Ear Infections

Ear infections are usually of two types.  The most common is a middle ear infection (otitis media).  Middle ear infections usually occur in children younger than 8 years old and are associated with colds.  The second type is external ear infections (Otitis Externa or “Swimmer Ear”) which are usually associated with children over 5 or 6 years old that have been swimming a lot during the hot, humid time of summer.

Middle ear infections are secondary infections from colds or prolonged allergies that cause fluid in the middle ear secondary to plugging of the Eustachian tube.  Middle ear infections occur more frequently in infants and smaller children, because they have smaller and more horizontal Eustachian tubes.  These tubes link the middle ear with the back of the throat.  These tubes normally act as a safety valve to drain the middle ear.  If during a cold or allergy symptoms, the adenoids of the other tissue around the tubes enlarge or the lining of the tubes themselves swell.  Then, this causes blockage and stagnation of fluid in the middle ear.  The fluid often has bacteria.  Ideal conditions now exist for bacteria to grow and pressure to build up.  This is what causes a middle ear infection and the pain is caused by the inflammation and pressure build up against the eardrum.

Small children are usually irritable and pull at the ears; older children feel fullness in the ears, experience hearing loss or earache.  Fever may or may not be present.  Discharge or leakage from the ear usually means that the eardrum has torn under pressure from an infection.  The discharge does not mean a more serious or dangerous infection.  You can think of the tearing of the eardrum as the opening of a safety valve which relieved the build-up of excess pressure.  Children usually have less pain after the pressure is relieved.  The tears are usually quite small and heal rapidly.

External ear infections can give similar symptoms as above. Except, external ear infections are rarely associated with fever, are usually very painful when the ear lobe is tugged on and are associated with summertime swimming.  Whereas, middle ear infections are not.

The symptoms of an ear infection may be similar to other illnesses like a simple cold, abrasion inside the ear canal, teething in an infant, or referred pain from a sore throat.  The exact diagnosis can be made only by a trained physician who actually views the structures with an Otoscope.

If a child develops ear pain, the most important initial treatment is pain relief (see initial treatment below).  If this is truly a middle or external ear infection, antibiotics will usually be necessary.  However, antibiotics will not solve the acute pain or fever. Therefore, if the pain occurs in the evening or the middle of the night; Ibuprofen or Acetaminophen is the treatment, not antibiotics!!!!!!!! The child can be seen in walk-in at Community Pediatrics the following day or with coverage if on a weekend that Community Pediatrics of Andover is not on call.

Initial Treatment for Pain or Fever:

  1. For the pain or fever treat with Ibuprofen (preferred) or Acetaminophen (See tables under Fever for dosage).
  2. You may also use an electric heating pad set on “low” to the area around the ear to provide comfort.

Subsequent Treatment:

If your child is diagnosed with an ear infection, the child usually will feel much better within 72 hours.  Nevertheless, it is important that the child finishes the antibiotic as prescribed. Many of us taking medicine or giving it to children tend to slack off when the symptoms disappear.   Remember, the antibiotics are aimed not at the symptoms, but at the underlying infection.  The infection may remain active for several days after the disappearance of symptoms.  Stopping the antibiotic before it is complete may only result in a recurrence of the infection.

After a number of ear infections ventilation tube (PE tubes) may be suggested.  PE tubes may have to be inserted into the ear drums for drainage by an ENT specialist.  These tubes allow drainage and eliminate the temporary hearing loss from fluid build-up. 

Remember:  Effectively treated childhood ear infections, even if recurrent, do not cause deafness or permanent hearing loss.

Call the office if…

  1. Fever does not respond to Ibuprofen or Acetaminophen.
  2. Severe headaches or pain of the ear which persists despite initial treatment above.
  3. Increasing swelling around ear.
  4. Convulsions.
  5. Dizziness.
  6. Drainage from the ear.