Ear Infections

Definition and Causes

Acute otitis media is an infection (bacterial or viral) of the space behind the eardrum (middle ear).  In children, the eustachian tube (the tube that drains the ear) is shorter and more horizontal than in adults.  This results in poorer eustachian tube function.  In addition, children tend to get more respiratory infections.  With these infections, the eustachian tube can become inflamed.  Bacteria can travel easily from the throat to the middle ear and lead to infection.

Other risk factors for ear infections include:

• Daycare: Colds often lead to ear infections.  Children in group daycare settings have a higher chance of passing their colds to each other because they are exposed to more germs and viruses from the other children.  If your child has recurrent ear infections, he/she may benefit from a change to a smaller daycare setting or removal from daycare.
• Eustachian tube dysfunction/obstruction: This may result from allergies and enlarged or infected adenoids.
• Tobacco Smoke: Children who are exposed to second-hand smoke experience a higher risk of developing health problems, including ear infections.
• Bottle Feeding: Babies who are bottle fed, especially while lying down, have a tendency to experience more infections than breast-fed babies.  If you bottle feed your child, hold his/her head above the stomach level during feedings. Never let your baby have a bottle in bed.
• Age:Infants and young children are more likely to get ear infections.  The highest incidence is in children between the ages of 6 and 18 months.
• Genetic Issues: Children with problems such as cleft palate and Down Syndrome have underlying abnormalities that affect eustachian tube function.
• Inheritance: Children with parents and siblings with a history of ear infections have a higher incidence.

Symptoms

Ear infection symptoms include earache, irritability and crying (especially during feedings), trouble sleeping, fever, ear drainage (yellow or white fluid), and difficulty hearing.

Complications

An untreated ear infection can cause hearing loss, pain, and local infection that can spread to areas nearby.

Treatment

Bacterial ear infections may be treated with antibiotics.  If antibiotics are prescribed, It is very important to follow your doctor’s instructions and take the full course of antibiotics.  If antibiotics are stopped too soon, some of the bacteria that caused the original reaction may still be present and cause an infection to start over again.

Antibiotics are not used in viral ear infections or when simple fluid accumulates in the middle ear.  This fluid may take up to 3 months or longer to clear and is not considered an infection.  The treatment is to recheck the ears to see if the fluid has resolved. Unnecessary antibiotic use should be avoided, since this can promote the growth of bacteria that are resistant to the usual antibiotics.

Home Care

To relieve earache or fever, give acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin).  For ear pain, the following may also help: a warm washcloth held against the ear, chewing gum (if your child is old enough), keeping your child sitting up as much as possible, and prescription ear drops to numb the eardrum.

During an ear infection, avoid air travel and swimming until the infection is over.  A trip to the mountains is safe, but encourage your child to swallow fluids, suck on a pacifier, or chew gum (if your child is old enough) while changing altitude.

When to Call the Doctor

Call your child’s doctor if:

• You feel your child is getting worse, develops a stiff neck, or develops any area of redness.
• Pain or fever is not gone within 48 hours of starting antibiotic treatment.  Your doctor may need to prescribe a different antibiotic or refer to a specialist to obtain a culture of the ear infection.