Ear infections

Ear infections, also known as acute otitis media (AOM), are a common health issue in children. In fact, over 80% of children will have at least one episode of AOM before their third birthday, and many will have more. AOM occurs when the middle ear, the space behind the eardrum, becomes infected, inflamed, and filled with fluid. This fluid, known as pus, contains dead immune cells, bacteria and/or virus particles. 

The Eustachian tubes connect the inner ears to our nasopharynx (where the nose and throat join), allowing equalization of the air pressure between the two spaces and normal, painless function of our ear drums. The various maneuvers we do on airplanes when our ears ‘pop’ involve opening these tubes to let the pressure behind our eardrums match the outside pressure, commonly called ‘equalizing’ (fun fact:  scuba divers have to ‘equalize’ their ears as they change depth underwater to avoid pain and ear drum injury).  Children are more susceptible to ear infections, compared to adults, due to the anatomy of their Eustachian tubes, which are shorter and more horizontal, making it harder for the naturally occurring fluid to drain down to our throat, and clear out the bacteria and viruses that make their way into middle ear from the nose, mouth and throat were they can cause an infection, accompanied by inflammation and fluid buildup. This  leads to increased pressure behind the ear drum, causing the pain, associated with ear infections. The fever is part of the body’s response to the infection.

Most ear infections, in healthy, vaccinated children, are caused by the same viruses that normally infect the respiratory tract and can cause a range of illness such as common colds, bronchiolitis or pneumonia.

Most ear infections, in healthy, vaccinated children, are caused by the same viruses that normally infect the respiratory tract and can cause a range of illness such as common colds, bronchiolitis or pneumonia. These include viruses you may have heard of, and most of us become infected with many times in our lives, such as rhinovirus, RSV, coronavirus, and adenovirus. Bacterial ear infections, which are less common (especially in vaccinated children), are caused by bacteria such as Streptococcus pneumonae, Haeomphilus influenzae and Moraxella catarrhalis. The standard infant vaccine schedule includes shots against the first two, significantly decreasing their prevalence however certain strains are not covered by current vaccines. 

Symptoms of ear infections in children may vary, but common signs include:

Ear pain: Children who can speak will complain of ear pain. Nonverbal children may show signs of ear pain, such as tugging on or rubbing their ear, shaking or hitting their head, sticking their fingers in the ear

Fever: Often, there is an accompanying fever. The fever itself is not harmful, and does not require treatment, but the pain can often be quite bad and should be treated even if there is no fever present.

Irritability:  Young children may become more fussy and restless than usual. They may refuse to eat or drink as much as they usually do.

Trouble sleeping:  The pain and discomfort may disrupt their sleep patterns.

Difficulty hearing: The buildup of fluid in the middle ear can cause temporary hearing loss.

Ear drainage:  In some cases, pus or fluid may drain from the ear. This may reflect a hole, or perforation, in the ear drum, which can occur in some cases. It may also reflect an outer ear infection, called otitis externa, or commonly called ‘swimmers ear.’ This requires a physician examination to determine if present and will affect treatment decisions.

What increases a child’s risk of developing an ear infection?

Environmental or seasonal allergies can cause inflammation and congestion in the upper respiratory passages and Eustachian tubes, making it more difficult for the fluid to drain and increasing the risk of infection.

Second-hand smoke exposure, air pollution and respiratory viral infections all increase the risk of a child developing ear infections. Attending child-care or multiple child households increase exposure to infections. Skipping or delaying vaccines increases a child’s exposure to many diseases, including ear infections.

What decreases a child’s risk of developing ear infections?

Avoiding second-hand smoke exposure. Good hand hygiene. Consistent hand washing with soap and water, or alcohol based hand sanitizer, is still the best method of decreasing transmission of all sorts of nasty bugs. Make it your child’s habit to wash hands, for 20 seconds, before eating, when coming home and after using the bathroom –  make it a fun game by singing a round of Ol McDonald’s farm or the ABC’s while handwashing to ensure adequate time for the soap and water to do its job! Breastfeeding significantly reduces the risk of ear infections, among many other benefits, by passing antibodies from the mother to the baby. Keeping your child up to date on all her vaccines, according to the American Academy of Pediatrics recommended vaccine schedule will increase her immunity and lower the rate of ear infections. 

What if I suspect my child has an ear infection?

If you suspect your child has an ear infection, it’s essential to seek medical attention. A pediatrician will examine the child’s ears using an otoscope to diagnose the infection.  Most ear infections in otherwise healthy children are caused by viruses and will resolve on their own. In some cases, a bacterial infection may be suspected and antibiotics will be prescribed. The decision will depend on the child’s age, severity and duration of symptoms and other factors. In either case, the child should be provided supportive care, such as pain relief, rest and hydration and be monitored. If your child is developing new or worsening symptoms, she should be evaluated promptly by a pediatrician

In recurrent or severe cases of ear infections, or when complications arise, further evaluation by an Ear, Nose, and Throat (ENT) specialist may be necessary. In some cases of recurrent ear infections, tubes (tympanostomy tubes) may be inserted into the ears to help drain fluid and prevent future infections.

Can my child fly with an ear infection?

This is a very common question encountered by pediatricians, especially during travel season. Unfortunately, there is no consensus on the best answer. In the absence of strong evidence or guidelines, parents are usually advised the child should avoid flying until two weeks after the diagnosis of the ear infection. This is because of the concern that the child will experience more severe pain and/or the ear drum is at greater risk of perforating (developing a hole) with the change in air pressure encountered on commercial flights.

If the travel cannot be rescheduled, speak with your pediatrician to determine the best option for your family.

“This information is for educational purposes only and not meant to be taken as medical advice. The information presented does not substitute for professional medical advice, nor should it be used to treat yourself or others. Please consult with your physician for any medical issues or concerns that you have for your child or yourself. Please seek immediate medical attention at your closest Emergency Room or call 911 if you believe you are having a medical emergency.”