Ear infections in children

Almost 90% of all children will have at least one ear infection before
reaching school age—most frequently between the ages of 6 months and 2
years. The specific kind of ear infection common to children is the middle
ear infection, or what doctors call Otitis Media. Since almost every child
has a case of Otitis Media, it should come as no surprise that American
parents bring children to their health care providers an average of 25
million times each year for concern about ear infection illnesses. However,
only 1 in 12 of these children is diagnosed with this condition.

Ear infections occur as a result of a blockage in the tubes that connect the
middle ear to the back of the nose and throat, called Eustachian Tubes.
These tubes help equalize the pressure in the ear, and allow you to “pop”
your ears when changing altitude, as in when a plane is taking off, for
example. When a common cold or seasonal allergies cause the nasal passages
to become clogged and congested, these tubes may become clogged as well.
Once the tubes are clogged, fluid collects in the middle ear, turning into a
breeding ground for viruses and bacteria that can easily develop a painful
ear infection. In infants, these tubes are smaller and more horizontal than
in adults (or older children), which allows them to become clogged much
easier. With their immature immune systems, infants also tend to get colds
more frequently, so they tend to get more ear infections than toddlers or
school-aged children.

The common symptoms of an ear infection depend on the age of the child. In
infants, the most typical (and most noticeable) finding may be as simple as
increased fussiness. This usually would be following a few days of a cold-
type illness, and now suddenly the baby is crying most of the day and
frequently has a fever. In older children who can point to what hurts, a
young child may come to the parent, holding the ear (or both ears) and crying
in pain, or tell the parent that their ear hurts. Ear pain alone, however,
could be indicative of a number of problems other than an ear infection.
Tooth pain, from cavities or teething, is often felt in the ear, and a sore
throat can also often be felt as ear pain. Fever, a hallmark of infection in
infants, is not as common in older children as it is in infants—just because
they don’t have a fever does not mean there is no infection. With all of
these uncertainties of symptoms, the only definitive way to diagnose an ear
infection is to have a medical practitioner examine the ears.

“Pulling at the ears” is a common symptom that parents bring up. For many
toddlers and older infants this may be their signal to their caregiver that
they are having pain or discomfort. Certainly the toddler who cries and
pulls on his left ear is likely to have a middle ear infection. This may not
be the case with the three month old healthy infant who is often seen pulling
happily on her ears—she may simply be discovering that her ears exist, or
enjoying the feel of having her ears rubbed. It is important to remember
that ear infections hurt. With their Eustachian Tubes blocked, fluid and
pressure build up behind the ear drum which is very painful. A child may
also be seen pulling at her ears before an infection starts, when there is
fluid build-up behind the ear drum, but not yet any breeding bacteria or
viruses. The fluid build-up can cause a feeling of fullness or pressure in
the ears, which a young child cannot verbalize, and may say her ears “hurt”
since that is the only word she knows that can fit her feeling. Her doctor
may be able to see this fluid build-up behind the ear drum when he checks the
ears, but an infection may not be present. That’s not to say that one might
not develop later, since the fluid is likely to attract infection the longer
it sits there.

Though the symptoms of an ear infection can be recognized by the caregiver,
only your child’s doctor can diagnose an ear infection for sure. And even
after the diagnosis has been made, treatment varies. Ear infections are
caused by either a virus or bacteria—bacteria we can treat with antibiotics,
viruses we can’t treat at all. There is no simple way for your doctor to
determine what exactly is causing your child’s infection. Depending on the
appearance of the ear drum, he may decide that the cause is likely viral,
which will resolve on its own without antibiotics. In that case, there are
ear drops available to help decrease the pain of the infection, and you may
be instructed to watch and see if your child becomes better on her own. Ear
drops can also be used for pain if antibiotics are prescribed for a likely
bacterial infection. Remember that antibiotics won’t treat your child’s pain—
Tylenol or Motrin along with ear drops are a good idea with or without
antibiotic treatment. For either treatment regimen, you should see some
improvement in your child’s symptoms in 2-3 days.