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Ear Infections in Children

Ear Infections in Children

The ear is home to our body’s smallest bones and structures. In part, it is due to its narrow canals and tiny spaces that this area is often the sight of infection, pressure, and discomfort when we are sick. While ear infections are common, children are especially susceptible to infection as their anatomy is even smaller than adults.

Ear infection in babies is often a symptom of an ongoing illness in your child. And, while it may be difficult for them to verbalize their discomfort, an earache can be very painful and sensitive. This article will address ear infection in babies through a basic description of the ear’s anatomy, various types of possible infant ear infections, baby ear infection symptoms, treatment, and prevention.

Anatomy of the Ear

The ear of a child is comprised of inner, middle, and outer regions.

  • Outer Ear – This is the region of the ear that consists of the visible structures such as the auricle. The auricle is most likely what you think of when you hear the word “ear”; however, the outer ear also includes the ear canal. The ear canal ends at the eardrum (tympanic membrane) and is air-filled.
  • Middle Ear – This is the section of the ear that begins behind the eardrum and consists of an air-filled space called the tympanic cavity and small bones called the ossicles: the malleus (hammer), incus (anvil), and stapes (stirrup). Important structures called the Eustachian tubes are connected to the middle ear and allow for accumulated fluid to drain to the back of the sinuses. This structural design helps to relieve middle ear fluid pressure and prevent inflammation. At the base of the Eustachian tubes, within the nasal passages, are the adenoids. The adenoids are small glands at the back of the throat that during childhood and early adolescence help fight infections. The adenoids commonly shrink during adolescence and by adulthood disappear.
  • Inner Ear (or, “bony labyrinth”) – This region of the ear contains the sensory organs for hearing and vestibular sense (our sense of balance and spatial orientation). The bony labyrinth contains three different components: the vestibule, cochlea, and semicircular canals. The vestibule is the central part of the inner labyrinth. It houses the saccule and utricle which respond to changes in the position of a child’s head in relation to position and gravity. The cochlea is a bony structure that is fluid-filled and is the organ that we use to hear. The semicircular canals are the portion of the ear that is involved in a child’s balancing system. The inner ear is positioned such that it is unable to be viewed externally.

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What is an Ear Infection?

A baby ear infection is medically referred to as otitis. Otitis typically occurs most often in the ear canal or in the middle ear, but rarely it is present in the inner ear. Depending on where they are located the symptoms and treatment can be different. In general, an ear infection is inflamed tissue caused by a bacterial or viral infection often from another illness like a cold, allergies or the flu. This inflammation causes congestion and swelling of the nasal passages, throat and Eustachian tubes.

The Eustachian tubes work to regulate air pressure in the middle ear and help to drain normal secretions. When an illness causes swelling, inflammation and mucus in the nasal passages the Eustachian tubes can become easily blocked. The accumulation of fluid in the inner ear does not allow the secretions of the middle ear to drain as well causing increased pressure to bulge the tympanic membrane. Consequently, this fluid and pressure creates a perfect environment for bacteria to grow and causing surrounding tissues to become irritated and painful.

Why do Children have More Ear Infections than Adults?

The reason that children typically have more ear infections than adults is two-fold. First, children’s ears have narrower Eustachian tubes that can prevent fluid from draining as easily into the back of the nasal passages, which increases the likelihood of the Eustachian tubes clogging. Second, as mentioned above, children also have adenoids which is the tissue located at the back of the nasal passage. Because the adenoids help fight-off infection in infants and children, they are prone to inflammation and enlargement which blocks the Eustachian tubes from fully draining into the back of the throat. This inability of the Eustachian tubes to drain causes fluid to accumulate in the middle ear, making it an ideal place for infection to take hold.

It is important to note that while we focus in this article on ear infections caused by bacteria or viral infections, ear infections in toddlers especially could be caused by damage to the ear through physical injury like scraping the ear canal with an object, or having a foreign object logged in the ear canal. Once injured, the area can become infected and inflamed causing sensitivity, irritation, and inflammation in that part of the ear canal or outer ear.

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Types of Ear Infections in Babies

Depending on what area of the ear is inflamed, ear infections have different names, associated symptoms, and treatment plans. Outer ear infections are medically called Acute Otitis Externa and Swimmers Ear commonly. This can be a very painful infection and can occur when the skin of the ear canal becomes infected and swollen. There are two different types of middle ear infections referred to scientifically as Otitis Media:

  • Otitis Media with Effusion is when fluid pressure builds in the middle ear behind the tympanic membrane (eardrum) causing it to bulge without any other signs or symptoms of infection.
  • Acute Otitis Media is when fluid pressure builds in the middle ear and is associated with other signs of infection either by bacteria or viruses.
    In rare circumstances the inner ear can become infected. They are often painless and unable to be seen externally, with the primary symptom being vertigo that lasts for a long period of time.

