Johns Hopkins Pediatric Otolaryngology
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Childhood Ear Infections Explained
Ear infections happen when there is inflammation usually from trapped bacteriain the middle ear, the part of the ear connects to the back of the nose and throat. The most common type of ear infection is otitis media, which results when fluid builds up behind the eardrum and parts of the middle ear become infected and swollen.
If your child has a sore throat, cold, or an upper respiratory infection, bacteria can spread to the middle ear through the eustachian tubes . In response to the infection, fluid builds up behind the eardrum.
Children are more likely to suffer from ear infections than adults for two reasons:
- Their immune systems are underdeveloped and less equipped to fight off infections.
- Their eustachian tubes are smaller and more horizontal, which makes it more difficult for fluid to drain out of the ear.
“In some cases, fluid remains trapped in the middle ear for a long time, or returns repeatedly, even when there’s no infection,” Tunkel explains.
How To Determine If Your Infant Has An Ear Infection
This article was co-authored by Laura Marusinec, MD. Dr. Marusinec is a board certified Pediatrician at the Children’s Hospital of Wisconsin, where she is on the Clinical Practice Council. She received her M.D. from the Medical College of Wisconsin School of Medicine in 1995 and completed her residency at the Medical College of Wisconsin in Pediatrics in 1998. She is a member of the American Medical Writers Association and the Society for Pediatric Urgent Care. This article has been viewed 55,024 times.
Ear infections are pretty common among babies, but it can still be a tough experience for both you and your infant. Luckily, we can help you be prepared by knowing what signs and symptoms to watch for so you can get your baby to their doctor and get the infection cleared up.
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Middle Ear Infection Treatment
Witha middle ear infection, its best to have a provider examine your ear with an otoscope to look for signs of infection or blockages. For this reason you should be seen in person at urgent care, at a convenient care or walk-in clinic, or at your primary care clinic. If your providerbelieves that bacteria may have caused the infection, shell prescribe an antibiotic. However, if a virus is causing the infection, an antibiotic wont help, and youll have to treat the pain and wait for the infection to get better on its own.
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Healing Time In Different Sections Of The Ear
The infections persist in the middle, the outer and inner part of the ear. Every part has its unique features. As a result healing time also depends on the section of the ear.
- Outer Causes of outer ear infection are different from a middle ear infection. The most common type of infection in the outer ear is bacterial infections. But fungal and viral infections can occur as well. It can last for a week or longer. Its symptoms are severe pain in the ear, purulent discharge, fever, etc.
- Middle The infection shouldnt last more than one or two days. After an ear infection clears up, fluid may remain in the middle ear and cause some of the more mild symptoms and can persist for several weeks to months. This condition is diagnosed as otitis media with effusion. Its symptoms are ear pain, feeling like your ear is clogged, Nausea, Reduced Hearing.
- Inner The infection exists for a long time in this section. Most commonly, viral is the reason for the inner ear infection. These viruses can be most of the flu and cold. Its symptoms are pain, fever, and reduced hearing. Nausea and tinnitus can also occur in an inner ear infection.
The Eustachian tube drains fluid and air from the middle ear. Blockage in the Eustachian tube may cause fluid to build up. This causes pain since it applies pressure on the eardrum. The fluid is also a fertile ground for bacteria growth and this leads to an ear infection.
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What To Do If Your Baby Has Repeated Ear Infections
It can be very stressful if your baby has repeated ear infections, though this is also common in childhood. If the infections are very frequent or if they are causing temporary hearing loss for your baby, your doctor may want to intervene.
The most common intervention for repeated ear infection are small tubes that are placed in your babys eardrum. These tubes are left in for six to nine months and decrease the fluid buildup as well as improve air flow quality. Frequent check ins with your doctor are necessary if your baby has ear tubes.
If tubes dont help solve the problem, sometimes doctors will suggest surgically removing your babys adenoids, especially if they are swollen, enlarged, and seem to be contributing to your babys ear infections.
