Ear Infections (Otitis Media)

• An infection of the middle ear (the space behind the eardrum)
• Cause: Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the nose. Blockage results in middle ear fluid (called viral otitis). If the fluid becomes infected (bacterial otitis), the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
• Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
• The onset of ear infections is often on day 3 of a cold.
• How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.

Symptoms

• The main symptom is an earache.
• Younger children will cry, act fussy or have trouble sleeping because of pain.
• About 50% of children with an ear infection will have a fever.
• Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.

Return to School

• An ear infection can't be spread to others. Your child should stay home only until any fever is gone.

1. What You Should Know:
   • Most ear infections are not cured after the first dose of antibiotic.
   • Often, children don't get better the first day.
   • Most children get better slowly over 2 to 3 days.
   • Note: For mild ear infections in older children, antibiotics may not be needed. This is an option if over 2 years old and infection looks viral.
   • Here is some care advice that should help.
2. Keep Giving the Antibiotic:
   • The antibiotic will kill the bacteria that are causing the ear infection.
   • Try not to forget any of the doses.
   • Give the antibiotic until the bottle is empty (or all pills are gone). Reason: To stop the ear infection from flaring up again.
3. Fever:
   • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
   • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
   • For babies, dress lightly. Don't wrap in too many blankets. Reason: Can make the fever higher.
4. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
5. Cold Pack:
   • Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
   • Note: Some children prefer heat for 20 minutes.
   • Caution: A hot or cold pack kept on too long could cause a burn or frostbite.
6. Eardrops:
   • If pain medicine does not help the pain, try eardrops. You can use plain olive oil or mineral oil (baby oil).
   • Use 3 drops every 4 hours.
   • There are also prescription eardrops for pain that you can use. (Same dose). Ask your child's doctor about these during office hours.
   • Caution: Don't use eardrops if has ear tubes or a hole in the eardrum.
7. Limits:
   • Your child can go outside and does not need to cover the ears.
   • Swimming is fine as long as there is no drainage from the ear. Also, do not swim if there is a tear in the eardrum.
   • Air Travel. Children with ear infections can travel safely by aircraft if they are taking antibiotics. For most, flying will not make their ear pain worse.
   • Give your child a dose of ibuprofen 1 hour before take-off. This will help with any pain they might have. Also, during descent (coming down for landing) have your child swallow fluids. Sucking on a pacifier or chewing gum may help as well.
8. Return to School:
   • Your child can go back to school when any fever is gone.
   • Your child should feel well enough to join in normal activities.
   • Ear infections cannot be spread to others.
9. What to Expect:
   • Once on antibiotics, your child will get better in 2 or 3 days.
   • Make sure you give your child the antibiotic as directed.
   • The fever should be gone by 2 days (48 hours).
   • The ear pain should be better by 2 days. It should be gone by 3 days (72 hours).
10. Ear Discharge:
    • If pus is draining from the ear, the eardrum probably has a small tear. This can be normal with an ear infection. Discharge can also occur if your child has ear tubes.
    • The pus may be blood-tinged.
    • Most often, this heals well after the ear infection is treated.
    • Wipe the discharge away as you see it.
    • Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)
11. Call Your Doctor If:
    • Fever lasts more than 2 days on antibiotics
    • Ear pain becomes severe or crying becomes nonstop
    • Ear pain lasts more than 3 days on antibiotics
    • Ear discharge is not better after 3 days on antibiotics
    • Your child becomes worse

1. Brief Hearing Loss:
   • During an ear infection, fluid builds up in the middle ear space.
   • The fluid can cause a mild hearing loss for a short time.
   • It will slowly get better and go away with the antibiotic.
   • The fluid is no longer infected, but sometimes, may take weeks to go away. In 90% of children, it clears up by itself over 1 to 2 months.
   • Permanent harm to the hearing is very rare.
2. Talking With Your Child:
   • Get close to your child and get eye contact.
   • Speak in a louder voice than you usually use.
   • Decrease any background noise from radio or TV while talking with your child.
3. Call Your Doctor If:
   • Hearing loss not better after the antibiotic is done.

1. What You Should Know:
   • Some children have ear infections that keep coming back.
   • If this is your child's case, here are some ways to prevent future ones.
2. Avoid Tobacco Smoke:
   • Contact with tobacco smoke can lead to ear infections.
   • It also makes them harder to treat.
   • No one should smoke around your child. This includes in your home, your car or at child care.
3. Stop Colds:
   • Most ear infections start with a cold. During the first year of life, try to reduce contact with other sick children.
   • Try to put off using a large child care center during the first year. Instead, try using a sitter in your home. Another option might be a small home-based child care.
4. Breastfeed:
   • Breastfeed your baby during the first 6 to 12 months of life.
   • Antibodies in breast milk lower the rate of ear infections.
   • If you breastfeed, continue it.
   • If you do not, think about it with your next child.
5. Do Not Prop the Bottle:
   • During feedings, hold your baby with the head higher than the stomach.
   • Feeding while lying down flat can lead to ear infections. It causes formula to flow back into the middle ear.
   • Having babies hold their own bottle also causes milk to drain into the middle ear.
6. Get All Suggested Vaccines:
   • The pneumococcal shot and the flu shot will protect your child from serious illnesses.
   • The shots also help to prevent some ear infections.
7. Control Allergies:
   • Allergies may lead to some ear infections.
   • If your baby has a constant runny nose and ear infections, suspect an allergy.
   • If your child has other allergies like eczema, ask your child's doctor about this. The doctor can check for a milk protein or soy protein allergy.
8. Check Any Snoring:
   • Large adenoids can cause snoring or mouth breathing. Suspect this if your toddler snores every night or breathes through his mouth.
   • Large adenoids can contribute to ear infections.
   • Talk to your child's doctor about this.

1. Ventilation (PE or Ear) Tubes:
   • Ear tubes are tiny plastic tubes that are put through the eardrum. They are placed by an ENT doctor.
   • The tubes allow fluid to drain out of the middle ear space. They also allow air to re-enter.
   • This lowers the risk of repeated ear infections and returns the hearing to normal.
2. Ear Tubes - When Are They Needed?
   • Fluid has been present in the middle ear nonstop for over 4 months. Both ears have fluid.
   • Also, the fluid has caused a hearing loss greater than 20 decibels.
   • Hearing should be tested first. Some children have nearly normal hearing and tubes are not needed.
   • Ear infections that do not clear up after trying many antibiotics may need tubes.
   • Prevention should be tried before turning to surgery.
   • Talk to your child's doctor about when ear tubes are needed.
3. What to Expect:
   • In most cases, the tubes come out after about a year. They fall out of the ear on their own. This happens with the normal movement of earwax.
   • If the tubes stay in the eardrum for over 2 years, ask your child's doctor. The surgeon may need to take them out.
4. Risks of Ear Tubes:
   • After the tubes come out, they may leave scars on the eardrum. They may also leave a small hole that doesn't heal. Both of these problems can cause a small hearing loss.
   • Because of these possible problems, there is a small risk with ear tubes. There is also a small risk when having to give anesthesia to young children. Therefore, doctors suggest ear tubes only for children who really need them.