What are the main causes of ear infections in children. How can parents identify the symptoms of an ear infection. What are the most effective home remedies and medical treatments for ear pain in children. When should parents seek medical attention for their child’s ear infection.

Understanding the Anatomy of Ear Infections in Children

Ear infections are a common childhood ailment, with approximately 5 out of 6 children experiencing at least one episode by their third birthday. The prevalence of these infections in young children can be attributed to two main factors: their immature immune systems and the anatomical differences in their ear structures compared to adults.

The Eustachian tube, a canal connecting the middle ear to the throat, plays a crucial role in maintaining proper ear health. In children, this tube is shorter and more horizontal, making it easier for bacteria and viruses to travel from the nose and throat to the middle ear. Additionally, the Eustachian tube helps regulate fluid and air pressure within the ear. When it becomes blocked or swollen due to conditions like colds, flu, or allergies, fluid can accumulate in the middle ear, creating an ideal environment for bacterial growth and subsequent infection.

Types of Ear Infections

• Outer ear infections (swimmer’s ear)
• Middle ear infections (otitis media)
• Inner ear infections (labyrinthitis)

Among these, middle ear infections are the most common in children. They occur when bacteria or viruses invade the space behind the eardrum, causing inflammation and fluid buildup.

Recognizing the Signs and Symptoms of Ear Infections

Identifying an ear infection in children, especially in infants and toddlers who cannot verbalize their discomfort, can be challenging for parents. However, there are several telltale signs to watch for:

• Ear pain or discomfort, especially when lying down
• Tugging or pulling at the ear
• Difficulty sleeping
• Irritability or crankiness
• Fever
• Fluid drainage from the ear
• Hearing difficulties
• Balance problems or dizziness
• Reduced appetite, especially in infants during bottle feeding

Is ear pain always indicative of an infection? Not necessarily. While ear pain is a primary symptom of ear infections, it can also be caused by other factors such as teething, sinus pressure, or even a buildup of earwax. Therefore, it’s essential to consider the presence of multiple symptoms and consult a healthcare professional for an accurate diagnosis.

Diagnostic Procedures for Ear Infections

To definitively diagnose an ear infection, a doctor will use an instrument called an otoscope. This device combines a magnifying lens with a light source, allowing the physician to examine the ear canal and eardrum closely.

What Does a Healthy Eardrum Look Like?

A healthy eardrum appears translucent with a pinkish-gray color. In contrast, an infected eardrum typically looks red, swollen, and may appear opaque due to fluid buildup behind it.

Additional Diagnostic Tests

1. Pneumatic otoscopy: This involves using a puff of air to observe eardrum movement. Limited movement may indicate fluid in the middle ear.
2. Tympanometry: A test that measures eardrum flexibility and middle ear pressure.
3. Acoustic reflectometry: This test measures how much sound is reflected back from the eardrum, helping to detect fluid buildup.

Treatment Options for Childhood Ear Infections

The approach to treating ear infections in children has evolved over the years, with a growing emphasis on judicious use of antibiotics to prevent antibiotic resistance.

The “Wait-and-See” Approach

Many ear infections, particularly those caused by viruses, resolve on their own without antibiotic intervention. For this reason, doctors often recommend a “wait-and-see” approach, especially for mild cases in children over six months old. During this period, parents are advised to manage symptoms and monitor the child’s condition closely.

When Are Antibiotics Necessary?

Antibiotics may be prescribed in the following situations:

• Severe symptoms
• Infections in infants under six months
• Cases where symptoms don’t improve after 48-72 hours
• Children with underlying health conditions

Why are doctors cautious about prescribing antibiotics for every ear infection? The overuse of antibiotics can lead to antibiotic-resistant bacteria, making future infections more challenging to treat. Additionally, antibiotics are only effective against bacterial infections, not viral ones.

Home Remedies and Pain Management for Ear Infections

While waiting for the infection to clear or for antibiotics to take effect, several home remedies can help alleviate pain and discomfort:

• Warm compress: Applying a warm washcloth to the affected ear can help soothe pain.
• Over-the-counter pain relievers: Acetaminophen or ibuprofen can help reduce pain and fever. (Note: Aspirin should never be given to children due to the risk of Reye’s syndrome.)
• Elevation: Elevating the child’s head while sleeping can help drain fluid from the ear.
• Hydration: Encouraging fluid intake can help thin mucus and promote drainage.
• Avoiding pressure: Advise children not to sleep on the affected ear.