Common Symptoms of Ear Infection in Babies

Ear infections are a normal occurrence, especially in childhood. Common symptoms that indicate your child may be experiencing an ear infection are:

  • Ear pain and tenderness
  • Tugging on the ear
  • Loss of balance
  • Increased crying or irritability
  • Difficulty hearing or responding to sounds
  • Fever of 100.4 F (38 C) or higher
  • Headaches
  • Loss of appetite
  • Drainage of fluid from ear

Treating Infant Ear Infections

Most ear infections will resolve on their own if your child does not have severe ear pain or a fever you may be able to wait a day or two to see if the ear infection improves and goes away. In the meantime, there are some things that you can give your child to soothe their pain like:

  • Warm compresses on their ear for 20 minutes.
  • Acetaminophen (Children’s Tylenol) or Ibuprofen (Children’s Advil)
  • Plenty of rest and fluids. If you are breastfeeding, nursing can be very soothing for your child, as well as, protective against infection.

If your child’s symptoms do not improve in 48 to 72 hours from when their symptoms began, National Institute on Health (NIH) guidelines suggest that doctors start your child on antibiotic therapy. Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over 7-10 days.

Chronic Ear Infection in Babies, Infants, or Toddlers

We still do not completely understand why some children get more ear infections than others. Current research has shown that it could be in part because of bacteria resistance, but more research is needed to fully understand. In general, if your child gets 1 to 2 ear infections in a year this is normal. However, if your baby, infant, or toddler has more than 3 ear infections in 6 months or greater than 4 in a year, it is a good time to seek medical care.

If your child is having upwards of 5 ear infections a year, your doctor may recommend a surgical procedure that places a small ventilation tube at the eardrum to improve ear flow and prevent fluid backup in the middle ear. It is common for these tubes to stay in place for 6-9 months and require your child to have follow-up visits with their pediatrician until the tubs fall out.

In rare cases, if the tubes do not prevent your child from getting ear infections, the doctor may remove the adenoids to prevent infection from spreading to the Eustachian tubes and causing inflammation and infection.

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What Can I do to Prevent my Child from Getting an Ear Infection?

The best way to prevent your child from getting ear infections is to reduce associated risk factors and environmental hazards that encourage bacterial or viral infections. Below are some suggestions that may help lower your child’s risk for infection:

  • Remove secondhand smoke – if you smoke, you may be exposing your child to secondhand smoke which could be contributing to their decreased immunity to fight off a virus and subsequent ear infections. Studies show that children who are exposed to second hand smoke are more likely to have ear infections. If your child continues to get sick, it may be time to talk with a doctor about quitting and ways to keep you and your child healthy.
  • Treat asthma and allergies – If you have a family history of asthma or allergies, it is important for you to go to the doctor and have treatment ready. Asthma and allergies can irritate the nasal passages of your child and cause them to itch their nose more frequently. This can make them more susceptible to infections as they wipe or rub their faces more frequently.
  • Breastfeed your baby – If possible, breastfeed your baby as breast milk contains important antibodies that help to protect your child from infection.
  • Prevent common infections like a sinus infection or flu – Teach your child how to wash their hands properly, and make sure that you and your family wash your hands frequently (e.g. after coming home, using the restroom, and before meals). Instruct your children how to cough properly, such as using the “Dracula method” where you cough into the crook of your elbow. Try and keep your child home when they are sick.
  • Complete all vaccinations – Talk with your doctor about appropriate vaccines for your child. Making sure that your child is up-to-date on their vaccines will help them be protected from getting associated infections and preventing them from having an ear infection.

When to contact a doctor

While a baby’s ear infection may resolve on its own, it is important to receive an accurate diagnosis and prompt treatment if:

  • Your child’s symptoms last for more than a day or two
  • The severity of the pain is worsening
  • Your child is under the age of 6 months
  • Your infant or toddler is sleepless or irritable
  • If you see any discharge of pus or blood from the ear

Seeing a doctor will be important for not only diagnosing what type of ear infection it is (outer, middle, or inner), but how to treat your baby’s specific ear infection. Should any of these non-emergency symptoms arise or if your child may be experiencing an earache, it is very important for you to make an appointment for your child to be examined. Consider making an appointment with your primary care physician or booking online with PlushCare in order to confirm the diagnosis and discuss a treatment plan.

Read more from our Ear Infection Series:

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Ashley Bauman

Ashley Bauman

Ashley is a public health professional who is passionate about creating a healthier society. Her aspiration is to become a doctor and to work in improving overall health as a primary care physician.

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