Acute (middle) ear infections, also known as acute otitis media, are very common in children and a frequent cause for children seeing their doctor.Most middle ear infections do not cause long-term complications, but frequent or persistent infections and persistent fluid buildup can result in some serious complications.
What is an acute middle ear infection?
An acute (middle) ear infection (acute 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. Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.
Otitis media can be painful because of inflammation and buildup of fluids in the middle ear. Some ear infections clear up on their own. Treatment may begin with managing pain and monitoring the problem. Ear infection in infants, and severe cases in general, often require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications.
How do you know if your child has an ear infection?
The symptoms and signs of an acute middle ear infection in children might develop very suddenly and might also vary in severity. Some common symptoms and signs include the following:
• Ear pain, especially when lying down
• Fever
• Loss of appetite
• Tugging or pulling at an ear
• Difficulty sleeping
• Crying more than usual
• Acting more irritable than usual
• Difficulty hearing or responding to sounds
• Loss of balance
• Drainage of fluid from the ear
• Headache
What causes acute middle ear infections in children?
The most common cause of an acute middle ear infection in children is a bacteria or virus. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.
What are some factors that increase the risk of your child getting an ear infection?
There are several factors that can increase the chances of your child developing an ear infection. These include the following:
• Group child care. Children cared for in group settings are more likely to get colds and ear infections – than are children who stay home – because they are exposed to more infections, such as the common cold.
• Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.
• Seasonal factors. Ear infections are most common during the colder months when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.
• Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of the eustachian tubes – and because of their poorly developed immune systems.
• Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.
Diagnosis
If you suspect that your child might have an ear infection take him/her to the doctor so that an accurate diagnosis can be made. Your doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and after a medical examination. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage.
Your doctor may perform other diagnostic tests if there is any doubt about a diagnosis, if the condition has not responded to previous treatments, or if there are other persistent or serious problems.
Treatment
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 antimicrobial treatment.
Some evidence suggests that treatment with antibiotics might be beneficial for certain children with ear infections. Talk to your doctor about the benefits of antibiotics weighed against the potential side effects – and concerns about overuse of antibiotics creating strains of resistant disease.
Managing pain
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
• A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
• Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) to relieve pain. Use the drugs as directed on the label. Use caution when giving aspirin to children or teenagers. Aspirin has been linked with Reye’s syndrome. Use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
• Eardrops. Prescription eardrops may provide additional pain relief for those whose ear drums are intact (not torn or perforated).
Antibiotic therapy
Your doctor may recommend antibiotic treatment for an ear infection in the some situations. Even after symptoms have improved, be sure to use all of the antibiotic as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications.
Decongestants and antihistamines — Cough and cold medicines (which usually include a decongestant or antihistamine) have not been proven to speed up healing or reduce complications of ear infections in children. In addition, these treatments have side effects that can be dangerous. Neither decongestants nor antihistamines are recommended for children with ear infections.
Can middle ear infections be prevented?
We know that some factors can increase the risk of ear infections. Doing the following might help prevent middle ear infections:
• 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. If possible, limit the time your child spends in group child care. A child care setting with fewer children may help. 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. Try to stay in smoke-free environments as much as possible.
• Breast-feed your baby. If possible, exclusively breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.
Conclusion
Acute middle ear infections in children are very common. About 50 percent of infants have at least one ear infection by their first birthday. Ear infections are a common reason for children visiting the doctor’s office. Ear infections can cause pain in the ear, fever, and general signs such as loss of appetite and irritability. If you think your child has symptoms suggestive of an acute middle ear infection, seek medical attention. Not all ear infections require antibiotics as many infections are caused by viruses. Your doctor is the best person to decide on treatment options.
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.
