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Ear Infections 101: Commonly Asked Questions For Parents

Wellness

If you are a parent reading this, chances are you already had a run-in with an ear infection. 80-90% of children will have an ear infection by 3 years of age, with the highest incidence being between 6 and 18 months. Ear infections are also the most common cause of antibiotic use in children. Because they are so common in children, I wanted to answer some of the questions I hear parents ask on a regular basis: 

Why are ear infections so common? 

Ear infections are associated with runny noses and young children tend to get colds frequently. Kids who attend day care are at higher risk of developing ear infections. Young kids also tend to have narrower nasal passages and larger adenoids which predispose them to ear infections. The weaker immune system of a young child is less equipped to fight off infections. Finally, ear infections tend to run in families. 

How do ear infections develop? 

The middle ear is a narrow box connected to the back of the nose through a canal (the Eustachian tube) and is lined with the same respiratory mucosa as the nasal passages. When viral infections cause swelling and secretions throughout the system, the Eustachian tube gets blocked and fluid cannot exit the middle ear, leading to fluid accumulation. Warm and moist environments are a perfect place for pathogens to thrive: once they start growing, a middle ear infection develops. 

What are the signs of an ear infection? 

Ear infections are frustrating for parents as they are not directly visible and there is not a definitive symptom that is associated with them. Usually, it is a combination of some of the following symptoms: nasal congestion, yellow and thick nasal discharge, ear pain or pulling, hearing loss, ear discharge, fever, fussiness. 

What are signs of complications with an ear infection? 

There are some signs that warrant urgent evaluation, such as dizziness, vision problems, swelling and redness about the ear or weakness of the facial muscles. 

What shall I do if I suspect my child has an ear infection? 

First of all, an ear infection is not an emergency, it is OK to wait until the morning to have your child evaluated. Make sure you treat the symptoms in the mean time: give him ibuprofen (better than acetaminophen for this kind of illness), put a sock full of warm salt or rice over the painful ear, apply saltwater to ease the nasal congestion. Take him to your pediatrician in the morning. If it is the weekend or a holiday and your child is still uncomfortable in the morning, take them to a Pediatric After Hours or Urgent Care center. Adult ER doctors are usually not experienced in diagnosing ear infections, as it is rare for adults to develop them. 

Are antibiotics needed? 

After an evaluation by your health care provider, a treatment plan will be developed. Antibiotics are usually used for children under age one, children who have high fever along with ear infections, when ear infections affect both ears or if ear infection and “pink eye” are present at the same time. If the child is older than one, does not have a high fever, has only one ear affected or the ear infection seems mild, “watchful waiting” is a great option. Your doctor will discuss comfort measures for ear pain and will ask you to observe your child closely for the next 2-3 days. If their condition seems to worsen, antibiotics can be started. The good news is that greater than 60% of ear infections resolve spontaneously without antibiotics. 

Do I need to follow-up? 

If antibiotics were prescribed and your child does not feel better in 3-4 days, you need to return for a follow-up evaluation. Follow-up is needed at the end of the antibiotic treatment for children with frequent ear infections. 

How about recurrent ear infections? How much is too much? 

Many children experience repeated ear infections. As long as they are spaced out and the child recovers completely between episodes, no intervention is needed. For children who have four ear infection within 6 months or six within 12 months, an evaluation by an the Ear Nose and Throat specialist is recommended. Also, if fluid in the middle ear does not resolve within three months of an ear infection, referral to a specialist is warranted. Frequently, these children will need ear tubes to help the middle ear fluid drain, thus preventing build-up of liquid and bacteria in the middle ear. 

What can be done to prevent ear infections? 

Breastfeeding as long as possible, but at least for the first three months of life, helps strengthen the immune system and develops the facial anatomy in a way that prevents the development of ear infections. Also, vaccinating your child in a timely manner against pneumococcal disease and influenza contributes to decreasing the chance of an ear infection. Despite your natural concern for the health and comfort of your child, there is good news: Most children will outgrow ear infections by 3 to 5 years of age. For more information about Texas Children's Pediatrics, visit here.