Childhood Ear Infections Explained
Ear infections happen when there is inflammation usually from trapped bacteriain the middle ear, the part of the ear connects to the back of the nose and throat. The most common type of ear infection is otitis media, which results when fluid builds up behind the eardrum and parts of the middle ear become infected and swollen.
If your child has a sore throat, cold, or an upper respiratory infection, bacteria can spread to the middle ear through the eustachian tubes . In response to the infection, fluid builds up behind the eardrum.
Children are more likely to suffer from ear infections than adults for two reasons:
- Their immune systems are underdeveloped and less equipped to fight off infections.
- Their eustachian tubes are smaller and more horizontal, which makes it more difficult for fluid to drain out of the ear.
“In some cases, fluid remains trapped in the middle ear for a long time, or returns repeatedly, even when there’s no infection,” Tunkel explains.
When Is Treatment With Antibiotics Necessary For An Ear Infection
If your child is in a lot of pain, and the symptoms last more than a few days, your pediatrician will likely recommend a round of antibiotics. According to the AAFP, here are some of the circumstances where antibiotics are likely to be prescribed for an ear infection:
- Infants six months or younger.
- Babies ages six months to two years, who have moderate to severe ear pain.
- Children 2 years or older who have a fever of 102.2 or higher.
- Children with another condition that could make an infection harder to heal, including cleft palate, Down syndrome, immune disorders and cochlear implants.
Natural Ear Infection Remedies
Are you struggling with symptoms of an ear infection and wondering how to cure an ear infection fast? Ear infections, whether they afflict adults or more commonly children, can be really unpleasant and outright painful.
Ear infections can be in the outer, middle or inner ear. For this article, Im going to focus on the most common type of ear infection, which is an infection of the middle ear.
According to the CDC, middle ear infections, may not need antibiotics in many cases because the bodys immune system can fight off the infection without help from antibiotics and a mild case often will get better on its own without antibiotic treatment, so your health care professional may recommend watchful waiting before prescribing antibiotics to you or your loved one.
So even conventional medicine agrees that antibiotics are often not the way to go, which means its time to talk about natural ear infection treatment and ear infection pain relief.
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Ear Infection Home Treatments And Remedies
Ear infections can occur in the outer ear , middle ear , and inner ear . Natural and home remedies to treat pain include:
- Over-the-counter pain relievers like ibuprofen and acetaminophen
- Applying a warm compress on the infected ear.
- Applying naturopathic ear drops with ginger, tea tree, or olive oil may help with pain and inflammation.
Talk with your doctor or pediatrician before using any herbal or naturopathic medicine for ear infections.
Home Remedies For Ear Pain
Before antibiotics, parents used home remedies to treat the pain of ear infections. Now, with current concern over antibiotic overuse, many of these simple remedies are again popular:
- Parents can press a warm water bottle or warm bag of salt against the ear. Such old-fashioned remedies may help to ease ear pain.
- Due to the high risk of burns, ear candles should not be used to remove wax from ears. These candles are not safe or effective for treatment of ear infections or other ear conditions.
- Researchers are studying the protective value of probiotics especially lactobacilli strains such as acidophilus. But it is important not to give your child any herbal remedies or dietary supplements without consulting with the pediatrician.
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Check If It’s An Ear Infection
The symptoms of an ear infection usually start quickly and include:
- discharge running out of the ear
- a feeling of pressure or fullness inside the ear
- itching and irritation in and around the ear
- scaly skin in and around the ear
Young children and babies with an ear infection may also:
- rub or pull their ear
- not react to some sounds
- be irritable or restless
- be off their food
- keep losing their balance
Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week.Differences between middle and outer ear infections
|Inner ear infection||Middle ear infection||Outer ear infection|
|Can affect both children and adults||Usually affects children||Usually affects adults aged 45 to 75|
|Caused by viral or bacterial infections||Caused by viruses like colds and flu||Caused by something irritating the ear canal, such as eczema, water or wearing earplugs|
|Affects parts of the inner ear like the labyrinth and vestibular system, and can lead to labyrinthitis||Affects the eustachian tube, which connects the middle ear to the back of the nose||Affects the ear canal|
When Should I Return To My Healthcare Provider For A Follow
Your healthcare provider will let you know when you need to return for a follow-up visit. At that visit, you or your childs eardrum will be examined to be certain that the infection is going away. Your healthcare provider may also want to test you or your child’s hearing.
Follow-up exams are very important, especially if the infection has caused a hole in the eardrum.
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About Middle Ear Infections
Otitis media is an infection of the middle ear that causes inflammation and a build-up of fluid behind the eardrum.
Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.
It’s estimated that around one in every four children experience at least one middle ear infection by the time they’re 10 years old.