Are ear drops effective for treating ear infections? In some cases, doctors may recommend ear drops to help alleviate pain. However, these should only be used under medical guidance, especially if there’s a possibility of a perforated eardrum.

Complications and Long-Term Effects of Recurrent Ear Infections

While most ear infections resolve without lasting effects, frequent or chronic infections can lead to more serious complications:

• Hearing loss: Temporary hearing loss is common during an ear infection due to fluid buildup. However, repeated infections can lead to permanent hearing impairment.
• Speech and language delays: Hearing loss from chronic ear infections can impact a child’s speech and language development.
• Eardrum perforation: In severe cases, pressure from fluid buildup can cause the eardrum to rupture.
• Mastoiditis: An infection of the mastoid bone behind the ear, which can occur if ear infections are left untreated.
• Meningitis: In rare cases, untreated ear infections can lead to meningitis, an inflammation of the membranes surrounding the brain and spinal cord.

How often should children with recurrent ear infections have their hearing tested? For children experiencing frequent ear infections, annual hearing tests are recommended to monitor for any developing hearing loss.

Surgical Interventions for Chronic Ear Infections

In cases of chronic or recurrent ear infections, surgical interventions may be considered:

Tympanostomy Tubes

Tympanostomy tubes, also known as ear tubes or ventilation tubes, are small cylinders inserted through the eardrum to allow fluid drainage and prevent fluid buildup in the middle ear. This procedure is typically recommended for children who:

• Have had three or more ear infections in six months
• Have had four or more ear infections in a year
• Have persistent fluid in the middle ear for more than three months
• Experience hearing loss due to fluid buildup

How long do ear tubes typically stay in place? Ear tubes usually remain in the eardrum for 6 to 18 months before falling out on their own. In some cases, they may need to be surgically removed if they don’t fall out naturally.

Adenoidectomy

In some children, enlarged adenoids can contribute to recurrent ear infections by blocking the Eustachian tubes. An adenoidectomy, the surgical removal of the adenoids, may be recommended in these cases, often in conjunction with the insertion of ear tubes.

Preventing Ear Infections in Children

While it’s not always possible to prevent ear infections, several strategies can help reduce their frequency:

1. Promote good hygiene: Teach children to wash their hands frequently to reduce the spread of germs.
2. Avoid secondhand smoke: Exposure to cigarette smoke can increase the risk of ear infections.
3. Breastfeed infants: Breastfeeding for at least six months can boost a baby’s immune system.
4. Practice safe bottle feeding: Feed babies in an upright position and avoid letting them drink while lying down.
5. Keep vaccinations up to date: Ensure children receive their recommended vaccinations, including the annual flu shot for those over six months old.
6. Manage allergies: If a child has allergies, work with a doctor to manage them effectively.
7. Avoid cotton swabs: Don’t use cotton swabs or other objects to clean inside the ears, as this can cause injury and increase infection risk.

Can swimming increase the risk of ear infections? While swimming doesn’t directly cause middle ear infections, it can lead to outer ear infections (swimmer’s ear). To prevent this, ensure children dry their ears thoroughly after swimming or bathing, and consider using ear plugs or swim caps for added protection.

When to Seek Medical Attention for Ear Infections

While many ear infections resolve on their own, certain situations warrant immediate medical attention:

• Severe ear pain
• Symptoms in infants under 6 months old
• High fever (over 102.2°F or 39°C)
• Discharge of blood or pus from the ear
• Symptoms lasting more than 2-3 days
• Swelling or redness behind the ear
• Stiff neck or severe headache
• Signs of hearing loss

Should parents be concerned if their child’s eardrum ruptures? While a ruptured eardrum sounds alarming, it often brings relief from pain as it allows fluid to drain. However, it’s essential to seek medical attention to prevent infection and ensure proper healing.

