Williamsville Pediatric Center

What is an ear infection?

There are two types of ear infections:

1. Middle ear infections (otitis media), caused by infected fluid in the small space deep behind the eardrum.
2. Swimmers ear (otitis externa), an irritation of the outer ear canal alone.

Next to the common cold, an ear infection is the most common childhood illness. Almost every child will have at least one middle ear infection in their liftetime. About 15% of children experience recurrent ear infections. Children at highest risk for ear infections include:

• Children under 2 years of age
• Daycare attendees
• Children exposed to cigarette or other second-hand smoke
• Those with a family history of frequent ear infections.

Children who are breastfed generally have fewer ear infections than others do.

Myths

Water in the ears, or exposure to cold winds and drafts does NOT cause ear infections.

Middle Ear Infections

Symptoms of middle ear infections

• Ear infections typically occur during a cold. Several days after the onset of the cold, your child may complain of:
  • Severe ear pain
  • Fever (sometimes)
  • Worsening pain when lying down (this increases the pressure in the middle ear, thus increasing the pain)
• Not all children who complain of ear pain have an ear infection. Foreign bodies in the ear canal, sore throats, or air pressure behind the eardrum often cause children to complain that their ears hurt.
• We can not diagnose an ear infection over the phone. An office visit is necessary for us to determine what is wrong if your child's symptoms persist.

Treatment of middle ear infections

• Approximately 70% of all ear infections will go away on their own without treatment.
• Control the pain
  • Pressure behind the eardrum can be very painful. You may give your child a dose of acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Warmed mineral oil or an anesthetic eardrop may also be of benefit.
  • If your child is old enough to reliably tell you if her ear hurts or not, it is advisable to wait 24-48 hours to see if it will resolve without antibiotics.
• Antibiotics
  • Some ear infections require antibioics
  • The choice of antibiotic varies depending upon your child's history of ear infections
  • Remember, it takes 2-3 days for an antibiotic to start relieving the pain and pressure

Possible complications of middle ear infections

• Recurrent infection
  • Some children, even though their infections respond easily to antibiotics each time they are treated, can get recurrent infections
  • We may choose to place such children on a low dose preventative antibiotic throughout the winter months.
  • If the ear infections persist, your child may need to see an ear, nose and throat specialist to discuss the possibility of ear tubes
• Persistent middle ear fluid
  • After an infection is treated, a non-infectious fluid may persist
  • This may last up to three months. 
  • Sometimes, despite antibiotics and time, middle ear fluid will not go away. Children with persistent fluid beyond 3-4 months may need to see an ear, nose and throat specialist to discuss the possibility of ear tubes.
• Ruptured eardrums
  • About 5% of all ear infections involve a spontaneous rupture of the eardrum. Pus and bloody fluid may leak out of the ear canal.
  • Ruptured eardrums usually heal during the course of treatment, make the pain go away, and are not considered a serious complication.
• Hearing loss
  • Fluid in the middle ear space may cause temporary hearing loss
  • This will resolve as the middle ear fluid resolves.
  • Permanent hearing loss is extremely rare with an ear infection

Swimmers Ear (Otitis Externa)

Frequent swimming often washes protective wax out of the ear canal, making the canal dry, cracked, irritated and prone to infection. Swimmer's ear is almost always seen in the summer, is not associated with head colds, and occurs in the older school-aged child. Gently tugging on the outer ear worsens the ear pain.

Swimmer's ear can be treated by using a mixture of one part white vinegar, one part tap water. Put 4-6 drops of this mixture in the ear canal four time a day for one week. If at any time, the pain is severe or does not begin to resolve after a few days, call the office. To help prevent repeated infections, two drops of the vinegar/water solution can be instilled in the ear canals after swimming is done for the day.