Everything Parents Need to Know about Middle Ear Infections in Children—Commentary
Commentary07/16/18 Udayan K. Shah, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Many of us remember getting ear infections as a child, and the intense pain and bubble gum flavored medicine that went with them. Ear infections are common in children, and many kids suffer at least one during childhood. Ear infections become less common after childhood because the anatomy of the ear changes. Here’s a rundown of what patients and parents need to know about middle ear infections (otitis media).

What is a middle ear infection and what causes it?

The ear is made up of three parts: the outer, the middle and the inner ear. The middle ear is the space just behind the ear drum (tympanic membrane). Sometimes, excess fluid can pool in this space and lead to infection.

Acute middle ear infections (or acute otitis media) are painful infections that last a few days. They are often caused by the same viruses that cause the common cold, or by bacteria. The distinction between viral and bacterial causes is important because only bacterial causes respond to antibiotic treatment—and some bacterial infections get better even without antibiotics.

Sometimes with an infection, the ear drum can rupture and have a hole that remains (called a perforation). When middle ear infections occur frequently, this is called recurrent otitis media. When fluid from the infection fails to clear, or a hole is present, doctors call this a chronic middle ear infection (chronic otitis media).

What symptoms should parents look for?

Acute ear infections can be quite painful.  Common symptoms include fever, irritability, trouble sleeping and eating, and sometimes pus or bloody fluid leaking from the ear. Very young children who cannot talk may pull or pick at their ears, “head bang,” or shake their head repeatedly.

Chronic ear infection symptoms may be more difficult for parents to spot. Children may complain of hearing loss, a sensation of pressure in their ears, and a loss of balance. Sometimes a discharge will come from the ear. There may be a delay in the development of speech and language.

When should parents take their child to a doctor?

If children have ear pain that is very severe or lasts more than a day, or if there is discharge from the ear, parents should take a trip to the doctor. A very young child who is not babbling or a child who complains of not hearing well should be checked for chronic middle ear infection.

Why don’t doctors prescribe antibiotics for all ear infections?

Many ear infections are caused by a virus, and antibiotics won’t help treat a viral infection. If a child does have an acute infection, the doctor will likely recommend a pain reliever to help with the fever and earache and start antibiotics if the symptoms don’t improve after a few days.

What can parents do to prevent ear infections?

Some things parents can do to prevent ear infections are

  • Breastfeed your baby
  • Avoid pacifier use
  • Keep up to date with vaccinations
  • Don’t expose children to tobacco smoke
  • Limit children’s exposure to large daycare settings

 What can be done if a child keeps getting ear infections?

If a child keeps getting ear infections, doctors may recommend the placement of ear tubes (tympanostomy tubes). Ear tubes are tiny tubes placed in the ear drum (tympanic membrane). The tympanic membrane is the thin sheet of tissue that separates the outer from the middle ear. Tubes in the ear drum “ventilate” the middle ear and so prevent recurrent middle ear infections. Ear tubes also allow fluid to drain from the ear when an infection does occur.

What can parents expect if surgery is needed to place ear tubes?

In general, surgery takes about 15 minutes. Doctors will place tubes in both ears during the same procedure. Children are under general anesthesia for the surgery, which means they will be completely asleep. After surgery, they should in most cases go home the same day.

Children may have mild discomfort and a bloody or pus-like drainage from the ears for about a week but can usually do all activities, including bathing, right away. A custom wax or putty ear plug can be used if the child swims in water deeper than three feet.

 After surgery, parents will need to

  • Put ear drops in their child’s ears for about a week. These drops can be expensive, so families should budget accordingly or talk with their doctor about cheaper alternatives.
  • Monitor the ear drainage and contact the doctors for follow-up if the drainage does not clear up after a week.
  • Follow up for a hearing test with an audiologist, and with your doctor, within two to four weeks after surgery. Also, see the doctor to monitor the ear tubes every four to six months until the tubes fall out or are taken out.

The ear tubes should fall out on their own after about a year.  If they don’t, another procedure may be needed to remove them.

Ear infections are common and painful infections in children. Knowing the usual symptoms and treatments can help parents obtain timely and proper medical proper care for their children.