Understanding ear infections, their causes, and appropriate treatments can help parents navigate this common childhood ailment more effectively. By recognizing symptoms early, implementing preventive measures, and seeking timely medical care when necessary, parents can help minimize the impact of ear infections on their children’s health and development. Remember, each child is unique, and what works for one may not work for another. Always consult with a healthcare professional for personalized advice and treatment options.

Anatomy of an Ear Infection

Medically Reviewed by Melinda Ratini, MS, DO on January 11, 2022

It’s not your imagination. Kids can get a lot of ear infections. In fact, 5 out of 6 children will have at least one by their third birthday. Why? Their immune systems are immature, and their little ears don’t drain as well as adults’ ears do.

It’s an infection in the outer ear that usually happens when the ear stays wet long enough to breed germs. But even if your kid hasn’t been swimming, a scratch from something like a cotton swab (or who knows what they stick in there?) can cause trouble. Watch out if your child’s ear gets itchy or hurts when you touch it. The answer is usually medicated drops and keeping ears dry.

The only way to know for sure if your child has one is for a doctor to look inside her ear with a tool called an otoscope, a tiny flashlight with a magnifying lens. A healthy eardrum (shown here) looks sort of clear and pinkish-gray. An infected one looks red and swollen.

The Eustachian tube is a canal that connects your middle ear to your throat. It keeps fluid and air pressure from building up inside your ear. Colds, the flu, and allergies can irritate it and make it swell up.

If the Eustachian tube gets blocked, fluid builds up inside your child’s middle ear. This makes the perfect breeding ground for bacteria that cause infections. Your doctor may look inside your child’s ear with an otoscope, which can blow a puff of air to make his eardrum vibrate. If it doesn’t move as much as it should, chances are there’s fluid inside.

If too much fluid or pressure builds up inside the middle ear, the eardrum can actually burst (shown here). If that happens, you may see yellow, brown, or white fluid draining from your child’s ear. It sounds scary, but the eardrum usually heals itself in a couple of weeks. Hearing usually returns to normal once the eardrum heals –unless the eardrum has been damaged.

The main warning sign is sharp pain. Your child may be more uncomfortable lying down, so he might have a hard time sleeping. Other problems to look for:

• Trouble hearing
• Fever
• Fluid oozing from ears
• Dizziness
• Stuffy nose

These infections can be sneaky with babies or children who are too young to tell you what hurts. A lot of times they’ll start tugging or pulling on an ear. Little kids can also just get cranky, have trouble sleeping, or not eat well. Babies may push their bottles away because pressure in their ears makes it hurt to swallow.

While the immune system fights the ear infection, you can ease any pain your child feels. A warm washcloth on the outside of the ear can be soothing. Depending on the cause of the earache, your doctor may recommend eardrops. Non-prescription painkillers and fever-reducers, such as acetaminophen and ibuprofen, are also an option. Do not give aspirin to children.

Ear infections often go away on their own, so don’t be surprised if your doctor suggests a “wait and see” approach. The more we use antibiotics, the less effective they become. That’s because bacteria learn to fight back against common medicines. Viruses can also cause ear infections, and antibiotics only work on bacteria. Your doctor will know best when to use them.

If your child’s ear infections keep coming back, they can scar his eardrums and lead to hearing loss, speech problems, or even meningitis. If he has lots of them, you might want to have his hearing tested just in case.

For kids who get a lot of ear infections, doctors sometimes put small tubes through the eardrums. They let fluid drain out of the middle ear and stop it from building up again. This can ease the pressure or pain and clear up hearing problems. The tubes usually stay in for 6 to 9 months and fall out on their own.

Sometimes a child’s tonsils get so swollen that they put pressure on the Eustachian tubes that connect her middle ear to her throat — which then causes infections. If that keeps happening, she may need to have her tonsils taken out.

The biggest cause of middle ear infections is the common cold, so avoid cold viruses as much as you can. The best way to stop germs is to make sure your child washes her hands well and often. Also, keep your child away from secondhand smoke, get her a flu shot every year once she turns 6 months old, and breastfeed your baby for at least 6 months to boost her immune system.

Like colds, allergies can also irritate the Eustachian tube and lead to middle ear infections. If you can’t keep your child away from whatever’s bothering him, consider an allergy test to figure out his triggers. Medicine or allergy shots may offer relief and stop the infections, too.

