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Ear Infection (Otitis Media)

What is an ear infection?

The middle ear is the space behind the eardrum. It can become infected by bacteria or viruses. An infection of the middle ear is also called otitis media (say: oh-TIE-tis MEE-dee-uh).

Ear anatomy
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The ear has three sections: the outer ear, the middle ear, and the inner ear. Each section is made up of smaller parts that work together to help you hear.
 

The eustachian (say: you-STAY-shun) tube connects the middle ear to the back of the throat, and helps vent and drain the middle ear. An ear infection happens when mucus or swollen tissues from a cold block the eustachian tube. When the tube is blocked, the middle ear is not ventilated well and the air pressure changes can cause pain. This is much like the ear pain that happens on take-off or landing in an airplane. Sometimes the blockage does not let the normal ear fluid drain properly. This fluid can become infected and build up in the middle ear. This puts pressure on the eardrum and makes it bulge, which causes pain.

Otitis media
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In otitis media, the Eustachian tube is blocked. Fluid and pressure then build up in the middle ear. This makes the eardrum bulge outward and causes pain.
 

Many children will have at least 1 ear infection at some point, and some children will have many ear infections. Ear infections are most common in children between the ages of 6 months and 2 years, but they can occur throughout childhood. As most children grow, their ear structures also grow, so they will grow out of the tendency to having ear infections.

This page explains the symptoms of an ear infection, how you can look after your child, and when to take your child to a doctor.

Symptoms of an ear infection

Your child may have one or more of these symptoms:

  • ear pain
  • pulling or rubbing the ear
  • crying
  • not sleeping well
  • fluid draining from the ear
  • fever

In some children, the eardrum develops a small perforation (ruptures) because of the pressure in the ear. The ear then drains a cloudy or yellow fluid. The hole usually heals within a week or so. In some children, repeated ear infections and perforations can lead to scarring of the eardrum and longer-term hearing problems.

How to care for your child with an ear infection

Antibiotics

Not all ear infections need to be treated with antibiotics. If the ear infection seems mild, your doctor may suggest not giving antibiotics for a day or so to see if the infection goes away on its own.

Antibiotics are more likely to be prescribed when the ear infection looks worse, when the child is having a lot of pain or high fever, or in children under 2 years of age. Your child’s doctor may also prescribe antibiotic ear drops if your child’s eardrum has burst and is draining fluid.

Antibiotics will kill the bacteria that cause the ear infection. Your child should feel better in a few days, but you must give the antibiotic to your child until it is finished. This will keep the ear infection from coming back. It will also lower the chance of your child getting an infection that is harder to treat with antibiotics in the future.

Pain and fever relief

Give your child acetaminophen (Tylenol or Tempra) or ibuprofen (Motrin or Advil) to help with the earache or fever. These medicines usually begin to work within 1 hour. You may need to give them during the first few days until the antibiotic has time to take effect. The pain medicines do not affect the antibiotic.

Do not give your child Aspirin (ASA or acetylsalicylic acid).

You can also give your child a warm water bottle to hold over the ear. This may help with the pain.

Activities, day care, and school

Your child can go outside. There is no need to cover your child's ears.

Your child can swim if there is not a hole in his eardrum and fluid is not draining from his ear.

Your child can go back to day care or school when the fever is gone and he feels better. Ear infections do not pass from one person to another.

Flying

Flying on an airplane with an ear infection is not dangerous, but it can make the ear pain worse. It can also increase the chance that the eardrum will burst. Be sure to bring pain medicine with you on the plane. During takeoff and landing, have your child suck on a pacifier, drink fluids, or chew gum. Swallowing often will help to equalize the pressure in the ears.

Follow-up appointment

Once your child finishes the antibiotic, you may want to make an appointment to see your child’s doctor. The doctor will make sure the infection is gone. If the infection caused a hole in the eardrum, the doctor can check to see if it has healed. The hole usually heals within a week or so. Your doctor may refer your child for a hearing test, if needed.

How to prevent ear infections

The following suggestions may help protect your child from ear infections:

  • Colds can lead to ear infections. Try to keep your child away from people with colds, especially before your child is 1 year old. For young children with frequent illnesses and repeated ear infections, you may want to avoid large day care centres during your child’s first year. Consider having a sitter watch your child in your home or at a small home-based day care.
  • Wash hands and your child's toys often.
  • By preventing influenza infections, the flu shot may prevent some ear infections, especially in children over 2 years old. Talk to your child's doctor about getting a yearly flu shot.
  • Protect your child from second-hand tobacco smoke. Exposure to tobacco smoke can increase the number of infections.
  • Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk may reduce the rate of ear infections.
  • If you bottle-feed, hold your baby with his head up. Feeding your baby while he is lying flat can make formula and other fluids flow back into the eustachian tube.
  • Using a pacifier (soother) may increase the risk of repeated ear infections. If your child has had an ear infection, try phasing out the use of a pacifier.
  • If your child has a continuous runny nose, an allergy could be contributing to the infections, especially if he has other allergies or eczema. Talk to your child’s doctor if you think your child may have allergies.
  • If your toddler snores or breathes through his mouth, he may have large adenoids. Large adenoids increase the risk of ear infections. Your family doctor can refer your child to a specialist to check his adenoids if necessary.

When to contact your child’s doctor

Call your child’s doctor if:

  • your child’s fever or pain is not better after he has taken an antibiotic for 48 hours
  • there is fluid always draining from his ear
  • you are concerned about your child’s hearing

Take your child to the nearest Emergency Department if:

  • the pain gets worse, even after your child takes pain medicine
  • your child's neck gets painful or stiff
  • your child seems lethargic (sleepy) or very irritable (cranky)
  • your child is vomiting (throwing up) repeatedly and cannot keep down enough fluids or the medicines
  • your child has redness and swelling behind his ear, or his ear seems to be sticking out
  • your child develops a rash, puffy face, or puffy lips while taking the antibiotic

Key points

  • Otitis media is an infection of the middle ear.
  • The infection can be caused by bacteria or viruses.
  • Give pain and fever medicine as needed.
  • Your child might need antibiotics for the infection.
  • Following a few tips may help prevent ear infections.

Trent Mizzi, BSc, MD, FRCPC

Bruce G. Minnes, BSc, MD, FRCPC, ABPEM

10/16/2009




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