Ear Infections Fact & Fiction

Ear infections, also known as otitis media, are one of the most commonly diagnosed illnesses in children.  In fact, about 50 percent of children have at least one ear infection by age 1 and that number jumps to 80 percent by the third birthday.  Concerned parents often have questions about how to approach their child’s ear health.  This article will address some facts and also some myths about ear infections. Unless otherwise stated, the ear infections discussed here are middle ear infections (otitis = ear, media = middle), not to be confused with external or outer ear infections, sometimes referred to as swimmer’s ear or otitis externa.

1. “If there is no fever, it’s not an ear infection.”

FICTION. There are several symptoms that can accompany an ear infection, but they need not all be present.  Fever, decreased appetite, trouble sleeping, fussiness, and ear pain are some of the most common symptoms.  Pulling or tugging at the ears in a non-verbal infant or toddler can represent pain, but may be associated with teething, self-soothing behavior, or simply exploring body parts.

2. “Some children are more susceptible to ear infections.”

FACT. Ear infections result from a combination of infection and anatomy.  Most ear infections develop following a viral cold infection.  The eustachian tubes, which run from each middle ear to the back of the throat, help drain secretions from the middle ear.  These tubes become inflamed and swollen during a cold infection and result in build up of fluid that can become infected with viruses or bacteria.

Children, in general, are more prone to ear infections because their eustachian tubes are more narrow and horizontal, resulting in more fluid accumulation.  Some children have large adenoids, which sit at the base of the eustachian tubes and prevent them from functioning well.  Others have seasonal or chronic allergies that become a risk factor.

3. “All ear infections need to be treated with antibiotics.”

FICTION. In recent years, new guidelines have recommended using the “watch and wait” approach for certain patients with ear infections.  This recommendation was issued for a few reasons.  Up to 40 percent of ear infections are caused by viruses and are not cured with antibiotics, but rather with the body’s own defenses.  The remaining 60 percent of infections caused by bacteria often get better without antibiotics, too.  There is no way to tell by looking in the ear which infections are viral versus bacterial.  With the growing bacterial resistance problem and low complication rate for ear infections, it is suggested that symptoms of pain and fever are treated with acetaminophen or ibuprofen while giving the child’s immune system an opportunity to fight off the infection.  If things don’t improve within 48-72 hours, antibiotics should be prescribed.  You can discuss with your doctor when this approach is appropriate.

4. “I shouldn’t use cotton swabs in my child’s ears to clean them.”

FACT. Ear wax, or cerumen, serve a protective role for your external ear canal by trapping dust and microorganisms.  It also provides a waterproof barrier to prevent infections like swimmer’s ear.  For this reason, wax should not be cleaned until it is visible and can be wiped away with a moist cloth.  Sometimes, excess wax production will build up in the ear and cause pain or hearing loss.  Your doctor can assist you with removal.  Ear wax has no role in middle ear infections, but watery or pus-like drainage from the ear can indicate swimmer’s ear or a perforated ear drum due to a middle ear infection.

5. “There is nothing I can do as a parent to prevent ear infections.” 

FICTION. There are some risk factors associated with ear infections that can be reduced.  Secondhand smoke is associated with an increased risk of ear infections and many other childhood illnesses.  Quitting can be very beneficial to your child’s health.  Studies show that breastfed infants have less ear infections than formula fed infants.  In addition, staying up to date on vaccines is another important step in risk reduction.  Among the bacterial causes of ear infection, Streptococcus pneumoniae and Haemophilus influenza are the most common organisms.  The routine vaccines given during the first year of life provide protection from these bacteria.

If your child experiences recurrent or persistent infections, your doctor will instruct you on the appropriate time to visit an otolaryngologist (ear, nose, and throat doctor) for further management.