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SOURCES:

Academy of American Family Physicians.

American Academy of Otolaryngology.

American Academy of Pediatrics: “Allergy Tips.”

Chonmaitree, T. Clinical Infectious Diseases, March 15, 2008.

Chavanet, P. Clinical Infectious Diseases, March 15, 2008.

KidsHealth: “Swimmer’s Ear.”

National Institute on Deafness and Other Communication Disorders: “Ear Infections in Children.”

Merck.

National Institute on Deafness and Other Communication Disorders.

Sander, R. American Family Physician, March 1, 2001.

Spiro, D. JAMA, The Journal of the American Medical Association, Sept. 13, 2006.

CDC.

Mayoclinic.org.

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Otolaryngologists: Ear, Nose, Throat Doctors

Written by Regina Boyle Wheeler

• What Conditions Do Otolaryngologists Treat?
• How Are ENT Doctors Trained?
• How Do I Find an Otolaryngologist?

If you have a health problem with your head or neck, your doctor might recommend that you see an otolaryngologist. That’s someone who treats issues in your ears, nose, or throat as well as related areas in your head and neck. They’re called ENTs for short.

In the 19th century, doctors figured out that the ears, nose, and throat are closely connected by a system of tubes and passages. They made special tools to take a closer look at those areas and came up with ways to treat problems. A new medical specialty was born.

ENTs can do surgery and treat many different medical conditions. You would see one if you have a problem involving:

• An ear condition, such as an infection, hearing loss, or trouble with balance
• Nose and nasal issues like allergies, sinusitis, or growths
• Throat problems like tonsillitis, difficulty swallowing, and voice issues
• Sleep trouble like snoring or obstructive sleep apnea, in which your airway is narrow or blocked and it interrupts your breathing while you sleep
• Infections or tumors (cancerous or not) of your head or neck

Some areas of your head are treated by other kinds of doctors. For example, neurologists deal with problems with your brain or nervous system, and ophthalmologists care for your eyes and vision.

Otolaryngologists go to 4 years of medical school. They then have at least 5 years of special training. Finally, they need to pass an exam to be certified by the American Board of Otolaryngology.

Some also get 1 or 2 years of training in a subspecialty:

• Allergy: These doctors treat environmental allergies (like pollen or pet dander) with medicine or a series of shots called immunology. They also can help you find out if you have a food allergy.
• Facial and reconstructive surgery: These doctors do cosmetic surgery like face lifts and nose jobs. They also help people whose looks have been changed by an accident or who were born with issues that need to be fixed.
• Head and neck: If you have a tumor in your nose, sinuses, mouth, throat, voice box, or upper esophagus, this kind of specialist can help you.
• Laryngology: These doctors treat diseases and injuries that affect your voice box (larynx) and vocal cords. They also can help diagnose and treat swallowing problems.
• Otology and neurotology: If you have any kind of issue with your ears, these specialists can help. They treat conditions like infections, hearing loss, dizziness, and ringing or buzzing in your ears (tinnitus).
• Pediatric ENT: Your child might not be able to tell their doctor what’s bothering them. Pediatric ENTs are specially trained to treat youngsters, and they have tools and exam rooms designed to put kids at ease.

Common problems include ear infections, tonsillitis, asthma, and allergies. Pediatric ENTs also care for children with birth defects of the head and neck. They also can help figure out if your child has a speech or language problem.

• Rhinology: These doctors focus on your nose and sinuses. They treat sinusitis, nose bleeds, loss of smell, stuffy nose, and unusual growths.
• Sleep medicine: Some ENTs specialize in sleep problems that involve your breathing, for instance snoring or sleep apnea. Your doctor may order a sleep study to see if you have trouble breathing at times during the night.

Ask your primary care doctor or go to the American Academy of Otolaryngology Head and Neck Surgery website to find one in your area. Look for one that specializes in your specific problem.

Top Picks

What to do when your ear hurts – an article on the website Aptechestvo, Nizhny Novgorod

Ear pain in adults or ear pain in a child is simply exhausting. Usually it is accompanied by discomfort, fatigue, sleep disturbance, loud crying. Practice shows that people with ear pain make many mistakes that lead to complications. What to do when your ear hurts? First of all, you need to consult a doctor who will diagnose ear pain and prescribe the appropriate course of treatment.

