Ear Infections

Overview

How does the ear work?

The ear works by receiving sound waves and sending messages to the brain. The outer ear includes the part of the ear you can see and the ear canal. The sound waves go through the ear canal and hit the eardrum and cause it to vibrate.

The vibration of the eardrum causes the tiny bones in the ear to move. This movement sends the sound waves to the inner ear.

What causes earaches?

A tube called the eustachian (say: "you-stay-shun") tube connects the middle ear with the back of the nose. Normally this tube lets fluid drain out of the middle ear. If bacteria or viruses infect the lining of your child's eustachian tube, the tube gets swollen and fills with thick mucus. This keeps fluid in the ear from draining normally. Bacteria can grow in the fluid, increasing pressure behind the eardrum and causing pain.

The eustachian tubes can become blocked because of allergies, a cold or other infection. In other cases, the adenoids (glands near the ear) become enlarged and block the eustachian tubes.

Acute ear infections usually clear up within 1 or 2 weeks. Sometimes, ear infections last longer and become chronic. After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.

Anatomy of the ear

Why are earaches so common in children?

This may be because children's eustachian tubes are shorter and more narrow than those of adults. Most children will have at least 1 ear infection by their third birthday.

What is otitis media with effusion?

Otitis media with effusion means that there is fluid (effusion) in the middle ear. The middle ear is the space behind the eardrum. Fluid in the middle ear usually doesn't bother children. It almost always goes away on its own in a few weeks to a few months. So, this kind of ear problem doesn't usually need to be treated with antibiotics, unless the fluid doesn't go away.

What is swimmer's ear?

Swimmer's ear (also called otitis externa) is a type of ear infection. It is an infection of the outer ear and the ear canal. Because the canal is dark and warm, it can easily get infected with bacteria and fungus. Swimmer's ear is different from the kind of infection you get in the middle part of your ear. That kind of infection is called otitis media.

Symptoms

What are the symptoms of ear infections?

The most common symptoms of an acute ear infection are ear pain and fever. If your child is too young to tell you what hurts, he or she may cry or pull at his or her ear. Your child may also be irritable or listless, have trouble hearing, or not feel like eating or sleeping.

What are the symptoms of otitis media with effusion?

Children who have otitis media with effusion may have the following symptoms:

A feeling of fullness in the ear
Muffled hearing
Fluid that drains from the ears
Some pain inside the ear (if your child is too young to speak and tell you his or her ear hurts, he or she may tug at the ear often)
Trouble sleeping
Irritability
Fever
Headache

Sometimes, otitis media with effusion does not cause any symptoms.

What does swimmer's ear feel like?

Symptoms of swimmer's ear include:

Pain or itching in the outer part of the ear (the pain is often worse when the ear moves, such as when you are chewing)
A stuffy or plugged-up feeling in the affected ear
Fluid draining from the affected ear
Decreased or muffled hearing

If left untreated, the affected ear can become swollen and very painful to the touch. The fluid may become more pus-like and the muffled of decreased hearing may become worse.

Causes & Risk Factors

What causes otitis media with effusion?

Fluid may build up in the middle ear for several reasons. When a child has a cold, the middle ear may produce fluid just like the nose does. A tube called the eustachian (say: "you-stay-shun") connects the middle ear with the back of the nose. Normally, the eustachian tube lets fluid drain out of the middle ear. However, bacteria or viruses can infect the lining of your child's eustachian tube causing it to swell. The adenoids (glands near the ear) can also become enlarged and block the eustachian tubes. It is also not a good idea to let your baby fall asleep with a bottle or to leave a bottle in the crib. Drinking while lying down may also block the eustachian tubes.

If the eustachian tubes are blocked, fluid in the ear cannot drain normally. If bacteria grow in the middle ear fluid, an effusion can become a middle ear infection (acute otitis). This will usually increase pressure behind the eardrum and cause a lot of pain. The eardrum will become red and bulging. If this happens, your child may need to be treated with antibiotics.

Children who have frequent ear infections can also develop otitis media with effusion after their infection is gone if the fluid stays in the middle ear.

