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Health 101: Ear Infections

When to Worry: Ear Infections
When to Worry: Ear Infections
baby

Ear infections are super common in kids: Nearly 75 percent of children will have at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders. (Of this group, about half of children will have up to three ear infections by that age.)

Ear infections occur when the eustachian tubes (tubes near the eardrum that connect the ear to the back of the throat) become blocked and can't drain fluid properly, says Amelia Drake, MD, professor of pediatric otolaryngology at the University of North Carolina, Chapel Hill, School of Medicine. Fluid trapped in these tubes can become a breeding ground for bacteria, resulting in redness and inflammation of the eardrum, and a generally harmless but painful infection.

Ear infections typically follow colds or allergy symptoms like a stuffy nose because these conditions make fluid more likely to collect and get trapped in the ear. Children under 3 are more susceptible to ear infections than older kids or adults because their immune systems are still developing (so they get sick more often) and their eustachian tubes are still growing, says John McClay, MD, a pediatric otolaryngologist at Children's Medical Center Dallas in Texas. At this age, a child's eustachian tubes are short (about 1/2 inch) and horizontal, but by the time kids are 5 or 6, their tubes are three times as long and are positioned more vertically, which helps fluid drain more easily and prevents infection.

Additionally, the location and size of children's adenoids -- infection-fighting immune system cells in the back of the throat -- make toddlers especially prone to ear infections. "Between 18 months and 2 years, a child's adenoids are enlarged because they have been processing bacteria to help develop the immune system. Large adenoids are often chronically infected and, because of their location next to the eustachian tubes, can easily spread bacteria to the ear," says McClay.

Ear infections can make your child pretty uncomfortable, so the most telltale sign for babies and toddlers is more fussiness and crying than usual -- especially toward the end of a cold or other respiratory infection. The following signs also may indicate your child is suffering from an ear infection:

  • Pain in the ear: Older children may tell you that their ears hurt; babies and toddlers may tug at their ears and sometimes even bang their heads on the wall or floor.
  • Difficulty falling or staying asleep: This is due to the pain from pressure building in the ears. "Sometimes active, busy kids will complain more about pain when things quiet down at the end of the day or when it's time for sleep," says Mona Mansour, MD, director of the Primary and School Health Division of General and Community Pediatrics at Cincinnati Children's Hospital Medical Center in Ohio.
  • Fever: A sign that her immune system is at work fighting off infection, your child's temperature may range from 99 F. to 104 F., taken rectally.
  • Trouble hearing: "Fluid build-up in the ear may block sound, but hearing usually returns to normal after the infection clears," says Dr. Drake.
  • Decreased appetite: "The ear infection itself shouldn't cause problems swallowing, but your child may lose his appetite because he just doesn't feel well," says Dr. McClay.
  • Yellow, white, or green drainage from the ear: While not very common, this means that the eardrum has ruptured, or torn, so the fluid blocked behind it can now leak out. This is a definite sign of infection, so call the doctor right away. Although it sounds scary, the ruptured eardrum should heal on its own as the infection gets better. And the good news is that your child may start to feel better as fluid drains and pressure decreases.

While ear infections are uncomfortable, they generally aren't an emergency and usually are not treated with medication right away. But you should let your doctor know as soon as you suspect that your child has symptoms of an ear infection -- especially if there's pus or blood discharge coming from the ear. "That could indicate a ruptured eardrum," says Dr. Drake. Your doctor will likely suggest you come into the office (especially for babies) so she can examine the ears, checking to see if the eardrum is red, swollen, and stiff, all signs of infection.

Although antibiotics used to be the go-to solution, the American Academy of Pediatrics now recommends a "watch-and-see" strategy for most children over 6 months without severe cases or who have not had recent ear infections. Why? Nearly 80 percent of children will recover from ear infections without antibiotics, and using them to treat every case can contribute to bacteria resistance -- and longer, more serious infections -- over time.

However, most doctors will prescribe antibiotics to babies under 6 months and to children predisposed to ear infections (those with a strong family history or conditions like Down syndrome and cleft palate), those who've had multiple, recent infections or if symptoms persist more than 48 to 72 hours. The most commonly prescribed drug is amoxicillin. Kids who are allergic to this, a type of penicillin, are usually prescribed antibiotics like cefdinir, cefpodoxime, or cefuroxime.

If your child is prescribed antibiotics, be sure to complete the entire course of treatment even if symptoms improve after a few days. The pediatrician will likely schedule a follow-up appointment to make sure the infection has cleared, but give her a call if your child doesn't start feeling better after two to three days, as she may want to try a different antibiotic.

"Ear infections can be very painful for kids because of the pressure building in the middle ear," says Dr. McClay. (Hence, the increased crying and occasional temper tantrums.) Regardless of whether your kid is taking antibiotics, most doctors recommend using pain relievers like children's acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to soothe discomfort, especially in the first 24 hours. (Children should never take aspirin, which contains ingredients that can cause Reye's syndrome, a rare but potentially fatal condition in children and teenagers.)

