Ear infections in children are very common and can cause much discomfort to the child and much concern and anxiety for parents as well. Ear infections are the most common reason parents bring their child to a doctor.
What is an ear infection?
An ear infection, also known as otitis media, is an inflammation of the middle ear usually caused by bacteria or a virus that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. Three out of four children will have at least one ear infection by their third birthday. There are three main types of ear infections. Acute otitis media is the most common. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. Another form of otitis media is Otitis media with effusion. This sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. The third type of otitis media is Chronic otitis media with effusion, this happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. Chronic otitis media with effusion makes it harder for children to fight new infections and can also affect their hearing.
What causes an ear infection?
An ear infection is usually caused by bacteria, and often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear. If the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary infection. As a result of the infection, fluid builds up behind the eardrum.
What are the symptoms of an ear infection?
The symptoms of an ear infection might vary. In fact, the child might not be in a position to complain of a specific symptom. The most common symptoms are pain in the ear and fever. If your child is not old enough to talk the following might suggest an ear infection:
Tugging or pulling at the ear(s)
Fussiness and crying
Trouble sleeping
Fever (especially in infants and younger children)
Fluid draining from the ear
Clumsiness or problems with balance
Trouble hearing or responding to quiet sounds
Diagnosis and treatment
If you think your child has an ear infection take him or her to the doctor where the diagnosis is usually made following a history and physical examination.
The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage.
Most ear infections resolve without treatment with antibiotics. What is best for your child depends on many factors, including your child’s age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any antibiotic treatment.
Antibiotics are beneficial when the cause is bacterial. Talk to your doctor about the benefits of antibiotics weighed against the potential side effects and concern about overuse creating strains of resistant disease. Your doctor will also give the child something to ease the pain as well.
For recurrent otitis media and chronic otitis media further therapy might be indicated.
Follow-up
Children with frequent or persistent infections, or with persistent fluid in the middle ear, will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
Preventing ear infections
It might not be possible to prevent all ear infections in children, but there are some things that can decrease the risk of getting an ear infection.These include the following:
• Prevent common colds and other illnesses. Teach your children to wash their hands frequently and thoroughly and to not share eating and drinking utensils. Teach your children to cough or sneeze into their arm crook. Try to keep your child home from child care or school when ill.
• Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.
• Breastfeed your baby. If possible, breastfeed your baby for at least six months following birth. Breast milk contains antibodies that may offer protection from ear infections.
• If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby’s mouth while he or she is lying down. Do not put bottles in the crib with your baby.
Complications of ear infections
Most ear infections do not cause long-term complications, but frequent or persistent infections and persistent fluid buildup can result in some serious complications:
• Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was, before the infection, after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum, or other middle ear structures, permanent hearing loss may occur.
• Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech and in social and developmental skills.
• Spread of infection. Untreated infections, or infections that do not respond well to treatment, can spread to nearby tissues.
• Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed
Conclusion
An ear infection (otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections. Some ear infections clear up on their own while others require antibiotics. If you think your child has an ear infection consult with your doctor.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
