Symptoms Of Chronic Ear Infections
Someone with a chronic ear infection does not usually have any visible symptoms. However, long-term OME can cause hearing problems and other difficulties, particularly in children. These include:
- delayed responses, or taking a long time to understand speech
- difficulties speaking or reading
- less ability to work independently
Doctors consider OME to be chronic if it lasts for or more.
According to a 2016 guideline, OME usually disappears by itself within 3 months.
They also report that 3040 percent of children experience OME more than once, and 510 percent of episodes last for 1 year or longer.
When someone has CSOM, they have a hole in their eardrum. When the eardrum bursts, it releases tension, so not everyone with CSOM will feel . However, people with AOM or recurrent AOM will likely experience pain.
The symptoms of CSOM include:
- leaking fluid from the ear
- a hole in the eardrum
People with CSOM are unlikely to have a fever.
Chronic ear infections develop from a long-lasting or recurrent acute ear infection. Preventing acute ear infections can help prevent chronic ear infection.
Acute ear infections happen when the eustachian tube, a tube that runs from the middle ear to the back of the throat, becomes clogged.
Children are more likely to be affected by ear infections because these tubes are shorter and narrower, so they become clogged more easily.
Fluid build-up in the middle ear can become infected, which will cause pain and other symptoms.
Causes of ear infections
Little Kids Have Little Ear Tubes
Although you can develop an ear infection at any age, children and babies are more likely to get them because they have proportionately shorter Eustachian tubes than older kids and adults do. Eustachian tubes are the little canals that run from the middle ear right behind the eardrum and drain into the upper part of the throat. Babies and childrens Eustachian tubes are also more parallel to the middle ear than adult tubes are, which means that fluids that build up behind the eardrum are less likely to drain through the throat, even when the child is healthy. Thats why children are more susceptible to swimmers ear than adults are.
If your kid has a cold, or other respiratory condition, mucus and inflammation make it even harder for the Eustachian tubes to drain properly. Bacteria can gather in the tubes and cause an infection. Even an infection in the childs adenoids can pass on to the Eustachian tubes and middle ear.
Symptoms Of An Ear Infection
Ear infections tend to be painful. Older children can tell you if their ear hurts. Babies may alert you to an earache by tugging on or rubbing their ears. Other symptoms of an ear infection or chronic otitis media include:
- Fluid draining from the ear
- Acting clumsy
- Nasal spray to clear tubes
- Humidifier on a cool setting
Your child may need antibiotics or other medications, such as prescription ear drops, to kill the bacteria. If your child has a viral infection, however, antibiotics wont work.
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Why Do Children Have So Many Ear Infections
If your child has frequent ear infections, you are not alone. The American Speech-Language-Hearing Association says it is the most common childhood illness for infants and young children. Ear infections occur most frequently between the ages of 3 months and 3 years, but are common until the age of 8. Five out of six children will have at least one ear infection before their third birthday and nearly 40% of children will have three or more ear infections before that age.
Why are ear infections so common?
Basically, ear infections are common because the tubes and spaces in childrens ears are so small. When a child gets a cold, sore throat or upper respiratory infection, bacteria from those illnesses can spread to the middle ear. The bacteria causes fluid to build up in the middle ear , it becomes infected, the eardrum becomes inflamed, and bingo, you have an ear infection.
The pathway that the bacteria takes to get to the ear is called the Eustachian tube. It runs from the top of the back of the throat to the ear and is designed to clear fluid from the ear. However, in infants and children, this tube is nearly horizontal so it fills up with fluid easily. As we age, the tube becomes more vertical, works more effectively and that is why the older we are, the fewer ear infections we get.
3 types of ear infections
Medically speaking, an ear infection is called Otitis Media and there are three types:
Why Do Kids Get Ear Infections
Kids get ear infections more than adults do for several reasons:
- Their shorter, more horizontal eustachian tubes let bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower, so more likely to get blocked.
- Their adenoids, gland-like structures at the back of the throat, are larger and can interfere with the opening of the eustachian tubes.
Other things that can put kids at risk include secondhand smoke, bottle-feeding, and being around other kids in childcare. Ear infections are more common in boys than girls.