Children may be at higher risk for ear infections if they:

Are around people who smoke.
Have had previous ear infections.
Have a family history of ear infections.
Attend day care (because they are exposed to more germs and viruses).
Were born prematurely or with a low birth weight.
Have frequent colds or other infections.
Take a bottle to bed.
Use a pacifier.
Are male (boys tend to get more ear infections than girls).
Have nasal speech (caused by large adenoids that block the eustachian tube).
Have allergies with nasal congestion.

What causes swimmer's ear?

Several things can make swimmer's ear more likely, including the following:

If you swim or shower a lot, too much water can get into your ears. Water removes the protective ear wax, which makes it easier for germs and fungus to grow.
Cleaning your ears can remove the protective wax layer and lead to infection.
If you injure the skin in the ear canal by putting your finger or some object (such as a cotton swab or a pencil) in your ear, an infection can develop in the canal.
Skin conditions (such as psoriasis) that occur in other parts of the body can also occur in the ear canal and cause an infection.
Bacteria from products you use in your hair (such as hairspray or hair dye) can get trapped in the ear canal and cause an infection.

Treatment

What is the treatment for ear infections?

The treatment for ear infections may include any of the following:

If your doctor thinks the infection is caused by bacteria, he or she may prescribe an antibiotic. (Antibiotics don't work for infections caused by viruses.) It's very important to follow the directions for giving your child the medicine.
Pain relievers like acetaminophen (brand names: Children's or Infants' Tylenol) and ibuprofen (brand names: Children's Advil or Children's Motrin) can help make your child feel better and reduce fever. Never give your child aspirin. Aspirin has been linked to Reye's syndrome. Reye's syndrome is a serious illness that can lead to death. Doctors recommend that parents should not give aspirin to children younger than 18 years of age.
A warm (not hot) heating pad held over the ear can also help relieve pain from the earache.
Your doctor may also prescribe ear drops to relieve pain.

FDA Warning

The. U.S. Food and Drug Administration (FDA) advises against the use of ear candles. Ear candles can cause serious injuries and there is no evidence to support their effectiveness. For more information, please visit the FDA Web site.

How is otitis media with effusion treated?

If your child is older than 6 months of age and only has mild symptoms, the best treatment is to let the fluid go away on its own. You can give your child an over-the-counter pain reliever, such as acetaminophen, (one brand: Children's Tylenol) if he or she is uncomfortable. A warm, moist cloth placed over the ear may also help.

Usually the fluid goes away in 2 to 3 months, and hearing returns to normal. Your doctor may want to check your child again at this time to see if fluid is still present.

Will my child need antibiotics?

Your child may need antibiotics if fluid is still there after a few months and is causing hearing loss or problems in both ears. For this reason, your child's ears should be checked a few months after an ear infection. If the fluid is still there, a hearing test may be the next step. Your doctor may also recommend antibiotics if your child is under 6 months of age or gets frequent middle ear infections.

Why not just try antibiotics right now?

Giving your child unnecessary antibiotics can be harmful. After each course of antibiotics, the germs in the nose and throat are more likely to become resistant. Resistant germs can't be killed by the usual antibiotics. More expensive and powerful antibiotics have to be used. Some of these antibiotics must be given in the hospital and their side effects can be very unpleasant or even dangerous. Since fluid in the ears doesn't usually bother children, it's better to wait and only give antibiotics when they are necessary.

What if the fluid doesn't go away on its own?

If the fluid stays for more than a few months, your doctor may want to check your child's hearing. Your doctor may recommend ear tubes (also called tympanostomy tubes) to drain the fluid. Ear tubes may also decrease the number of ear infections your child gets.

What are ear tubes?

Ear tubes are tiny plastic tubes that help balance the pressure in your child's ears. They allow air into the middle ear so that fluid can drain out down the eustachian tube. They're put into the eardrum (which is also called the tympanic membrane) during surgery and stay in place for an average of 6 to 9 months.

The tubes are usually left in place until they fall out on their own or your doctor decides your child no longer needs them. Sometimes, another set of tubes may be needed.

