infections. However, if your child has an ear infection, it can be harmful to the eardrum (and painful) to dive into deep water. Flying with an ear infection can be painful, and it is possible that changes in cabin pressure during a flight can damage an infected ear.  Although there is no unanimous opinion among ear specialists, most pediatricians and ear specialists agree that after several days of antibiotics, the risk of damage to the ear from flying is very minimal.

When to call our office:

It is necessary for us to examine your child in order to diagnose an ear infection. We all feel very strongly that it is not good medical care to prescribe oral antibiotics over the telephone, and we hope that you will understand this policy. It is very rare that the above "management" measures are not successful at keeping a child comfortable until he or she can be seen in the office for a proper diagnosis.

Takeaway Message:

Ear infections are extremely common in children. Most ear infections are easily treatable and not harmful to children.  If you think your child may have an ear infection consider either calling our nurse or scheduling an appointment for evaluation in our office. 

Additional Resources:

Information on ear infections from the American Academy of Pediatrics.