When an adult’s ear hurts or a child’s ear hurts, discomfort can occur in different departments. We will analyze them in accordance with the generally accepted classification.

Pain in the outer ear

This part of the auditory organ is considered the most unprotected for infections. Why does my ear hurt? Very often, pain occurs due to inflammatory processes caused by bacteria. Another reason is improper cleaning, physical damage, foreign bodies. All this leads to the appearance of boils and even eczema. In such cases, doctors put otitis externa.

Pain in the middle ear

Ear pain can also appear in the middle ear. The department is closely connected with the outer ear and nasopharynx. Therefore, it is also characterized by the appearance of infections. Pathologies in the middle ear are accompanied by shooting pain, pulsation, hearing loss, distortion of the perception of one’s own voice.

Main pathologies:

• inflammatory processes;

• tumors in the tympanic cavity;

• trauma and breach of integrity;

• problems in the auditory tube.

In some cases, severe ear pain may appear after going to the pool. Pain extends both to the outer ear, where the infection could have entered, and to the middle ear, where pain is caused by the strong pressure of water when diving to depth.

Pathologies of the inner ear

The defeat of the inner ear in most cases is not accompanied by pain. Therefore, here, it is best to talk about pathologies. The main symptoms: impaired coordination, periodic nausea, extraneous sounds, headaches, dizziness and rapid hearing loss. The list of the main diseases that are the result of damage to the inner ear:

• labyrinthitis;

• hearing loss;

• Meniere’s disease;

• otosclerosis.

In addition, in some cases, acute ear pain may be due to complications in other organs. For example, dental problems, trigeminal neuralgia, or swelling of the larynx.

Ear hurts, how to treat?

Sometimes, if a child’s ear hurts, the parents don’t know what to do. If acute ear pain is not possible to see a doctor, you should use painkillers. For example, take a tablet of Solpadein, Tempalgin or Pentalgin. In some cases, it is possible to use vasoconstrictor ear drops. In addition, a solution of ammonia with camphor will help. Gauze is dipped into the solution and placed in the ear for a few minutes. This allows you to get rid of pain.

What not to do if your ear hurts

What not to do if your ear hurts – Polyclinic News

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October 15, 2020

Ear pain is considered one of the most unpleasant and excruciating pains. It can completely disrupt night sleep and significantly worsen the quality of life.

The main causes of ear pain are infections and injuries (improper cleaning of the ear canal, various bumps and injuries can lead to an inflammatory process).
⠀
If the lesion is in the outer section, then you will feel itching in the auricle, pain (most often acute). As for the middle ear, here diseases can “come” from the nasopharynx. Most often, we experience shooting pain in the ear, a sensation of throbbing, hearing loss, a strong and unusual perception of our own voice. With damage to the inner ear, pain is extremely rare. Symptoms such as incoordination, nausea, noise are characteristic.

Sometimes excruciating pain can occur due to disease in neighboring organs (dental disease, trigeminal neuralgia, inflammation in the throat, nose or paranasal sinuses, diseases of the esophagus, cardiovascular pathologies, etc.). In this case, the pain simply “gives” to the ears.

Causes of ear pain can be caused by both infections and injuries

Absolutely not to do for ear pain:

⠀

• Warm up the ear. If the cause of the problem is not established (and it is very difficult to do it yourself), then you can seriously harm yourself. In the inflammatory process, the risk of spreading the lesion is high.
• Apply antibiotics. Antibacterial drops, at best, may be ineffective (with fungal otitis), at worst (in some pathologies they have a toxic effect on the nerve endings) – they can lead to deafness.

⠀
If there is no purulent discharge from the ear cavity, and the body temperature remains normal, you can take an anesthetic drug. Vasoconstrictor drops in the nose will also help. They reduce internal pressure on the membrane and thereby significantly reduce pain.

The best thing, of course, is not to get sick! So be sure to take care of your ears. Always wear a hat in the winter, carefully clean your ears from wax and do not start the disease.