Ear Infections
Anatomy of the Ear
Types of Ear Infections
Middle Ear Infections
- 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.
External Ear Infections
- 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.
Signs and Symptoms of Ear Infections
Middle Ear Infections
- 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!
External Ear Infections
- 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
Diagnosis
- 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:
- To confirm that an infection is present
- To document the frequency of ear infections
- To determine the most appropriate oral or topical antibiotic to prescribe if indicated
- To avoid antibiotic use when not necessary
Treatment
Middle Ear Infections
- 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.
External Ear Infections
- 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.
Are Ear Infections Contagious?
- 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.
Reach Out to Modern Pediatrics If…
Middle Ear Infection
- 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.
External Ear Infection
- Pain is still present after 5 doses (not days) of prescription ear drops.
Follow-up for Ear Infections
- 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.
Can Ear Infections Be Prevented?
Middle Ear Infections
- 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
External Ear Infections
- 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.