What Is an Ear Infection?
Ear infections are the most common reason children are brought to a pediatrician's office, and they're a frequent source of questions from parents: How do I know if my child has an ear infection? What causes them? And, especially, how can I prevent them? Parents have also heard about new vaccines or advances in treatment and want to know what's best for their child. Here's a primer on preventing and treating this notorious ailment.
An ear infection, also called otitis media, is specifically an infection of the middle ear -- the part that contains tiny bones that transmit sound from the eardrum to the inner ear. The middle ear also produces secretions, which normally drain to the back of the throat through the eustachian tube.
However, if the fluid doesn't drain and builds up in the middle ear, it creates a warm, moist environment where germs love to grow. Invading bacteria or viruses thrive and result in the pain, crankiness, and fever that signal to parents that their child has an ear infection.
Anatomy is the main reason little ones are afflicted with ear troubles. The eustachian tubes of children are angled less steeply than those of adults, which makes it harder for fluid to drain from the middle ear. And their tubes are also shorter, which makes it easier for germs in the throat to work their way up into the middle ear. The muscles that open the tube and allow fluid to drain (this is what you flex when swallowing to relieve ear pressure) are also not as well developed in babies and toddlers. Plus, young children have less mature immune systems, so they can't fight off infections as well as adults can. As a result, they're more susceptible to the upper respiratory infections (colds and flus) that can lead to ear infections.
It's not unusual for a baby or toddler to get ear infections. Ninety percent of children have at least one ear infection by the time they're 2 years old, according to one study. Children are most at risk for ear infections between 6 and 18 months, although about half of all kids get their first ear infection before 6 months.
Fortunately, the rate of ear infections declines after age 3. However, there are some things that put your child at a greater risk for ear infections even beyond age 3.
For example, frequent ear infections tend to run in families. In the same way blue eyes or athletic ability is inherited, how well your ear muscles open and close is also passed on. Children with allergies are also prone to ear infections. The congestion caused by exposure to dust or pollen blocks the eustachian tube so that it can't drain. This can quickly lead to an ear infection when germs invade.
Babies who are born with a cleft palate or Down syndrome are also more likely to get ear infections. The differences in their anatomy make it harder for their eustachian tubes to function properly.
Ear infections are not always easy for a parent to diagnose, because the symptoms can be vague and mimic those of a regular cold or flu. In fact, ear infections often start as a cold with a cough and a runny nose. A cold virus causes the entrance to the eustachian tubes to swell so that it's easier for fluid to get trapped and infected. The next thing you know, your baby has a fever and is becoming more irritable. He may also pull on his ears and seem crankier when lying down, because this position causes the fluid to push on the eardrum, resulting in more discomfort.
The only way to be sure that your child has an ear infection is to visit your pediatrician. Take a baby younger than age 2 to the doctor if a cold and apparent discomfort don't go away in two or three days, or if a fever doesn't go away in one or two days. (If your infant is less than 4 months old, notify your doctor of any fever immediately.) When your physician peeks in your child's ear to check for signs of an infection, she's looking at the eardrum to see if it is red, thick, or bulging.
There are two major germ classes that cause infections: viruses and bacteria. Bacteria are responsible for about 70 percent of ear infections, viruses cause about 8 to 25 percent of ear infections, and bacteria and viruses working in concert are found in the remaining cases. Ear infections that are caused by viruses can't be treated with antibiotics, in the same way that no medicine can cure the common cold. But antibiotics can fight bacterial infections.
For a child who has never had an ear infection or hasn't been on antibiotics for the past 30 days, the most commonly prescribed antibiotic is liquid amoxicillin, the pink, bubble-gum-flavored kind.
But if your child has recently been treated for another ear infection, it's likely that he's infected with a strain of bacteria that is resistant to amoxicillin. If that's the case, there are several stronger antibiotics your physician may select, including Augmentin, Zithromax, and Biaxin.
But pay attention to whether your child likes the taste. "Bad taste" is a huge reason certain antibiotics don't work; it's extremely difficult to get a cranky toddler to take his medicine even when it tastes good. If getting your child to take a "yucky" antibiotic is a problem, ceftriaxone, an injectable antibiotic, is also available.
After starting oral antibiotics, your child should begin to feel better in two or three days, but you must always have your child finish the complete prescription. It's also important to bring him in for a follow-up visit so the doctor can ascertain that the infection has indeed cleared up.
Importance of Treatment
The only way your physician can know if an infection is caused by a virus, bacteria, or both is to remove some of the fluid from the middle ear with a small needle. However, it takes 48 hours to get lab results back, and parents usually want a quicker response. Some pediatricians will assume it is a bacterial infection and treat it with antibiotics immediately. In children younger than 2, immediate action is critical.
Untreated ear infections can spread and cause serious -- even life-threatening -- problems, such as a brain abscess or meningitis. Another rare but serious complication in young children is facial paralysis if the infection spreads to the facial nerve.
A less dangerous and more common consequence of untreated ear infections is a perforated eardrum. The fluid in the middle ear builds up until the pressure causes the eardrum to burst. Although this is frightening to parents, it results in immediate relief from the pain the child was experiencing and lets the fluid drain from the middle ear. Most of these perforations heal on their own, but some do require surgical repair.
It's common for fluid to remain in the middle ear, but that means bacteria can get into it and cause a repeat ear infection. In about two-thirds of children this remaining fluid will clear in one month, and in 90 percent it will clear in three months. Your doctor will monitor the situation at subsequent visits to make sure your child does not get another infection in the meantime and that the fluid doesn't remain for more than 6 months.
That's because fluid in the middle ear for a prolonged period can result in a temporary hearing loss, which is especially problematic for young children who are learning how to talk. Although studies have shown that there's no long-term impact on a baby or toddler's language development, the hearing loss is a concern and may mean that your child requires ventilating, or tympanostomy, tubes. These small plastic or metal tubes are placed in the eardrums in a minor surgical procedure to help drain the fluid and keep it from collecting. A child's hearing returns to normal once the fluid drains.
After having tubes inserted, many children get significant relief from their ear infections. The tubes stay in place until they fall out on their own. Half of the children will have to get tubes put in again, but the other half will have already outgrown ear infections by this time.
Fortunately, the majority of children avoid serious consequences of ear infections, such as getting tubes. And although the ailment is troubling for both parents and kids, there's a lot that can be done to fight and treat ear troubles.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.