Ear Infections

Children may be at higher risk for ear infections if they:

Are around people who smoke.
Have had previous ear infections.
Have a family history of ear infections.
Attend day care (because they are exposed to more germs and viruses).
Were born prematurely or with a low birth weight.
Have frequent colds or other infections.
Take a bottle to bed.
Use a pacifier.
Are male (boys tend to get more ear infections than girls).
Have nasal speech (caused by large adenoids that block the eustachian tube).
Have allergies with nasal congestion.

A tube called the eustachian (say: “you-stay-shun”) tube connects the middle ear with the back of the nose. Normally this tube lets fluid drain out of the middle ear. If bacteria or viruses infect the lining of your child’s eustachian tube, the tube gets swollen and fills with thick mucus. This keeps fluid in the ear from draining normally. Bacteria can grow in the fluid, increasing pressure behind the eardrum and causing pain. This is called an acute ear infection, or acute otitis media.

The most common symptoms of an acute ear infection are ear pain and fever. If your child is too young to tell you what hurts, he or she may cry or pull on his or her ear. Your child may also be irritable, have trouble hearing, or not feel like eating or sleeping.

If your doctor thinks bacteria caused your child’s ear infection, he or she may prescribe an antibiotic. It’s very important to follow your doctor’s directions for giving the medicine to your child and to use all of it. The pain and fever should go away within 2 to 3 days of starting an antibiotic.

If a virus caused your child’s ear infection, antibiotics will not work. You’ll have to wait until the virus goes away on its own.

To help your child feel better and reduce fever, your doctor may suggest using a pain reliever such as acetaminophen or ibuprofen. Don’t give your child aspirin unless your doctor says it’s OK. Aspirin can cause Reye's syndrome, a serious illness, and in some cases, death when it's used in children under 18 who have the flu. Your doctor might prescribe ear drops to reduce pain. A warm (not hot) heating pad held on your child’s ear may also relieve his or her pain. (This is not recommended for young babies.)

Sometimes after the symptoms of an acute ear infection go away, fluid stays in the middle ear. This is called otitis media with effusion. (Effusion is another word for fluid buildup.) Unlike an acute ear infection, otitis media with effusion doesn’t usually cause much pain or fever. Your child may have trouble hearing and a “plugged up” feeling in his or her ear.

Uninfected fluid in your child’s middle ear will almost always go away on its own and usually doesn’t have to be treated with antibiotics. This may take up to 3 months.

If the fluid is still there after a few months and is causing hearing problems in both ears, antibiotics may help some children. For this reason, your doctor will probably check your child’s ears a few months after an acute ear infection.

Giving your child unnecessary antibiotics can be harmful. After each course of antibiotics, the germs in the nose and throat are more likely to become resistant. This means the usual antibiotics can’t kill the germs. You have to use more expensive and powerful antibiotics. Some of these antibiotics must be given in the hospital and their side effects can be very unpleasant or even dangerous.

Middle ear infections and fluid in the ear are the most common causes of temporary hearing loss in children. Children who have ongoing problems with hearing may have trouble developing their speech and language skills. For this reason, it is important to talk with your doctor if your child has lots of ear infections.

If your child has very frequent ear infections, your doctor may recommend preventive antibiotic treatment or ear tubes. Preventive antibiotics can be given in a low dose every day for several months, usually in the winter when respiratory illnesses are common.

Ear tubes are put in the eardrum by a surgeon to help the middle ear fluid drain. Because of the way the eardrum heals, ear tubes will often come out on their own after several months to 2 years.