What Are The Symptoms Of An Ear Infection
There are three main types of ear infections. Each has a different combination of symptoms.
- Acute otitis media is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the earcommonly called an earache. Your child might also have a fever.
- Otitis media with effusion sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument.
- Chronic otitis media with effusion happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.
Most Sinus Infections Dont Require Antibiotics
Ah, . The New England Journal of Medicine published a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.
It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, theres the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.
When To See Your Doctor
See your doctor if your child:
- Is six months of age or younger
- Has a high fever or bad earache
- Has an ear discharge that lasts more than 24 hours
- Continues to have fever or bad earache two days after they start treatment
- Still seems to have trouble hearing after six to eight weeks
- Seems to be getting worse or you are worried at any time.
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Adenoids And/or Tonsil Removal
Adenoid removal or adenoid and tonsil removal may help some children who have repeat ear infections or fluid behind the eardrum. Children younger than 4 dont usually have their adenoids taken out unless they have severe nasal blockage.
As a treatment for chronic ear infections, experts recommend removing adenoids and tonsils only after tubes and antibiotics have failed. Removing adenoids may improve air and fluid flow in nasal passages. This may reduce the chance of fluid collecting in the middle ear, which can lead to infection. When used along with other treatments, removing adenoids can help some children who have repeat ear infections. But taking out the tonsils with the adenoids isnt very helpful.footnote 4 Tonsils are removed if they are frequently infected. Experts dont recommend tonsil removal alone as a treatment for ear infections.footnote 5
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|
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When Are Antibiotics Prescribed
Antibiotics are typically only prescribed to treat AOM and swimmers ear. This is because OME and COME occur after the bacterial infection has passed antibiotics are not effective against the fluid buildup alone.
Your doctor will examine your ear with an otoscope and evaluate your symptoms to determine what type of infection you have and whether antibiotics will be effective. If your symptoms are mild, they may recommend taking a wait-and-see approach. If symptoms dont resolve on their own or if theyre severe, then antibiotics will likely be prescribed.
Why Do Kids Get Ear Infections
Kids get ear infections more than adults do for several reasons:
- Their shorter, more horizontal eustachian tubes let bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower, so more likely to get blocked.
- Their adenoids, gland-like structures at the back of the throat, are larger and can interfere with the opening of the eustachian tubes.
Other things that can put kids at risk include secondhand smoke, bottle-feeding, and being around other kids in childcare. Ear infections are more common in boys than girls.
Ear infections are not contagious, but the colds that sometimes cause them can be. Infections are common during winter weather, when many people get upper respiratory tract infections or colds .
If you care for children, you likely know already how often they come down with earaches. Adults get them, too, but youngsters have them much more often. Thatâs because they donât fight off viruses and bacteria as well, and their little ears arenât good at draining fluids yet.
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What Is An Ear Infection
There are different types of ear infections. Middle ear infection is an infection in the middle ear.
Another condition that affects the middle ear is called otitis media with effusion. It occurs when fluid builds up in the middle ear without being infected and without causing fever, ear pain, or pus build-up in the middle ear.
When the outer ear canal is infected, the condition is called swimmers ear, which is different from a middle ear infection. For more information, visit Swimmers Ear .
Can Ear Infections Be Prevented
Some lifestyle choices can help protect kids from ear infections:
- Breastfeed infants for at least 6 months to help to prevent the development of early episodes of ear infections. If a baby is bottle-fed, hold the baby at an angle instead of lying the child down with the bottle.
- Prevent exposure to secondhand smoke, which can increase the number and severity of ear infections.
- Parents and kids should wash their hands well and often. This is one of the most important ways to stop the spread of germs that can cause colds and, therefore, ear infections.
- Keep children’s immunizations up to date because certain vaccines can help prevent ear infections.
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How To Tell When You Need Antibiotics For An Ear Infection
Earaches are the most common reason why parents bring their children to the doctors. In fact, before the age of three, 5 out of 6 kids will experience an earache.
Because kids ears dont drain as well as adults, it is much more common for kids to get ear infections. But adults can get them as well.
If youre having severe pain in your ear that lasts for days, you may need medical attention. Heres how to tell if you need antibiotics for an ear infection.
Antibiotics For Ear Infections In Children: 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. Health care providers often treat bacterial infections with antibiotics. Antibiotics are strong medications that kill bacteria. Infants and some children do need antibiotics.
But using antibiotics when they are not needed 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 immediately help the pain.
- Usually, viral infections and some bacterial infections go away on their own in two to three days, especially in children who are over two years old.
First, treat the pain and talk to a health care provider.If you think your child has an ear infection, you should speak with a health care provider and describe the symptoms. 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 .
- Do NOT give acetylsalicylic acid or any medicine containing it to children.
Antibiotics do not relieve pain in the first 24 hours. They only have a small effect on pain after that. So, pain relievers may be 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. Sometimes immediate treatment is important.
