Ear infections and kids: What parents should know  – CHOC

If your child complains of ear pain or discomfort or is seen tugging on their ears following a cold, they may be struggling with otitis media or infection of the middle ear. 

In this Q&A, Dr. Qiu Zhong, an otolaryngologist at CHOC, answers parents’ common questions about the signs, symptoms and treatment of ear infections.

What are middle ear infections?

When we talk about ear infections in children, we’re commonly referring to infections of the middle ear, says Dr. Zhong. Ear infections happen when viruses or bacteria get into the middle ear, the space behind the eardrum.

When a child has a middle ear infection (also called otitis media), the middle ear fills with pus (infected fluid). The pus pushes on the eardrum, which can be very painful.

What are the signs and symptoms of an ear infection in children?

Usually, a middle ear infection starts with an upper respiratory infection. Children may have a runny nose, congestion or cough — all the typical symptoms of a cold. Susceptible children may go on to have middle ear infections after the cold.

Ear pain is the most common sign of an ear infection, but some kids might also have a fever, or have trouble eating, drinking or sleeping. Chewing, sucking, and lying down can cause painful pressure changes in the middle ear.

Older children may be able to tell you that their ears hurt, or they may tug on their ears. But infants who have an ear infection will not be able to tell you that their ear hurts. Their symptoms may include fussiness, fever or changes in behavior with feeding or sleep. In more severe infections, children may have drainage coming out of their ears.

Why do kids more commonly get ear infections than adults?

Most ear infections start with a cold or flu symptoms that lead to a buildup of fluid in the middle ear space. Then, sometimes that fluid can become overgrown with harmful bacteria. Children, especially young children ages 2 to 4 years, are more prone to middle ear infections because of several factors.

First, the eustachian tube, or the drainage pathway that connects the middle ear with the nose, does not function as well in kids as it does in adults. Their shorter, more horizontal eustachian tubes let bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower, and more likely to get blocked.

A cold, acid reflux, or allergies can make the eustachian tubes swell, which blocks the mucus from draining. Then, bacteria grow in the mucus and make pus, which builds up in the middle ear. The fluid accumulates and the bacteria overgrowth leads to an infection.

The second factor making children more prone to middle ear infections is that their immune systems are still developing. A virus that an adult may be able to fight off easily may lead to a more serious infection in a child.

What is the typical treatment for ear infections?

For healthy children, research has shown that ear infections can sometimes resolve on their own even without treatment. Especially in older children, parents may be able to observe them for two to three days. If their symptoms improve, you may not necessarily have to bring them to their pediatrician. Of course, if there’s any doubt, you should always check in with your pediatrician.

For children under six months of age we recommend antibiotic therapy for all acute ear infections and middle ear infections, says Dr. Zhong. Or, if there is no improvement in the infection after 48 to 72 hours, antibiotics are recommended. 

Symptoms that fail to resolve or improve within two to three days after the ear infection develops should raise concern. In addition, persistent fever or alterations in your child’s mental state — such as being more lethargic or not being at their normal level of activity or attention — may be evidence of a more severe infection called acute mastoiditis.

Acute mastoiditis is the infection of the bone behind the ear. In those cases, the ear may pop out a little bit or you may see swelling and redness behind the ear.

If you see any signs of severe infection, you should take your child to the pediatrician or urgent care right away.

How can I help my child’s ear feel better during an infection?

With or without antibiotic treatment, you can help to ease discomfort by giving your child acetaminophen or ibuprofen for pain and fever as needed. Your doctor also may recommend using pain-relieving ear drops as long as the eardrum isn’t ruptured.

How long should ear infections last?

Ear infections with observation and no treatment should last about two to three days. With treatment, you should expect to see improvement in your child within one or two days of taking antibiotics. But the whole course of the infection can last one or two weeks, much like a cold.

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Can an ear infection negatively affect hearing?

An ear infection usually starts with fluid in the middle ear, which can impact the vibration of the eardrum causing conductive hearing loss. Conductive hearing loss is when something — like fluid in the middle ear — blocks sound from getting to the inner ear. Kids with this problem might:

  • Not respond to soft sounds.
  • Need to turn up the TV or radio.
  • Talk louder.
  • Seem inattentive at school.

In most cases, this type of hearing loss is usually temporary. When the infection resolves and that fluid goes away, the hearing should return to normal.

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Can an ear infection cause long-term damage to a child’s hearing?

In the case of a severe ear infection where it may be impacting the inner ear, it can lead to a different type of hearing loss called sensorineural hearing loss.

If the pressure from the fluid buildup gets high enough, it can rupture the eardrum, with fluid draining from the ear. This is a common cause of ruptured eardrums in children. A child with a ruptured eardrum might feel dizzy or nauseated, and have ringing or buzzing in the ear.

A rupture of the eardrum or scarring of the eardrum from infection could cause a hearing loss that doesn’t go away when the infection goes away.

What can you do to reduce your child’s risk of getting an ear infection?

There are a lot of factors that are associated with an increased risk of ear infections. Those risk factors are exposure to secondhand smoke and bottle feeding. If parents can eliminate those risk factors — like having no smokers in the home or secondhand smoke exposure and using a sippy cup instead of a bottle — they can reduce the risk of ear infections for children.

Research also shows that breastfeeding lowers the risk of ear infections, as well as receiving routine childhood vaccinations, like the yearly flu vaccine. Good hygiene is always important — children should be washing their hands frequently, especially after touching their face or blowing their nose.

Learn more about ear infections from Dr. Zhong