The bane of many a parent and child is the inner ear infection.  Most people know it as just ‘ear infection,’ as opposed to an infection of the ear canal (swimmer’s ear).  

What is an ear infection?

An ear infection is when the middle ear space is filled with pus, or starting to be.

How does that happen?

The middle ear generally drains into the back of the mouth through the eustachian tube.  When you have a cold, allergies, or are irritated by things like cigarette smoke or dust, that area gets swollen.  Then the fluid that is collected there is a great place for bacteria to gather and grow, which is what causes your ear infection.

Why is my child more likely to get ear infections?

Several reasons, actually.  First is that that area is much smaller in children, so it gets closed off more quickly.  Also their eustachian tube isn’t as angled as adults, so it doesn’t drain as easily. Second is that their immune system is younger, so they are more susceptible to getting colds.  Third, kids are generally in close contacts with other sick children, which make them more likely to get sick. Fourth, especially in areas of the country like the Texas Panhandle, allergies cause a lot of head congestion.  And lastly, some families are more likely to get ear infections.

How do I know if my child has an ear infection?

A younger child may cry in pain especially when laid down, not take their bottle well, pull at their ear, and have a fever.  In younger children this often happens after a few days of nasal congestion and cough. For some reason older children tend to not have the few days of obvious nasal congestion beforehand.  They are, however, usually able to tell you their ear hurts.

Sometimes a child may come into the clinic complaining of their throat instead of their ears, but turn out to have an ear infection.  This can be because of the drainage down the throat of the cold or allergies that started the ear infection. Also, since the ears, throat, and sinuses are very close together, the brain can sometimes get confused about what actually hurts.

Also, a few children don’t seem to notice if they have an ear infection or not.  They come in for an unrelated matter and can be found with a nasty bulging ear with pus.

Does a painful ear always mean an ear infection?

No.  As stated above sometimes the brain can be confused about what actually hurts.  I’ve had kids come in complaining of ear pain that turned out to have a bad throat.  Or it can be another problem, like swimmer’s ear.

Also, the buildup of fluid in the ear that happens before an ear infection (called serous otitis media) can be painful for some children.  This isn’t treated with antibiotics, though, because it is not yet an infection. It can go away by itself, especially as a child gets bigger.

How long does it take for an ear infection to develop?

I can be from days to hours.  I have seen an ear infection develop within 24 hours.  

So I should probably take my child to the pediatrician if I think they have an ear infection, then?

Yes.  Pediatricians are very experienced at looking at ears, and can tell you if your child’s ear is truly infected, or if there is another problem.  Your pediatrician will be able to treat you with the right antibiotic if needed, and follow up if you’re not getting better.

What will happen if their ear infection doesn’t get treated?

Honestly, a lot of ear infections can go away by themselves.  However, they can cause significant pain and distress to the child, and cause lost work days for parents.  Having fluid in the ear for months lowers the hearing slightly, and can impact their speech development.

Some kids’ eardrums do rupture, although it’s not very common.  It’s not necessarily because of how bad the infection is because I have seen many very infected ears that never ruptured.  It seems that there are just some people more prone to it. With proper treatment most of these ruptures heal by themselves by a 14 day recheck.

Occasionally a child will have an ear infection that just refuses to get better, even after two or three rounds of treatment.  Or they will regularly get infections every month or more for several months in a row. These cases are usually sent to the ENT for further treatment, which can include surgery for tubes.

And finally, rarely the infection can spread to other parts of the head.  This is very rare due to treating infections with antibiotics and preventing infections with immunizations like Prevnar.  

Is there any way I can prevent ear infections?

Besides getting your child the proper immunizations on time there are a few things you can do.  First is to not smoke, and don’t let other people smoke around your child. Even if you smoke outside the smoke is still on you and your clothes, and can irritate the young airways.  Second is to treat their allergies if they have them. They generally can’t be completely fixed, but decreasing some of the allergies may help. Finally, even though daycare is a necessary evil, if you can find one with a smaller amount of children, or a sitter, they will be exposed to less viruses (until they go to school).     

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