Ear infections are not contagious, but the colds that sometimes cause them can be. Infections are common during winter weather, when many people get upper respiratory tract infections or colds .
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Who Is At Higher Risk For Ear Infections
- Children less than 5 years old, because they have shorter eustachian tubes.
- Children who attend daycare, because they tend to have more colds.
- Children with allergies.
- Children who are exposed to cigarette smoke. Smoke causes inflammation of the eustachian tube, making ear infections more likely.
- Children who were not breastfed. Breast milk has antibodies that help fight infections.
- Babies who are being bottle fed, especially if they swallow milk while lying too flat. Milk can enter the eustachian tube and cause inflammation, which increases the risk of an ear infection. Children should be held upright while drinking a bottle. When they are old enough to hold their own bottle well, they should be taught to drink from a regular cup and no longer given a bottle.
- Children with cleft palates, as their eustachian tubes are often inflamed.
- Children of First Nations and Inuit descent, though its not clear why.
Preventing Ear Infection In Babies
Its important to remember that your child will get sick. You can follow every preventative measure in the book and the child could still get sick. Thats not necessarily a bad thing, as it will help your child build the antibodies required to fight the infection next time it comes around. But if you want to try and prevent your child from getting an ear infection, there are a number of ways that may help out.
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What To Do About Chronic Ear Infections In Children
According to the NIH, five out of every six kids have at least one ear infection by their fifth birthday. Ear infections are so common in children and babies that they account for more visits to the pediatrician than any other single ailment. Doctors refer to ear infections as otitis media, which means an infection in the middle ear.
The ear, nose, and throat experts at Pediatric ENT Specialists at Childrens of Alabama in Birmingham, Alabama, know how painful and frustrating otitis media can be for babies and children. Though most earaches are easily treated with at-home remedies or antibiotics, if your child has chronic ear infections, they may need other therapies to alleviate their pain and prevent hearing damage.
How Is An Ear Infection Treated
Treatment of ear infections depends on age, severity of the infection, the nature of the infection and if fluid remains in the middle ear for a long period of time.
Your healthcare provider will recommend medications to relieve you or your childs pain and fever. If the ear infection is mild, depending on the age of the child, your healthcare provider may choose to wait a few days to see if the infection goes away on its own before prescribing an antibiotic.
Antibiotics may be prescribed if bacteria are thought to be the cause of the ear infection. Your healthcare provider may want to wait up to three days before prescribing antibiotics to see if a mild infection clears up on its own when the child is older. If your or your childs ear infection is severe, antibiotics might be started right away.
The American Academy of Pediatrics has recommended when to prescribe antibiotics and when to consider waiting before prescribing based on your childs age, severity of their infection, and your childs temperature. Their recommendations are shown in the table below.
American Academy of Pediatrics Treatment Guide for Acute Otitis Media
|in one or both ears||Mild for < 48 hours and temp < 102.2° F||Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesnt improve within 48 to 72 hours of start of symptoms|
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What Puts My Child At Risk Of Getting Ear Infections
We know some important risk factors, but not all the reasons why some children develop more ear infections than others. The most important risk factors include:
- a family history of ear infections
- living with someone who smokes
- going to early childcare – babies and children are exposed to more colds and viruses
- having an older brother or sister in childcare or early primary school also increases the risk
- season of the year – ear infections are more common during the autumn and winter months
There is no clear evidence that allergy causes ear infections.
How To Treat A Child’s Ear Infection
An ear infection usually goes away on its own but, if it doesn’t, your child may need treatment. Most doctors will prescribe an antibiotic such as amoxicillin. It’s important that your child takes the exact dosage over the full amount of time, even if symptoms improve. Your doctor may also recommend over-the-counter medicine for ear infections with pain relievers such as ibuprofen or acetaminophen.
If your child has repeated ear infections within a short period of time, or has hearing loss due to fluid build-up, your child’s physician may recommend ear tube surgery. Learn more about when a child may need ear tubes.
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What Happens If A Babys Ear Infection Goes Untreated
A few complications may arise out of untreated and recurring ear infections .
