Ear infections are one of the most common diagnoses we make as pediatricians. Almost every child will experience at least one sometime in the first few years of life, so let’s learn about them.
What causes an ear infection?
Ear infections start after a child gets a cold that causes mucus build up in the middle ear, which is the area behind the eardrum. Once that mucus builds up, that allows bacteria or viruses to move in and start replicating, causing inflammation in the middle ear. Kids get more ear infections than adults because their eustachian tube (a tube that drains fluid from the middle ear) is smaller and more horizontal which makes it harder for it to do its job. Importantly, ear infections can be bacterial or viral – remember this for when we discuss treatment!
What are the signs and symptoms of ear infections?
Most commonly, ear infections present with fever, fussiness, and ear pain that arises in the setting of cold symptoms. Younger babies don’t often have specific signs of ear pain, so a demeanor change is usually more of a marker for them. However, toddlers will often pull, tug, or bat at the affected ear(s). Finally, if the pressure from fluid build-up has caused the eardrum to rupture, you will see drainage from the ear (despite sounding scary, perforations from infections heal well!)
It’s important to know that ear tugging doesn’t always mean there’s an ear infection. Teething can also cause kids to mess with their ears because the nerves of the gums and ears run along the same path, so it’s hard for kids to differentiate where the pain is coming from. Some kids might also feel irritated by wax in their ears, or others will just mess with their ears for behavioral reasons unrelated to any discomfort.
What are we looking for when we do an ear exam?
Signs of an ear infection include the eardrum looking red, pus behind the eardrum, and bulging of the eardrum. The exam is crucial to diagnosis, which is why we can’t make an accurate diagnosis over the phone or by symptoms alone.
How do we treat ear infections?
Here’s where there’s some nuance. As we discussed, ear infections can be viral or bacterial. This is important because a viral ear infection doesn’t need to and shouldn’t be treated with antibiotics, whereas a bacterial one is more likely to need treatment with antibiotics. The only way to know for sure if it’s viral or bacterial is to do surgery to cut into the eardrum and take a sample of the fluid – which obviously is not something we are going to be doing in the office. So we have to use clinical guidelines when deciding how to treat.
For ear infections in young babies and anyone with severe symptoms (high fevers, severe pain, pain for more than 48 hours) or evidence of a ruptured eardrum, we treat with antibiotics as these are more likely to be bacterial. In most toddlers without severe symptoms and with any kid older than 2 years old, there’s a high chance that the infection is viral and will self-resolve without any antibiotics. For these cases, we practice watchful waiting and give the symptoms a few days to see if they improve before starting antibiotics. We know it can be hard to let your child be uncomfortable, but it’s in their best interest to avoid unnecessary antibiotics that can lead to side effects of their own, including future antibiotic resistance.
Whether the infection is viral or bacterial, it’s also important to remember that ear infections can really hurt, so age appropriate pain medications are also a very important part of treatment!
What happens if your child has recurrent/chronic ear infections?
Some kids end up getting recurrent ear infections leading to many rounds of antibiotics. One option for this is ear tubes – tiny straws inserted into the eardrum by an Ear, Nose, and Throat (ENT) doctor that give an alternative way for fluid to drain from the ear, and allow us to treat with antibiotic drops instead of oral antibiotics. We start talking about the possibility of tubes when kids get four ear infections in a season, or if they have an infection we cannot clear despite multiple rounds of antibiotics.
What is Swimmer’s Ear?
The information I’ve discussed above refers to an infection in the middle ear canal (behind the eardrum). Swimmer’s ear refers to an infection in the outer ear canal (the part of the ear canal exposed to the outside world) that typically results from bacteria found in water. These infections tend to present with pain when the external ear is touched, and sometimes discharge. We treat these infections with antibacterial drops in the ear.
To sum things up, ear infections are really common and need a visit in the office to diagnose and decide if treatment is needed. If you’re seeing the symptoms above, give us a call or schedule online for an appointment!