There are many types of ear infections including external ear canal infections (“otitis externa”), middle ear infections (“otitis media”) and inner ear infections (“labyrinthitis” or “vestibular neuritis”). Inner ear infections are extremely rare in children so will not be discussed here.
Otitis Externa (“Swimmer’s Ear”)
An infection of the ear canal is call otitis externa and is also known as “swimmer’s ear” because it most commonly occurs after water exposure and stagnant water in the ear canal. This allows bacteria to grow and produce an infection. Usually the child will experience severe pain, swelling, and pus-like drainage from the ear. It is most commonly treated with antibiotic eardrops, keeping the ear dry, and having the ear suctioned in the office. In severe cases, your child may need an otowick placed in the ear for a few days to keep the swollen canal open to allow the eardrops to penetrate into the canal. While otitis external may occur sporadically, it may be prevented by using earplugs or drying the ear out immediately after leaving the water. The ear canal can be dried out by using tissue formed into a spear wick, a blow dryer over the canal, or the use of alcohol based drops that are sold at the pharmacy.
Word of caution: DO NOT use these alcohol based drops if your child has eartubes! It will sting!
Otitis Media
A middle ear infection or “otitis media” is the most common type of ear infection in children and is the most common reason why kids visit a pediatric ENT surgeon.
Middle ear infections most often start with an upper respiratory infection, or common cold. The bacteria or virus in the back of the nose can cause infection to travel and grow in the middle ear via the Eustachian tube, which is a tube that connects the back of our nose to our middle ear space. This tube is responsible for equalizing air pressure between our middle ear space and the outside environment. When air can’t freely pass between the middle ear and back of the nose, and there is poor middle ear ventilation, then an infection can occur in the middle ear with bacteria or viral pathogens.
Young children usually under the age of 5 are prone to middle ear infections because their Eustachian tubes are not well developed anatomically and thus don’t function properly. As a result, when they get an upper respiratory infection and are congested, fluid can get trapped in the middle ear and they can get an ear infection. Because their immune systems are new to the environment, kids tend to catch many colds and thus prone to many ear infections. This is why children in daycare tend to get more ear infections, because they are exposed to many viruses and bacteria from other kids and surfaces. Severe allergies in older kids may also cause middle ear infections but this is not a common cause in the younger ones. 1
Most middle ear infections present with ear pain, fussiness, fever, poor appetite, hearing impairment or hardly any symptoms at all. On exam, your doctor may see a red, bulging eardrum. They are often initially treated with antibiotics for a suspected bacterial infection. Interestingly, most middle ear infections (over 90%) are actually viral and not bacterial! Antibiotics are still given for a few reasons. In the chance that the infection is bacterial, we don’t want miss treating it since it could lead to a complication like a perforated eardrum or mastoiditis (infection in the bone behind the ear). Additionally, there is evidence that despite an infection being viral, antibiotics may reduce the duration of the ear infection and reduce symptom severity, often by having an anti-inflammatory effect.
If your child has had one of the following you will likely need to visit a pediatric ENT:
- At least 3 episodes of otitis media in 6 months or 4 or more in a year
- Requiring 3 or more antibiotics for the same infection
- Persistent fluid in the middle ear causing hearing impairment for at least 3 months
- Intolerance to antibiotics
- Speech delay and/or persistent hearing impairment from the ear infections and fluid.
These are the indications for placing eartubes in the eardrum. This procedure is called a “bilateral myringotomy and tympanostomy tube insertion.” Click here to learn more about ear tube surgery.