Ear Infections – What Are They and How to Prevent Them?

“For the last two nights, he keeps waking up at night.  He used to be a wonderful sleeper... I don’t know what’s wrong with him,” reported a tired mom holding an cute infant on her lap.  She wiped his runny nose with a tissue.

Another dad tells me about his toddler daughter, “She’s been congested for over a week, and woke up last night with a fever to 101.  She seems a little better during the day when I give her ibuprofen, but she’s miserable at night.”

"My son woke up this morning and told me that his ear hurt," said another mom about her four-year old.

All of these children have signs of a possible ear infection. 

What is an Ear Infection?  

When doctors refer to an “ear infection,” we are talking about a viral or bacterial infection in the middle ear.  This is a space behind your ear drum that is connected to your nose via your Eustachian tube.  See illustration below.

Fluid is produced in the middle ear space all day long and normally it is not a problem.  However, when our noses get congested, then our Eustachian tubes can become blocked.  Then the tubes do not function to drain the middle ear.  This is especially true with young children and infants because their tubes are much smaller and are more horizontally oriented.    

When fluid builds up in the middle ear, then bacteria and viruses can replicate in the fluid and cause an infection.  If it is a bacterial infection, then antibiotics are needed to treat the infection.  More than 50% of ear infections are caused by viruses and do not require antibiotic treatment.  Your child’s doctor can assess for the possibility of a bacterial infection.  If your child is having significant pain, fever, ear drainage, or other signs of bacterial infection, then your child’s doctor may prescribe antibiotics.

How do you know if your child has an ear infection?

Well, unfortunately, the answer is that you may not know.  The good news is that if your child is not acting sick, has no symptoms other than a cold lasting less than two weeks, then he is unlikely to need antibiotics, so do not worry about missing an ear infection.  Some symptoms of an ear infection that need to be treated are described below.

Pain:  Generally, children experience pain and pressure from the fluid accumulation – so they do not sleep well or complain of pain when they are old enough to talk.  Pulling on the ears is not a good indicator of an ear infection since some infants pull on their ears when they are just tired or when they are teething.

Fever:  Many children have fevers with their ear infections.  If your child has a fever after having a cold for several days, then he may have developed a secondary infection, such as an ear infection.  Take your child to the doctor to be checked. 

Congestion/Cold:  Since the fluid builds up because the drainage system or Eustachian tube is not functioning, then your child is more at risk for an ear infection when she has been congested for several days.  If your baby is fussy or has a fever after having a cold for several days to weeks, it may be an ear infection.

Ear Drainage:  If you see drainage of fluid from your child’s ear, then the eardrum may have ruptured from the pressure.  While this sounds horrible, your child will probably experience relief since there is less pain.  In general, small ruptures of the eardrum heal well.  However, the infection still needs to be treated, so see your child’s doctor.

How can I prevent my child from getting an ear infection?

Focusing on the nasal congestion is one of the best ways to prevent the fluid from building up and getting infected.  Nasal saline works well for all ages.  For younger children, help to clear their noses by putting a few drops of nasal saline in each nostril and then cleaning the nose using a bulb suction device.  For older children, spray or drop the nasal saline into their nostrils and then have them blow their noses.  Running a humidifier (cool or warm) in your child’s room will also help with the congestion.  If the congestion is from allergies, treating the allergies with antihistamines may be appropriate depending on your child’s age. 

Some children are more prone to ear infections due to their anatomy.  Unfortunately, these children will get ear infections despite their parents’ best efforts to keep their noses clear.  If your child has multiple ear infections in a year (usually 5 or 6 episodes), then your child’s doctor may recommend myringotomy or PE tubes to prevent recurrent infections.

Stay healthy, and thanks for reading!