Ear Infections

Ear infections are a very frequent, and very unwelcome, presence in the lives of children and their parents. They are so common that five out of every six children will experience at least one ear infection by the time they turn three years old. Every year, around 30 million appointments are made in response to an ear infection, which means they are the most common reason that children are brought into the doctor’s office, other than wellness checkups and vaccinations. But adults are not immune to ear infections either, and they can produce debilitating pain and pressure even in people who probably thought they were safe from the condition.

What is an ear infection?

There are actually three main categories of ear infections. They include:

  1. Otitis media – This is the most common type of ear infection and the one that children suffer from most often. Otitis media refers to an infection of the middle ear, or the space that sits right behind the ear drum. The vast majority of prescriptions filled for ear infections are done to fight otitis media. Otitis media is almost always an acute condition, though it is possible for it to develop into a chronic problem.
  2. Otitis externa – Also known as swimmer’s ear, otitis externa is an infection of the outer portion of the ear canal. It affects older children most often, and adults are more likely to suffer from otitis externa than otitis media. It can also be an acute or chronic condition.
  3. Otitis interna, or labyrinthitis – Labyrinthitis is much less common than otitis media or externa, and involves inflammation of the inner ear. It is associated with more severe symptoms, including vertigo or potential hearing loss. Nausea, vomiting and eye nystagmus (involuntary eye movement) are also associated with the condition. It usually presents as a brief episode or a condition that persists for several weeks.

What are the symptoms of otitis media?

The classic childhood ear infection is marked by ear pain, which can be dull and lasting, or sharp and acute, ear drainage, pressure or fullness in the ear, nausea and reduced hearing. Patients often report that their hearing sounds like it is muffled.

In young children, fever, irritability, restlessness, reduced appetite and serious distress are also common. It’s the distress that usually has parents calling the doctor, and for good reason. Children usually have trouble coping with the symptoms of an ear infection.

Otitis media is usually the result of an upper respiratory infection, including the common cold. Other triggers include allergies, smoke and other environmental hazards. When affected by an upper respiratory infection, the Eustachian tube, which links the middle ear to the throat, is swollen shut. This isolates the middle ear and greatly reduces air flow, producing a warm, moisture environment in the middle ear that is perfect for microbial invaders. If bacteria or viruses access the middle ear at this time, an ear infection is likely.

Who is most at risk of developing otitis media?

In children, the Eustachian tube is underdeveloped, so it is prone to collapsing and swelling shut. This is why some children are plagued with ear infections. When adults develop otitis media, the underlying cause is the same, but the Eustachian tube in adults is more rigid and less susceptible to collapse.

However, some children are at a particular risk of ear infection. This includes:

  • Male children
  • Children who regularly spend time at day care
  • Children who are bottle-fed
  • People with a family history of ear infections
  • People regularly exposed to tobacco smoke
  • People with palate abnormalities or people with poor immune systems and chronic respiratory diseases

Given these risk factors, it’s clear what parents can do to help prevent ear infections. Keep the child away from other sick children, if possible, restrict pacifier or bottle use when the child is lying down and maintain good air quality in the home. Research also shows that children who breastfed for the first 12 months of their life suffer from fewer infections, and children who are immunized also resist ear infections to a greater degree.

How are ear infections treated?

Ear infections are diagnosed using the patient’s recent medical history, symptom profile and a physical examination. During examination, the doctor will check the patient’s ear using an otoscope, and some versions of the otoscope can produce a puff of air to reveal how the eardrum moves in response. If it doesn’t move much, there is likely fluid built up behind the drum. This process can be difficult with a fussy child who is in pain, so prepare to offer comfort and assist with handling the little patient. If hearing loss is suspected, a special test will be needed to confirm.

Treating an ear infection is usually about treating the symptoms. Most infections are caused by viruses, so antibiotics will not normally have an effect on the infection. If, though, bacteria is suspected by the healthcare provider, they won’t hesitate to prescribe one.

Pain relief through the use of over the counter medication is normally recommended, but parents must avoid giving Aspirin to their children, as this can result in a rare and deadly condition known as Reye’s syndrome. Parents can also reduce pain in their children by applying low heat to the outside of the ear via a compress. This is often effective and can keep the child calm and comforted.

If major complications result from an ear infection, the healthcare provider may recommend surgical intervention to allow for better drainage out of the middle ear. This is only necessary when pain is severe, hearing loss is present, or when repeated infections are occurring. During the procedure, a tiny hole is made in the eardrum and a tube is inserted so that fluids and pus can drain out of the ear before they cause problems. The tube stays in the ear for six to 18 months, and will fall out on its own. The procedure is considered extremely safe and can be done while the patient is awake, if they are older. Once the tube comes out, the benefits are usually long-lasting.

Ear infections aren’t fun for the child or the parent. But with physician intervention and a lot of care, it’s normally a short-lived condition without lasting effects.