Ear Infections

Ear pain is one of the top reasons for visits to the pediatrician. Ear infections (middle ear infections) are especially common in younger children (less than 2 years of age), children exposed to cigarette smoke, and children who attend daycare.

There are two kinds of ear infections: middle ear infections, and outer ear infections (sometimes called "Swimmer's Ear")

How do children get middle ear infections?

Middle ear infections come from the inside out. The inner ear canal (eustachian tube) connects to the back of the throat (pharynx). When a child is congested either from a cold or allergies, the draining mucous sometimes moves up the inner ear canal until it reaches the middle ear or the inside of the ear drum. This dark moist setting creates an ideal environment for bacteria to grow. It is this bacteria that can usually be killed with antibiotics by mouth.

How do children get outer ear infections?

Outer ear infections are usually caused by water in the external ear canal. This can come from swimming, hot tubs, or even the bath tub or shower. Water remains in the canal creating a moist environment for bacteria to grow.

How are ear infections treated?

Middle ear infections are treated with oral (by mouth) antibiotics or in cases of chronic infections, ear tubes. Outer ear infections are treated with antibiotic drops.

Does ear wax cause ear infections?

Certainly not! The only time that ear wax is a problem is when the physician is trying to see the ear drum.

Does playing with the ears mean a child has an ear infection?

There is very poor correlation between playing or rubbing of the ears and ear infections. There are many reasons small children play with their ears; there may be wax there, there may be a small amount of fluid, there may be an ear infection, or there may be no discernable reason at all. The only way to be sure is to have a qualified physician take a look.

What is the use of a re-check if my child is acting better?

It is important to reevaluate all ears after an infection. Sometimes there is no outward symptoms of a persistent ear infection. It is important to know if fluid still remains in the middle ear. It is important to know that an ear infection has resolved so that if the child comes back with similar complaints in the future, it will be clear if it is a new infection or the initial infection never completely cleared.

What does "there is still a little bit of fluid there" really mean?

Even when an ear infection is appropriately treated, often times a small amount of fluid will remain for up to one month following the infection. This fluid slowly drains down the inner ear canal. While making the child slightly more at risk for becoming re-infected, this does not necessarily mean that the course of antibiotic should be continued.

Why won't the doctor prescribe antibiotics over the phone?

Quite simply, it is important to make the correct diagnosis before appropriate therapy can be initiated. There are many conditions that seem to present with ear pain. Without a full exam, it is impossible to determine what exactly may be wrong. Treating without the correct diagnosis can be very dangerous. For example, if there is a more serious infection, antibiotics may partially treat that infection and the child may become worse overtime. This also may ultimately make diagnosis much more difficult.

JDMD 12/24/00, revised 3/7/01