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Tubes For Recurrent Ear Infections Have Limited Effectiveness And High Risk
For children with chronic ear infections, inserting grommets, or ear tubes, into both ears is common practice. The tubes are meant to help fluid drain from the ears before an infection occurs. But the community is split on how effective they are at preventing future ear infections, especially beyond six months after insertion. Furthermore, even though ear tubes did decrease overall time with ear infections compared to watchful waiting in one study, it increased instances of infection in the opposite ear, ear discharge, and eardrum scarring. These are some pretty severe and uncomfortable side effects.
If you have a child who is experiencing ear infection after ear infection, a bigger underlying health issue is probably present and should be addressed. I would advise trying some of the health-boosting recommendations below before resorting to ear tubes because the research on their effectiveness is mixed, side effects are possible, and any surgery requiring general anesthesia carries its own separate risks. However, some children who already have severe, chronic ear infections may benefit from having tubes inserted while they also work on any underlying health issues.
How Is An Acute Middle Ear Infection Treated
Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain.
If your doctor isnt able to make a definite diagnosis of OM and your child doesnt have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that cant be definitively diagnosed, especially those between the ages of 6 months to 2 years. If theres no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isnt caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics.
If your doctor prescribes an antibiotic, its important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasnt completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. Its also important to return for your childs follow-up visit, so that the doctor can check if the infection is gone.
Who Should Take Oral Antibiotics For Ear Infections
- Children without ear tubes should take oral antibiotics for middle-ear infections, especially when they have severe ear pain or high fever.
- Children with ear tubes should take oral antibiotics if:
- They are very ill.
- They have another reason to be on an antibiotic.
- The infection doesnt go away with eardrops.
But Will It Still Work
In most cases, yes! Thats why the guidelines for treating ear infections changed in 2013.However, each childs situation is unique, and your familys medical provider is the best personto decide how long your child should take an antibiotic for an ear infection. On the other hand, ifyour child is over the age of two and has a non-severe ear infection, it makes sense to ask yourprovider about the possibility of a shorter course of treatment.
As always, talk to your doctor if you have other questions or concerns, and always follow thedirections on your childs medication.
You can read the full AAP clinical practice guideline for treating ear infections here.
If you are a medical provider, please consider taking our 5-minute survey.
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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.
Watchful Waiting: Who Would Do It
Is watchful waiting ready for U.S. prime time? Harvard researcher Jonathan Finkelstein, MD, MPH, and colleagues note that some experts don’t think it’s a good idea, despite the new treatment guidelines.
To see whether watching and waiting might really work for U.S. kids with otitis media, Finkelstein’s team asked more than 2,000 parents and 160 doctors what they thought about holding off antibiotic treatment. Their findings:
- 38% of parents say they’d be satisfied or extremely satisfied with watchful waiting.
- 40% of parents say they’d be unsatisfied or extremely unsatisfied with watchful waiting.
- 38% of doctors say they never or almost never try watchful waiting.
- 39% of doctors say they “occasionally” try watchful waiting.
- 17% of doctors say they “sometimes” try watchful waiting.
- 6% of doctors say they recommend watchful waiting most of the time.
For parents, the results are clear.
“Parental opinions in a community are likely to change as experience with successful treatment of acute otitis media without antibiotics becomes more common,” Finkelstein and colleagues write.
For doctors, it’s not so clear. While there are community-wide benefits such as a reduction in antibiotic resistance, watchful waiting isn’t a very great benefit to an individual patient. Some experts don’t think it’s a good idea at all. And U.S. doctors tend to prefer active treatment over passive waiting.
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Common Types Of Ear Infections
The two most common types of ear infections are in the middle ear or the outer ear.
An infection in the middle ear often follows a cold or respiratory problem. The infection moves to the ears through the eustachian tubes causing them to swell.
Infections in the outer ear sometimes referred to as swimmers ear are usually caused by an outside source such as water. If water sits in the ear for too long, it can cause the skin to break down and become a breeding ground for bacteria.
Seek medical attention immediately if you have nausea, dizziness, or vomiting along with ear pain. You may have a more serious issue with your inner ear.
How Does It Cause Disease
As long as air entering from the back of the nose is able to reach the middle ear space via the eustachian tube, the middle ear rarely becomes infected. The eustachian tube in younger children is flimsy and easily collapses. As the child grows, the cartilage tissue surrounding the eustachian tube becomes stiffer, longer, and more angulated inside the skull.
Pneumococcus, Haemophilus, and Moraxella commonly reside in the back of the nose, and do not infect the child. Once a child becomes infected with a respiratory virus, it not only causes congestion of the nose and the lungs, but also of the eustachian tube. When this tube becomes clogged, the cells in the middle ear space produce a fluid-like substance, which allows bacteria to grow and infect the middle ear space. A virus infection precedes up to 90% of cases of acute otitis media.
Respiratory virus infections also trigger ear infections by upsetting the body’s normal defenses in the nose and the eustachian tube, and allowing certain normal bacteria that reside in the nose to “stick” better to the lining of the nose and the eustachian tube. Certain viruses, such as the flu and RSV , are more frequently associated with ear infections. Occasionally, the child’s nose becomes colonized by a new aggressive strain of bacteria, which rapidly invades the middle ear. Unfortunately, more exposures to viruses and new strains of bacteria increase the likelihood of ear infections.
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