- An outer ear infection (“Swimmer’s Ear”) is caused by irritation of the skin inside the ear canal, often caused by moisture from swimming or bathing. Symptoms include ear pain worse with movement of the outside of the ear. These children rarely have cold symptoms or fever. Call during office hours to be evaluated. Treatment includes keeping the ears dry for seven days and using antibiotic ear drops.
- An inner ear infection is caused by bacteria and fluid in the middle ear space, behind the eardrum. It has nothing to do with covering ears outside or submerging in water. Middle ear infections are very common in babies and young children. Ear pain often follows a cold, which causes a dysfunction of the Eustachian tube. The Eustachian tube is a small tube that connects the middle ear to the back of the throat to equalize air pressure and drain fluid from the middle ear space. This tube is short and more horizontal in young children, allowing fluid and bacteria to build in the middle ear space.
Signs of a middle ear infection may include the following: ear pain, fever (not always), irritability—increased when lying flat, night waking, refusal to nurse on one side, crying or pulling away from the breast or bottle, dizziness, popping or plugged sensation, diminished hearing.
Complications: Some children have so much infected fluid buildup behind the ear drum that the ear drum will burst. These children usually feel much better as the pressure is relieved. You may note mucous-like discharge draining from the ear. If drainage occurs, do not put oil in the ear. Call our office during office hours to get a prescription for antibiotic drops for the ear. If a child perforates an eardrum, it usually heals on its own without issues. We always re-check these ears 4-6 weeks after the ear infection.
WHAT TO DO:
Treat pain with Tylenol or Motrin. Warm sweet oil or olive oil dropped in the ear canal may provide comfort. Warmth to the ear is often soothing. Hold the child upright, or have a child sleep in a carseat. (The pain of a middle ear infection throbs more when a child is lying flat.)
WHEN TO CALL:
- If your child is younger than 2 months of age and has a fever 100.5 degrees or higher, call the office or the on call doctor.
- If your child is younger than six months of age, call the office during office hours for an appointment.
- If your child is six months of age or older, treat her pain for 48 hours. If symptoms have not improved after 48 hours, then call the office during office hours to schedule a visit. The majority of children six months of age or older are able to fight off an ear infection on their own, thereby avoiding antibiotics.
- If your child develops a stiff neck or severe headache or acts very sick despite Tylenol or Motrin, call.
Note: It is important to diagnose and document ear infections. Doctors will not call in antibiotics over the phone for presumed ear infections.
- Antibiotics kill bacteria that cause inflammation in the middle ear. If your child’s symptoms have not improved 48 hours after starting antibiotics, call during office hours. The bacteria may be resistant to the antibiotics, and we may need to switch medicine.
- It is normal to have fluid remain in the middle ears for 4-6 weeks following an infection. Children may have decreased hearing, muffled speech, or complain of popping noises. If these symptoms persist longer than six weeks, please call during office hours. Fluid in the ears does not cause pain and would not wake children from sleep.
In addition to simply being young, several factors place children at higher risk for ear infections:
- Protect your child from tobacco smoke. Never smoke in the house or car. Second hand smoke has been linked to increased frequency of middle ear infections.
- Day care centers often expose children to more upper respiratory infections, leading to more ear infections.
- Breastfeed your baby during the first 6-12 months of age. Breastfed babies have a lower incidence of ear infections.
- Avoid bottle propping. Feeding in the horizontal position can cause a backflow of formula and other secretions into the Eustachian tube.