Remedies For Ear Infections In Children
In addition to treating your child’s ear infection, there are ways to help an ear infection in a child. Some of the best remedies for easing the pain of ear infections include:
- Applying a cold or warm compress to the ear
- Sleeping in a position that avoids putting pressure on the infected ear
- Getting plenty of rest
- Slowly rotating the neck
- Try getting a child’s mind off their pain by doing a low-impact activity such as coloring, playing a board game, solving a puzzle or watching a movie
Ear Infection Symptoms Treatment
Middle ear infection is a bacterial or viral infection that may cause earache, temporary hearing loss, and fluid discharge. A middle ear infection that does not clear up on its own may require treatment with antibiotics.
Middle ear infections occur mainly in early childhood, although older children and adults also get these kinds of infection. The incidence of acute ear infection in New Zealand children was recently estimated at 27%. A complication associated with middle ear infections is the retention of fluid, causing glue ear. Children should always be taken to a doctor if they have earache.
What Happens If My Child Keeps Getting Ear Infections
To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics arent helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out.
If placement of the tubes still doesnt prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.
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Risk Factors For Ear Infections
Ear infections occur most commonly in young children because they have short and narrow Eustachian tubes. About of children develop an acute ear infection at some point.
Infants who are bottle-fed also have a higher incidence of ear infections than their breastfed counterparts.
Other factors that increase the risk of developing an ear infection are:
- altitude changes
- Take OTC decongestants like pseudoephedrine .
- Avoid sleeping on the affected ear.
The Link To Hearing Loss
Middle ear infections can affect your childs hearing. This can be unsettling, but its almost always temporary and doesnt result in any permanent hearing loss. Still, any hearing loss should be evaluated by a healthcare professional.
Addressing hearing loss is important because infants and toddlers who suffer from chronic ear infections experience stretches of mild hearing loss during a crucial learning period for speech and language.
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Ear Infections: Most Common Cause
- Definition. An infection of the middle ear . Viral ear infections are more common than bacterial ones.
- Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.
- Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.
- Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.
- Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
- Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
- Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.
When Do Children Need Tubes In Their Ears
If your child has frequent ear infections, or if they have trouble hearing because of ongoing fluid in the middle ear, they may need a tube inserted through the eardrum and into the middle ear. The tube helps to keep air pressure normal on both sides of the ear drum and helps fluid drain from the middle ear.
Putting tubes in requires a brief operation by an ear, nose and throat surgeon. Children can usually go home the same day.
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What Are The Symptoms Of Ear Infection In Toddlers
A toddler with an ear infection will display the following signs of the condition .
- Fluid Discharge From Ear: A clear or yellowish discharge from the ear could indicate pus, which is a collection of white blood cells that attack a pathogen. This occurs when the ear drum bursts open and the pus from the middle ear comes out.
- Unpleasant smell from the ear: An unpleasant odor emanates from the ear canal even if the toddler is otherwise clean. The smell comes from the infected middle ear fluid if it drains out.
- Tugging of ears due to pain: The toddler would pull or pinch the ear due to severe earache and discomfort. The ear ache is quite severe.
- Fever: An ear infection can cause fever without any signs of other visible illnesses. It means the toddler would seem otherwise fine. The fever due to ear infection would be greater than 100.4°F .
- Loss of appetite: A swollen eustachian tube can make swallowing painful due to high pressure within the middle ear . Therefore, the toddler develops a loss of appetite and disinterest in food.
- General irritability and trouble while sleeping: The toddler will seem irritable and fussy while having trouble sleeping due to acute pain in the ear. While lying down, every time the toddler turns his head to the side of the infected ear, he would squeal in pain.
Take your toddler to a doctor to understand the exact cause of the ear infection.
Check If It’s An Ear Infection
The symptoms of an ear infection usually start quickly and include:
- discharge running out of the ear
- a feeling of pressure or fullness inside the ear
- itching and irritation in and around the ear
- scaly skin in and around the ear
Young children and babies with an ear infection may also:
- rub or pull their ear
- not react to some sounds
- be irritable or restless
- be off their food
- keep losing their balance
Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week.