- Cholesteatoma: It is an abnormal tissue growth on or behind the eardrum. This growth may pose a problem by preventing the drainage of fluids from the ear. It may also cause mild hearing loss and changes in the structures of the ears bones .
- Hearing loss: Fluid accumulation in the ears could cause temporary or permanent hearing loss. Chronic fluid buildup may also affect the inner ear in the long run.
- Rupture of the eardrum: Chronic fluid accumulation and infection of the middle ear may create pressure on the eardrum. It may result in a small tear in the eardrum and may heal within two weeks after treatment.
- Mastoiditis: A bone called mastoid protects the delicate parts of the ear. Middle ear infections could cause mastoiditis, an inflammation of the inner lining of the bone .
- Meningitis: The inflammation of the protective membranes around the brain is called meningitis. It may occur when the pathogens from the ear infection enter the cerebral spinal fluid. This condition may lead to severe complications, including brain damage, if left untreated .
How Is An Acute Middle Ear Infection Treated
Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain.
If your doctor isnt able to make a definite diagnosis of OM and your child doesnt have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that cant be definitively diagnosed, especially those between the ages of 6 months to 2 years. If theres no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isnt caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics.
If your doctor prescribes an antibiotic, its important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasnt completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. Its also important to return for your childs follow-up visit, so that the doctor can check if the infection is gone.
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When Do Children Need Tubes In Their Ears
If your child has frequent ear infections, or if he has trouble hearing because of ongoing fluid in the middle ear, he may need a tube inserted through the ear drum 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 usually go home the same day.
What Are Other Causes Of Ear Pain
Other causes of ear pain include:
- A sore throat.
- Teeth coming in in a baby.
- An infection of the lining of the ear canal. This is also called swimmers ear.
- Pressure build up in the middle ear caused by allergies and colds.
Last reviewed by a Cleveland Clinic medical professional on 04/16/2020.
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Home Remedies For An Ear Infection
If you or your child has a typical ear infection without severe symptoms, you might try some of these home remedies:
- Pain relievers. A dose of over-the-counter medication such as acetaminophen or ibuprofen can reduce the pain and fever.
- Compresses. Whether you prefer a warm compress or an ice pack, this method is safe for children and adults. You can even alternate them if doing so helps you feel better.
- A change in sleeping position. Try putting extra pillows under your head to help your ear drain when you go to sleep at night.
- Distraction. If your child is really fussy, try a distraction technique to take their mind off their painful ear. A favorite toy, snack, or game might do the trick.
How Are Ear Infections Treated
To treat an ear infection, health care providers consider many things, including:
- the type and severity of the ear infection
- how often the child has ear infections
- how long this infection has lasted
- the child’s age and any risk factors
- whether the infection affects hearing
The type of otitis affects treatment options. Not all kinds need to be treated with antibiotics. Because most ear infections can clear on their own, many doctors take a “wait-and-see” approach. Kids will get medicine for pain relief without antibiotics for a few days to see if the infection gets better.
Antibiotics aren’t routinely prescribed because they:
- won’t help an infection caused by a virus
- won’t get rid of middle ear fluid
- can cause side effects
- usually don’t relieve pain in the first 24 hours and have only a minimal effect after that
Also, overuse of antibiotics can lead to antibiotic-resistant bacteria, which are much harder to treat.
If a doctor does prescribe antibiotics, a 10-day course is usually recommended. Kids age 6 and older who don’t have a severe infection might take a shortened course for 5 to 7 days.
Some children, such as those with recurrent infections and those with lasting hearing loss or speech delay, may need ear tube surgery. An ear, nose, and throat doctor will surgically insert tubes that let fluid drain from the middle ear. This helps equalize the pressure in the ear.
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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.
What Can I Do For My Child Now
Do what you can for your childs pain and tears. In addition to giving him lots of TLC, you can give him pain relievers, or your doctor may prescribe pain-relieving ear drops. You may also want to talk with your doctor about getting your childs hearing tested chronic ear infections or chronic fluid buildup in the ear can cause hearing problems, which in turn can cause speech delays.
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