Placing tubes in the ears requires an operation and has some risks. Your child will need general anesthesia when the tube is inserted. Your doctor will talk with you about the risks if he or she thinks your child needs ear tubes.

How is swimmer's ear treated?

Your doctor will look in your ear canal and remove any drainage or pus. Your doctor will check your eardrum to make sure there's no other infection. Most swimmer's ear infections can be treated with ear drops that contain antibiotics to fight infection and medicine to reduce itching and swelling. You can also take an over-the-counter pain medicine to relieve pain, such as ibuprofen (some brands: Advil, Motrin).

How should I use ear drops?

Your doctor will tell you how long and how often to use your ear drops. Warm the bottle in your hands before putting the drops in your ear. Using warm ear drops may prevent discomfort when the drops go in. Moving the earlobe back and forth after putting the drops in will also help the medicine go deep into the ear canal.

What else can I do for swimmer's ear?

Follow your doctor's directions carefully and use all of your medicine(s). Swimmer's ear can be hard to treat. Here are some things that will help you get better:

Keep your ear as dry as possible for 7 to 10 days. Take baths instead of showers. Try to keep water out of your ears when you wash your hair. Use a cotton ball to protect your ear from water while bathing (but don't stuff the cotton into the ear canal). Don't swim or play other water sports. If you're on a swim team, ask your doctor before you return to swimming.
Don't put anything except the prescribed medicine in your ears. Scratching and rubbing will only make swimmer's ear worse.

Symptoms are usually much better in 3 days. They should be completely gone in 10 days. If you're not better by then, call your doctor.

Complications

Will earaches hurt my child's hearing?

Middle ear infections and fluid in the ear are the most common causes of temporary hearing loss in children. Children who have ongoing problems with hearing may have trouble developing their speech and language skills. For this reason, it is important to talk with your doctor if your child has repeated ear infections.

Prevention

How can I help prevent ear infections from returning?

Some children seem to get many ear infections. If your child has had 3 ear infections in 6 months or 4 in 1 year, your doctor may suggest that your child take a low dose of antibiotic every day, usually during the winter, when these infections are most common.

Your doctor may want to see your child a few times when he or she is taking the antibiotic to make sure another ear infection does not happen.

How can I prevent swimmer's ear?

The best way to prevent swimmer's ear is to keep the ear canal's natural defenses against infection working well. Follow these tips:

Never put anything in the ear canal (cotton swabs, your finger, paper clips, liquids or sprays). This can damage or irritate the skin. If your ears itch a lot, see your doctor.
Leave ear wax alone. If you think your ear wax affects your hearing, see your doctor to be sure there's no other cause.
Keep your ears as dry as possible. Use a towel to dry your ears well after swimming or showering. Help the water run out of your ears by turning your head to each side and pulling the earlobe in different directions. A hair dryer set on the lowest heat and speed can also help to dry ears. Be sure to hold it several inches from your ear. If you swim or surf, use a bathing cap or wet suit hood to keep water out of your ears. There are also special earplugs designed to keep water out of your ears while you are swimming.

Questions to Ask Your Doctor

My ear hurts and itches. Could I have swimmer's ear?
How can I make my child more comfortable?
When should I call my doctor?
If my child has frequent ear infections, will he/she have to have ear tubes?
If my child gets several ear infections, could he/she have trouble hearing?
Is there anything I can do to help my child hear better?
My child has allergies. Will he/she be more likely to get ear infections?
When will my doctor prescribe antibiotics for my child?
How often will my child need to see the doctor if he/she has frequent ear infections?
If fluid drains from my child's ear, should I call the doctor right away?

Bibliography

Appropriate Use of Antibiotics for URIs in Children: Part I. Otitis Media and Acute Sinusitis by SF Dowell, M.D., M.P.H., B Schwartz, M.D., WR Phillips, M.D., M.P.H., and The Pediatric URI Consensus Team (American Family Physician October 01, 1998, http://www.aafp.org/afp/981001ap/dowell.html)

Otitis Externa: A Practical Guide to Treatment and Prevention by R Sander, M.D. (American Family Physician March 01, 2001, http://www.aafp.org/afp/20010301/927.html)

2/11/9