When You Need Themand When You Dont
Many children get ear infections. The infections are usually in the middle ear behind the eardrum. They may be caused by bacteria or by a virus. Doctors often treat bacterial infections with antibiotics. Antibiotics are strong medicines that kill bacteria.
Infants and some babies and children do need antibiotics.
But using antibiotics too often can be harmful. Heres why:
In most cases, antibiotics are not needed.
- They do not work for ear infections caused by viruses.
- They do not help the pain.
- Usually, viral infections and many bacterial infections go away on their own in two to three days, especially in children who are over two years old.
First, call the doctor and treat the pain.
If you suspect your child has an ear infection, you should call the doctors office and describe the symptoms. Usually, your doctor should ask you to wait a few days before bringing your child in.
The main sign of an ear infection is pain, especially on the first day. Or, a child may have a fever.
Start by giving your child an over-the-counter pain reliever, such as:
- acetaminophen .
- ibuprofen .
Antibiotics do not relieve pain in the first 24 hours. They only have a small effect on pain after that. So, pain relievers are an important treatment, and usually they are the only treatment needed.
When is treatment with antibiotics needed?If the infection is very painful and lasts more than a few days, chances are it is a bacterial infection.
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Ear Infection Treatment: Antibiotics
Sometimes ear infections resolve without any specific treatment. Some ear infections are caused by viruses, and antibiotics are only effective against bacterial infections, not viral infections. It is possible that your doctor may not want to prescribe antibiotics to start. Your doctor will decide if and when antibiotics should be used.
Cause Of Ear Infections
- A bacterial infection of the middle ear
- Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
- Blockage results in middle ear fluid .
- If the fluid becomes infected , 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.
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Signs In Young Children
As babies are unable to communicate the source of their discomfort, it can be difficult to tell what’s wrong with them. Signs that a young child might have an ear infection include:
- raised temperature
- pulling, tugging or rubbing their ear
- irritability, poor feeding or restlessness at night
- coughing or a runny nose
- unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness
- loss of balance
Otitis Media: Diagnosis And Treatment
A more recent article on otitis media is available.
This is a corrected version of the article that appeared in print.
KATHRYN M. HARMES, MD R. ALEXANDER BLACKWOOD, MD, PhD HEATHER L. BURROWS, MD, PhD JAMES M. COOKE, MD R. VAN HARRISON, PhD and PETER P. PASSAMANI, MD
University of Michigan Medical School, Ann Arbor, Michigan
Am Fam Physician. 2013 Oct 1 88:435-440.
Otitis media is among the most common issues faced by physicians caring for children. Approximately 80% of children will have at least one episode of acute otitis media , and between 80% and 90% will have at least one episode of otitis media with effusion before school age.1,2 This review of diagnosis and treatment of otitis media is based, in part, on the University of Michigan Health System’s clinical care guideline for otitis media.2
SORT: KEY RECOMMENDATIONS FOR PRACTICE
An AOM diagnosis requires moderate to severe bulging of the tympanic membrane, new onset of otorrhea not caused by otitis externa, or mild bulging of the tympanic membrane associated with recent onset of ear pain or erythema.
AOM = acute otitis media.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
AOM = acute otitis media.
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Observation Vs Antibiotic Therapy
Antibiotic-resistant bacteria remain a major public health challenge. A widely endorsed strategy for improving the management of AOM involves deferring antibiotic therapy in patients least likely to benefit from antibiotics.18 Antibiotics should be routinely prescribed for children with AOM who are six months or older with severe signs or symptoms , and for children younger than two years with bilateral AOM regardless of additional signs or symptoms.8
Among children with mild symptoms, observation may be an option in those six to 23 months of age with unilateral AOM, or in those two years or older with bilateral or unilateral AOM.8,10,19 A large prospective study of this strategy found that two out of three children will recover without antibiotics.20 Recently, the American Academy of Family Physicians recommended not prescribing antibiotics for otitis media in children two to 12 years of age with nonsevere symptoms if observation is a reasonable option.21,22 If observation is chosen, a mechanism must be in place to ensure appropriate treatment if symptoms persist for more than 48 to 72 hours. Strategies include a scheduled follow-up visit or providing patients with a backup antibiotic prescription to be filled only if symptoms persist.8,20,23
Do Ear Infections Always Need To Be Treated With Antibiotics
I see many parents bring their children in to Express Care with ear infections and request antibiotics, but sometimes antibiotics arent the right choice. Most ear infections cure themselves without the help of antibiotics.
