Ask the Doctor: 'Ear All About It

“Not another ear infection!” you’ll often hear parents groan. Most children experience several ear infections during early childhood. For some kids, they seems to pop up almost as frequently as the next mortgage or rent payment.

Ear infections are very much an illness of early childhood and are most common in children from 3 months to 4 years old. Although they can cause temporary pain and discomfort, you can rest assured that most children will outgrow them.

Q: Why do some children get so many ear infections?  

A: Ear infections usually result from an upper respiratory illness, such as a simple cold. The cold causes swelling and mucus to accumulate in the sinuses, throat and the pair of narrow tubes (eustachian tubes) that connect the middle ear to the back of the throat, behind the nasal passages. When these tubes get blocked, fluid gets trapped in the middle ear and your child ends up with an infection.

Young children are particularly susceptible to ear infections as their eustachian tubes are shorter and aligned horizontally – not ideal for drainage. This means that the tubes are more likely to get blocked.

As your child grows, his or her eustachian tubes will grow. The tubes lengthen and their alignment changes, so that they are more efficient at draining fluid, making an ear infection less likely.

Q: How can I tell if my 2-year-old son has an ear infection?  

A: Your son will likely have had a cold, be a lot fussier than usual and cry a lot, especially when lying flat. Your son’s nighttime sleep may also be disrupted. Children often have fevers the first one to three days of a cold. But, if your son has a fever that lasts longer than a few days or that returns after it has initially broken, an ear infection is a definite possibility.

Just to dismiss an old wives’ tale: You may have heard that ear pulling is a sign of an ear infection. Not necessarily. He might be pulling on his ear for many other reasons.

Q: Are antibiotics the recommended treatment for ear infections? I’m hearing a lot of different advice and am confused.  

A: There has been a lot of confusion on this score. Your doctor will follow the advice from the American Academy of Pediatrics, which forms its recommendations based on evidence from a compilation of studies from professionally recognized sources.

Currently, the following evidence-based treatments are recommended:

  • Under 1 year of age: Antibiotics should be started immediately upon diagnosis.
  • From 1 to 2 years of age: For most children this age, antibiotics are recommended, although your doctor may encourage you to wait 48 hours to see if the ear infection resolves by itself. Your doctor will usually provide a prescription for antibiotics that you can start using if symptoms don’t seem to be improving or are getting worse.
  • Over 2 years of age: Observant management for the next 48 hours is usually recommended, as most ear infections get better by themselves. This type of treatment plan is particularly recommended for children who don’t have a fever or history of recurring ear infections. To ease the pain, you can give your child an over-the-counter pain medication such as ibuprofen (Motrin). Motrin is particularly effective, as it provides longer pain relief (approximately six to eight hours) and has anti-inflammatory properties (reducing the swelling in the sinuses and middle ear areas). If your child does not seem to be getting any better after 48 hours, is experiencing worsening pain and/or develops a new fever, contact your child’s doctor right away. Antibiotics are then usually recommended.

Q: My daughter seems to get ear infections all the time. What are the treatment options?  

A: If she gets more than three or four ear infections in a season (particularly if she is under 2 years old), your doctor may refer her to an ENT (ear, nose and throat) or otolaryngology specialist to discuss inserting tubes (typanostomy tubes) in her ears. Tubes can help:

  • Prevent ear infections because they let fluid drain out of the middle ear through the tube into the ear canal.
  • Prevent future fluid build up and a feeling of pressure and pain in the ears.
  • With possible hearing issues.

The ENT specialist inserts the tubes through a small surgical opening created in each eardrum. Although the surgery is usually done under general anesthesia, it is a simple outpatient procedure that only takes 10 to 20 minutes. Your daughter will most likely have little pain and recover quickly after the surgery.

The tubes typically stay in place and function well for six months to a year. Often, they fall out by themselves. They can then be replaced if your daughter continues to get ear infections. However, by the time the tubes fall out, your daughter might well have outgrown getting ear infections.

Q: Is there anything I can do to prevent my baby son from getting ear infections?  

A: Ear infections are very much part and parcel of being a little kid. As they are mostly due to a child’s anatomy, there are neither home remedies nor medications that will stop him from getting ear infections. Make sure you don’t smoke or that your son is not exposed to second-hand smoke, as that can weaken his immunity. Breastfeeding can provide your son with additional antibodies to fight off infections, but it is not a panacea. He might still be susceptible to ear infections depending on his anatomy.

Cara Barone, M.D., is a board-certified pediatrician at the Palo Alto Medical Foundation’s Palo Alto Center. Advice is not intended to take the place of an exam or diagnosis by a physician.




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