For natural relief, Dr. Drake recommends gently pressing a warm (not hot) wash cloth on the ear, which can help mask the pain and distract your child. Your doctor may also prescribe ear drops with benzocaine, which can help ease pain by temporarily numbing the ear. Ear drops of any kind should not be used if the eardrum has ruptured, however -- unless a doctor prescribes them.

If your kid's prone to repeat ear infections -- three to four over a six-month period or six or more infections in a year -- or has persistent fluid build-up that won't go away, he may benefit from having tubes inserted in his ears.

The procedure -- called a myringotomy, or tympanostomy tube placement -- is one of the most common childhood surgeries; more than one million are performed every year. It's typically an outpatient procedure, done under general anesthesia in about 10 to 15 minutes. A small incision is made in the child's eardrum so a small metal or plastic tube can be inserted. The tube helps to ventilate the middle ear, equalize pressure, and allow the eardrum to properly transmit sound. Tubes will normally stay in place for 6 to 18 months, and then usually fall out on their own.

Another, though far less common, treatment is removing the adenoids -- infection-fighting immune system cells in the back of the throat. "Tonsils and lymph nodes in the throat and neck serve the same infection-fighting function as the adenoids, so your child will still be protected from germs without adenoids," says McClay. "However, this is generally only recommended for kids older than 4, whose immune systems are more developed."

These procedures are often recommended not just to prevent repeat infections, but because some experts believe that babies and children who have persistent ear infections are more prone to hearing loss, which may in turn affect language development. Not all doctors believe tubes or adenoid removal are necessary however, so make sure to have a thorough chat with your pediatrician (and possibly seek a second opinion) before deciding if they're right for your child.

Because a number of bacteria and viruses (like colds) can lead to ear infections, no one vaccine can prevent them completely. However, the vaccines that protect your child against serious diseases like pneumonia and meningitis have also been shown to also reduce some cases of ear infection. In a study of 37,000 infants in California, those who received the pneumococcal vaccine (usually administered in three doses at 2, 4, and 6 months with a booster at 12 to 15 months) had 7 percent fewer ear infections and 20 percent fewer ear tube procedures than those who did not get the vaccination, according to the Centers for Disease Control and Prevention.

Most kids start having fewer ear infections after age 5 or 6, when their immune systems and eustachian tubes develop more . Until then, these strategies may help lower your child's risk of getting sick:

  • Soap up more often: Hand washing is the best way to keep germs at bay, especially for kids in daycare or playgroups, who tend to be more prone to ear infections than children who aren't around other kids as much.
  • Breastfeed as long as you can: Immune-boosting antibodies are transmitted to your baby through breast milk, helping to prevent illness.
  • Don't feed your baby while she's lying down flat: Breast- or bottle-feeding your child horizontally makes it more likely that fluid will pool at the back of the throat and nose -- and possibly to back up into the ears -- instead of down the esophagus.
  • Limit pacifier use: The sucking motion triggers the eustachian tube to open and close, allowing mucus and bacteria from the back of the throat and nose to enter the middle ear. Also, pacifiers that aren't cleaned regularly may collect germs that can then travel up the back of the throat and collect in the ear tubes.
  • Stop smoking or exposing kids to secondhand smoke: Children who inhale cigarette fumes are more likely to get ear infections than those who don't. Experts believe the toxins can weaken the immune system.

The vast majority of ear infections are not serious and clear on their own within two to three days. Although severe cases that go untreated can cause your child's eardrum to rupture, this sounds more serious than it is. (A ruptured eardrum typically heals on its own within a few days or weeks, says Dr. Drake; your child may have some short-term trouble hearing until the eardrum heals completely.)

Ongoing ear infections may also cause some temporary hearing loss, but there are mixed opinions about whether this would have any long-term impact on language development. "Theoretically, if a child spends a good portion of his critical language development years with poor hearing due to recurrent ear infections, it stands to reason that his vocabulary and verbal skills could be impacted," says Dr. Mansour. "However, it's likely that many children would not have any significant delays as they develop and have continued exposure to language."

In very, very rare cases, an untreated ear infection could lead to meningitis, dangerous inflammation of the membranes around the brain and spinal cord.

Sources: Amelia Drake, MD, professor of pediatric otolaryngology at the University of North Carolina, Chapel Hill, School of Medicine. Mona Mansour, MD, director of the Primary Care Division of General and Community Health at Cincinnati Children's Hospital Medical Center in Ohio. John McClay, MD, a pediatric otolaryngologist at Children's Medical Center Dallas in Texas. AAP sections on Ear Infections, Diagnosis, and Management of Acute Otitis Media, Recommended Immunization Schedules and Management of Otitis Media and Functional Outcomes Related to Language, Behavior and Attention. National Institute on Deafness and Other Communication Disorders section on Otitis Media. CDC section on Pneumococcal Disease in Children. AFP section on Otitis Media with Effusion. Mayo Clinic Sections on Ear Infections and Vaccines Schedules for Children.

Copyright © 2008 Meredith Corporation.

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