If you, or your child, have a high temperature or you do not feel well enough to do your normal activities, try to stay at home and avoid contact with other people until you feel better.
|Inner ear infection||Middle ear infection||Outer ear infection|
|Can affect both children and adults||Usually affects children||Usually affects adults aged 45 to 75|
|Caused by viral or bacterial infections||Caused by viruses like colds and flu||Caused by something irritating the ear canal, such as eczema, water or wearing earplugs|
|Affects parts of the inner ear like the labyrinth and vestibular system, and can lead to labyrinthitis||Affects the eustachian tube, which connects the middle ear to the back of the nose||Affects the ear canal|
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When To See An Ear Nose And Throat Specialist
If you suspect your child has an ear infection, your first step is to call their pediatrician or primary care provider. If they do identify an infection, theyll most likely prescribe antibiotics and the infection will usually clear up quickly. If your child doesnt get better, is in severe pain, or suffers from repeated ear infections, you may be referred to a pediatric ENT specialist like Dr. Wertz also known as an otolaryngologist.
The most common treatment for chronic ear infections is to place a tube in the eardrum to provide ventilation to the middle ear and prevent fluid buildup, says Dr. Wertz. This very minor outpatient procedure usually resolves the issue right away.
Dr. Wertz explains that in 95 percent of her patients, the ear tubes fall out once they are past the stage where ear infections are common, and she rarely has to perform a retubing procedure. Another less common procedure she performs involves surgically removing adenoid tissue from back of the nose. But thats only in rare cases, she says.If your child suffers from recurring or severe ear infections, its important that they see their pediatrician or primary care provider who can refer them to an ENT specialist if necessary, adds Dr. Wertz. Most ear infections arent serious and are easy to treat, but left untreated, they can affect your childs hearing and speech development. So, its definitely worth having them checked out.
How Does A Doctor Diagnose A Middle Ear Infection
The first thing a doctor will do is ask you about your childs health. Has your child had a head cold or sore throat recently? Is he having trouble sleeping? Is she pulling at her ears? If an ear infection seems likely, the simplest way for a doctor to tell is to use a lighted instrument, called an otoscope, to look at the eardrum. A red, bulging eardrum indicates an infection.
A doctor also may use a pneumatic otoscope, which blows a puff of air into the ear canal, to check for fluid behind the eardrum. A normal eardrum will move back and forth more easily than an eardrum with fluid behind it.
Tympanometry, which uses sound tones and air pressure, is a diagnostic test a doctor might use if the diagnosis still isnt clear. A tympanometer is a small, soft plug that contains a tiny microphone and speaker as well as a device that varies air pressure in the ear. It measures how flexible the eardrum is at different pressures.
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What Is A Middle Ear Infection
The middle ear is the space just behind the eardrum. Germs can get in the middle ear and cause an infection. A middle ear infection is also called otitis media. An acute middle ear infection is one that starts quickly and causes lots of symptoms right away.
Children with an ear infection have ear pain
They may have a fever and trouble sleeping
Doctors will look inside your child’s ear with a light
Most ear infections get better on their own without antibiotics
Your child will likely need medicine for pain and fever
Treatment For Middle Ear Infection
Symptoms of middle ear infection usually improve by themselves within 24-48 hours, so antibiotics arent often needed.
You can give your child paracetamol in recommended doses to help with pain. Your GP might suggest some anaesthetic ear drops if your child has severe pain.
If your child still has pain and is unwell after 48 hours, is particularly unwell or is less than 12 months old, your GP might prescribe a short course of antibiotics, usually penicillin.
Most children improve after a few days of antibiotic treatment, but always make sure your child finishes the whole treatment, even if she seems better. Stopping too soon could make the infection come back. Often your GP will want to see your child again when your child has finished the treatment, to make sure the infection has cleared up.
Putting cotton wool in your childs ear or cleaning discharge with a cotton bud can damage the ear. It isnt recommended.
Recurrent ear infections Some children with recurrent ear infections or glue ear might need a long course of antibiotics.
Glue ear generally improves within three months. Your GP will need to monitor your child during this time to check that its getting better.
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