Ear Infections: Understanding & Prevention
Cold season is around the corner, and along with it, the dreaded ear infection. Ear infections are, after all, the most common reason parents have to bring their young children to the doctor. If your child hasn’t experienced an ear infection yet, you’re in the minority: 75% of children experience at least one infection by their third birthday, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).
While nobody is immune to middle ear infections, they’re especially rampant among children aged three and younger. That’s partly because the tube that drains fluid from their ears is smaller and more level, making it easy for fluid to build up and become infected.The following are the CDC’s tips on recognizing the symptoms, understanding the treatment, and advice for how parents can avoid things that could lead to a future ear infection.
The classic infection is accompanied by fever and earache. If your child can’t verbalize that they are having trouble hearing, look for signs like irritability, ear pulling, and balance problems. Ear infections frequently happen during or after colds or congestion.
Diagnosis and Treatment
The doctor will examine the interior of your child’s ears with a lighted otoscope and look for redness and swelling. If the doctor is not positive there’s an infection and there’s no fever or severe earache, then the doctor may send you home to see if it gets better on its own. This would be following the protocol of The American Academy of Pediatrics, which tries to prevent unessential use of antibiotics (utilizing them only when there is evidence of an infection). If you’re sent home and there’s no improvement, it’s important to return for a follow-up appointment to ensure that your child’s ears remain uninfected.
If your child has an ear infection, she or he will be prescribed a seven- or 10-day course of antibiotics, and he or she should feel better within a few days. If he doesn’t feel better, it’s possible he has some antibiotic resistance and will require a different antibiotic—and possibly another trip to the pediatrician.
Once the ear infection is treated, trapped fluid typically disappears in about three to six weeks, and any related hearing loss is restored.
Larger problems may come about when the infection stops but the fluid cannot properly drain or when fluid initially builds up behind the eardrum with no related infection. That means the trapped fluid still impairs hearing, but there are no obvious signs that something is wrong. This can be allergy-related and clear up on its own. If it doesn’t, children can go on for months with fluid in the middle ear and difficulty hearing.
Built-up fluid causes an average (temporary) hearing loss of 24 decibels, or the equivalent of wearing an ear plug. Thicker fluid can cause a larger hearing loss to the point that it’s difficult to understand conversations. If this happens repeatedly over an extended period of time, delays in speech and language skills could result.
If you suspect prolonged fluid build-up is causing problems, contact your pediatrician if your child exhibits any of the following: pulling or scratching the ears, inattentiveness, wanting the television louder than usual, misunderstanding directions, listlessness, and unexplained irritability.
In addition to looking in the ear with an otoscope, the pediatrician can use a similar-looking tool to check for fluid behind the ear by blowing a small puff of air into it and seeing if the eardrum is able to move easily. If there’s still a question, she can use a more complex device called a tympanometer to measure flexibility of the eardrum at different pressures. Depending on the outcome, you may be referred to an audiologist or ear, nose, and throat doctor (ENT) for more evaluations.
In cases of chronic fluid build-up that impairs hearing or causes multiple infections (five or more in a year), an ENT may decide to have small tubes placed in the eardrum. These tubes ventilate the ear and prevent fluid from accumulating.
This is a minor outpatient surgical procedure done under general anesthesia at the hospital. Tubes typically fall out on their own after six months to two years, depending on the tubes. Follow-up with an ENT will confirm whether the problem is still present. If it is, the procedure may need to be done again.
One of the easiest ways to prevent ear infections is by reducing your child’s chances of getting colds and the flu. Hand washing and flu shots are a great start. The CDC also suggests not laying babies down to sleep with bottles and limiting exposure to cigarette smoke, as studies show that second-hand smoke increases the risk.
If you take these precautions, your child might avoid ear infections or, at least, reduce the number of infections they have this year.
MORE TO KNOW . . .
Ear Infection Terminology
Eustachian Tube: The tube that carries fluid from the middle ear to the back of the throat. It helps drain fluid and keeps the pressure inside the ear the same as on the outside. When pressure outside the ear becomes different than on the inside, as happens on an airplane, it makes it harder to hear.
Middle Ear: The eardrum plus three small bones that vibrate to amplify sound and send it to the inner ear.
Acute Otitis Externa (AOE): This is the scientific name for an infection of the ear canal, which is also called swimmer’s ear.
Acute Otitis Media (AOM): It occurs when fluid builds up in the middle ear and is often caused by bacteria, but can also be caused by viruses. Streptococcus pneumoniae is a common bacterial cause of AOM, so getting a pneumococcal vaccination will help protect against Streptococcus pneumoniae. Breastfeeding exclusively until your baby is 6 months old and continuing to breastfeed for at least 12 months can protect your baby from infections, including AOM. AOM is usually treated with antibiotic ear drops.
Otitis Media with Effusion (OME): It occurs when fluid builds up in the middle ear without pain, pus, fever, or other signs and symptoms of infection. OME usually goes away on its own and does not benefit from antibiotics.