Middle Ear Infection, otherwise known as Acute Otitis Media, or in common terminology simply “ear infection,” is a common occurrence in babies, toddlers and young children. It is an infection in the middle ear, which is an internal structure inside the skull, behind the ear drum. Ear infections can be viral or bacterial, and they typically occur during or shortly after an upper respiratory illness (a cold).
During a cold, a child’s nasal passages become congested with mucous. This in turn causes fluid to build up in the eustachian tubes (an internal passageway between the nose and the ears). Children’s eustachian tubes are more horizontal and “floppier” than those of an adult, and therefore tend to retain fluid more easily. Over time, this fluid can grow bacteria. (Bacteria thrive in environments that are warm, dark and moist – exactly the characteristics of a fluid-filled eustachian tube!)
Common symptoms of an ear infection include ear pain or tugging, fever, fussiness, poor appetite, and occasionally vomiting or diarrhea. In most cases, the ear drum is intact, and the fluid that builds up behind it during an ear infection is not visible to the naked eye. A healthcare provider can examine the middle ear with a lighted device called an otoscope, and can diagnose an ear infection based on the presence of purulent (pus-like) fluid behind the ear drum, along with a bulging shape and redness of the tissue. If the pressure becomes great enough, occasionally an ear infection can cause the ear drum to rupture (burst), in which case you might see thick off-white or yellowish fluid draining out of the ear canal. If you notice any of these symptoms described above, you should have your child seen by their healthcare provider.
Image credit: UpToDate, Patient education: Ear infections (otitis media) in children (The Basics)
If your child is diagnosed with an ear infection, there are a few treatment options. The best course of action will depend on the severity of the infection, your child’s age, and his or her past medical history. If your child is under 2 years old, your provider will likely prescribe an oral antibiotic to treat the infection. If they are over 2, the infection is unilateral (just one ear instead of both), and he or she has no fever, then your provider may offer the option of “watchful waiting.” This is because some ear infections are caused by viruses and may self-resolve, without the use of antibiotics.
With watchful waiting, your provider will advise you to treat your child’s pain with Tylenol or Motrin for 2-3 days, and to monitor their symptoms closely. If their ear pain is persistent or worsening, or if they develop fever, your provider will likely advise starting an oral antibiotic. However, if their ear pain resolves and they remain fever-free, then they likely do not need antibiotics! This is a positive outcome, because overuse of antibiotics can kill good bacteria in the intestines, and can cause unpleasant side effects such as diarrhea.
If your child ultimately needs an oral antibiotic to treat their ear infection, then it is important for them to take the entire course as directed. Typically by day 3 of the medication, they will be feeling much better – but they should still finish the whole course. This is so that the infection is treated completely and will be less likely to reoccur. We also want to make sure the bacteria are fully eradicated, so that we do not contribute to the development of drug-resistant organisms (germs that can be very difficult to treat with standard antibiotics). If your child has been on oral antibiotics for 3 days and their pain or fever has not resolved, then they should have a follow-up visit for another ear check. Occasionally, a change in antibiotics may be necessary.
For most children, an occasional ear infection is an unpleasant but common part of childhood. If your child is prone to frequent or recurrent infections, your provider may recommend your child see an Ear, Nose and Throat (ENT) specialist. In some cases, children with frequent or recurrent ear infections may need to have a small tube surgically placed in each ear drum, which allows fluid to drain and therefore decreases the frequency of ear infections.
Please don’t hesitate to call our nurse triage line or schedule an appointment if you are concerned that your child may have an ear infection. In most cases, ear infections can be easily diagnosed and treated, and your child will be feeling better soon.