Lets first discuss what an ear infection is and other approaches to take. An ear infection is a bacterial or viral infection that affects the ear. It becomes painful when buildups of fluid and inflammation occur in the air-filled space behind the eardrum. Signs and symptoms of infection will quickly show. A great way to tell if your child has an ear infection is if he or she start showing the following symptoms:
- Pain in the ear, especially while lying down
- Pulling or tugging the ear
- Difficulty sleeping
- Difficulty hearing or responding to sounds
- Fever or headache
Generally, an ear infection will improve within the first couple days, and clear up within one to two weeks without any treatment. It is recommended to use the wait-and-see approach for:
- Children age 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature less than 102.2 F
- Children age 2 and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F
Check out these additional tips to reduce the risk of developing ear infections.
Leanna Munoz is a nurse practitioner at Express Care in Eau Claire, Wisconsin.
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Persistent Or Recurrent Aom
Children with persistent, significant AOM symptoms despite at least 48 to 72 hours of antibiotic therapy should be reexamined.8 If a bulging, inflamed tympanic membrane is observed, therapy should be changed to a second-line agent.2 For children initially on amoxicillin, high-dose amoxicillin/clavulanate is recommended.8,10,28
For children with an amoxicillin allergy who do not improve with an oral cephalosporin, intramuscular ceftriaxone, clindamycin, or tympanocentesis may be considered.4,8 If symptoms recur more than one month after the initial diagnosis of AOM, a new and unrelated episode of AOM should be assumed.10 For children with recurrent AOM with middle ear effusion, tympanostomy tubes may be considered to reduce the need for systemic antibiotics in favor of observation, or topical antibiotics for tube otorrhea.8,10 However, tympanostomy tubes may increase the risk of long-term tympanic membrane abnormalities and reduced hearing compared with medical therapy.33 Other strategies may help prevent recurrence .3437
Strategies for Preventing Recurrent Otitis Media
Check for undiagnosed allergies leading to chronic rhinorrhea
Eliminate bottle propping and pacifiers34
Eliminate exposure to passive smoke35
Routinely immunize with the pneumococcal conjugate and influenza vaccines36
Use xylitol gum in appropriate children 37
Information from references 34 through 37.
Strategies for Preventing Recurrent Otitis Media
Information from references 34 through 37.
Antibiotics For Ear Infections
Antibiotics are the first-line therapy for the treatment of ear infections. Ear infections, or as they are also called otitis are the second most common group of diseases after cold, which affects children. Only in the USA, according to the most conservative estimates, more than 25 million visits to physicians are registered because of the otitis every year.
Ear infections may be external, middle and inner. Otitis externa is an inflammation of the ear or ear canal, which occurs due to careless ears cleaning, water ingress, etc. Otitis externa is often accompanied by swelling and acute pain.
Otitis media occurs, when an infection penetrates the middle ear. During the course of the disease, the middle ear secretes a fluid that causes ringing in the ears, severe throbbing pain, and sometimes to eardrum damage.
Internal otitis, or Labyrinthitis is the most serious of all ear infections. The internal otitis may cause partial or complete loss of hearing and balance disorders.
You should buy antibiotics for ear infections, if you observe the following symptoms:
- Fluoroquinolones Ciprofloxacin
- Cephalosporins Cephalexin, Cefdinir
In addition to the four main groups, antibiotics of Tetracyclines group and Lincosamides may also be used for treatment of ear infections.
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What Causes Acute Otitis Media
Acute otitis media usually is caused by one of four bacteria:
The pneumococcus bacteria is now the most difficult to treat. Some strains have become very resistant to antibiotics by using their unique ability to transform their genes and cell wall into a bacterial form, which is resistant to most of the antibiotics that commonly are used to treat ear infections. These resistant strains frequently are cultured from children who do not respond to several courses of antibiotics. When a child has an ear infection that does not respond to antibiotics, resistant pneumococcus bacteria may cause it.
Pneumococcus has 90 different types, which are all genetically related however, 7 types account for the majority of ear infections in childhood and nearly all of the antibiotic resistant strains. In addition, pneumococcus is the leading cause of meningitis, bloodstream infections, and serious pneumonia in children, sometimes as a result of a preceding ear infection.
Up to half of Haemophilus and nearly all Moraxella bacteria produce an enzyme , which makes these bacteria resistant to some of the commonly used antibiotics. This enzyme may destroy many antibiotics when they come in contact with the bacteria. Nonetheless, several available antibiotics are still quite effective against these strains.
Ear Infection Symptoms: Babies
Ear infections aren’t always apparent in babies and children who are too young to describe their pain. They may signify ear pain by pulling on or fussing with their ear. They may just be irritable, or not eating or sleeping well. Babies sometimes refuse to drink from a bottle because swallowing hurts their ears. Ear infection symptoms in babies may include:
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