Ear Infections

Anatomy of the Ear

The medical term for this type of ear infection is acute otitis media.
- Otitis = ear
- Media = middle
In this type of ear infection, there is infected fluid build-up in the middle ear behind the eardrum.
- This type of ear infection almost always follows a viral cold with congestion, runny, and cough.
This type of ear infection is most common in children 2 years of age and younger but can occur in older children as well.

The medical term for this type of ear infection is acute otitis externa.
- Otitis = ear
- External = outer
In this type of ear infection, there is an infection in the outer ear canal.
- The ear canal is the part of the ear that goes from the outer ear to the eardrum.
An outer ear infection happens when the skin in the ear canal gets irritated or scratched, and then gets infected.
This type of infection is commonly called “swimmer’s ear.”
However, your child can develop an outer ear infection even if they have not been swimming.
This can happen when a child:
- Puts cotton swabs, fingers, or other things inside the ear
- Cleans the ear canal to remove wax
- Swims regularly
  - Water can soften the skin of the ear canal, which allows germs to infect the skin more easily.
- Wears hearing aids, headphones, or earplugs that can irritate or damage the skin inside the ear canal.
This type of ear infection is most common in children 5 years and older.

Typically these infections develop during or following a viral cold that includes congestion, runny nose, and/or cough.
- The onset of pain and/or fever is typically quite sudden.
Fussiness and irritability may develop suddenly as well.
- These symptoms may be amplified during naps and overnight sleep, as lying down causes the infected fluid to put more pressure on the eardrum, therefore increasing pain.
Ear tugging and pulling is NOT a reliable indicator of anything medical in children under 2 years of age!

Sudden onset of pain inside the ear
- Your child will often complain that the pain is worse when the ear is pulled or moved as happens when taking clothing off or brushing hair.
- Your child will feel pain inside the ear, especially when the ear is pulled or moved.
Itching inside the ear
White, chunky fluid (pus) leaking from the ear
Trouble hearing

Ear infections require diagnosis by a trained medical professional.
- An otoscope is placed in your child’s ear canal to enable the provider to examine the eardrum and ear canal.
Remember- ear infections cannot and should not be treated based on signs and symptoms alone!
- This is very important for many reasons:

Treatment varies based on your child's age, history of previous infections, and severity of symptoms.
Ear infections are often treated with oral antibiotics.
- However, depending on the age of your child, their symptoms, duration of symptoms, and their history (or lack thereof) of ear infections, antibiotics may not be prescribed right away.
Children age 2 years and younger are typically started on oral antibiotics immediately.
Children over 2 years of age can often be monitored to see if the symptoms resolve on their own as long as the pain is easily controlled by pain-reducing medications.
- This is called the “watch and wait approach.”
Treat pain and fever with acetaminophen or ibuprofen as needed.

Outer ear infections are treated with prescription ear drops that contain an antibiotic and often an anti-inflammatory medication.
These drops are instilled in your child’s ear canal.
Tips for instilling ear drops:
- Have your child lie down on their side with the infected ear facing up.
- Pull down on the bottom of the ear and instill the drops as directed.
- Encourage your child to remain in this position for 5 to 10 minutes or place cotton in the ear for 10 minutes.
Pain typically improves 2-4 days after starting drops.
- In the meantime, keep acetaminophen or ibuprofen on hand for your child.
Try to keep the inside of your child’s ear canal dry while the infection heals.
- Do not swim until treatment is completed and the pain is completely resolved.
- It is okay for your child to shower or bathe but keep the ear as dry as possible.
  - Put vaseline on a cotton ball and place it in the outer ear to cover the opening to the ear canal.
  - Do not push the cotton ball far into the ear canal.
Do not allow your child to use in-ear earphones until treatment is completed and the pain has resolved.

Middle infections are NOT contagious.
- Remember that ear infections are usually secondary to a viral cold.
- The cold itself can be contagious but the ear infection is not.
External ear infections are not contagious.

Fever is still present after 5 doses (not days) of antibiotics.
Fussiness and/or pain are still present after 5 doses of antibiotics, or if they go away and then return.
Antibiotics may not have a noticeable effect until the 5th dose is given.
- You should expect fever and/or pain prior to receiving the 5th dose of antibiotics.
- Have acetaminophen and ibuprofen ready during this time.

If your child is no longer exhibiting the signs and symptoms that accompanied the initial ear infection we will re-examine the ears based on the most up-to-date guidelines as follows:
- For children <2 years of age and children ≥2 years of age with language or learning problems, we will re-examine their ears 8-12 weeks after diagnosis.
- For children ≤2 years, this timeframe may coincide with a previously scheduled well visit.
Previously, many health care providers would recommend a follow-up 2 weeks after an ear infection was diagnosed but current evidence proves this is unnecessary.

Unfortunately, there is no one thing you or your child can do to prevent ear infections.
There can be a genetic predisposition to ear infections and honestly many kids just have bad luck!
However, several interventions can help reduce the risk of recurrent ear infections:
- Continue vaccinating your child per the CDC guidelines
- Encourage good hand hygiene and cover coughs and sneezes
- Avoid exposing your child to tobacco smoke
- Breastfeed your child if possible

Avoid cleaning your child’s ears with Q-tips.
- Ear wax is normal and it helps protect the ear canal.
Encourage your child not to stick anything in their ears.
After swimming:
- Encourage your child to shake their ears dry after they swim
- You may also use over-the-counter ear drying drops such as these
  - These usually contain alcohol or vinegar and can help prevent infection.