Dr. Adam Cassis

By Adam Cassis, MD

The recurrence of ear infections is one of the most common reasons for visits to the pediatrician, urgent care, or emergency room, as well as for referrals to ear, nose, and throat (ENT) specialists. Parents often have questions about what causes ear infections in children and how they are treated.

What is an ear infection?

The scientific term for an ear infection is otitis media, an inflammation and/or infection of the middle ear – the space behind the ear drum. The middle ear is between the ear canal and the inner ear.

Is this what is called “swimmer’s ear”?

No. Swimmer’s ear is an inflammation of the external ear, or the ear canal, and not the middle ear.

How do I know if my child has an ear infection?
Symptoms vary between patients, but sometimes can be non-specific. Often times, ear infections start after an upper respiratory infection, but not always. Typical symptoms include pain, fussiness, fever, pulling at the ear, drainage from the ear (not ear wax), imbalance, and hearing loss. Some patients may display most of these symptoms, but some will have little to no symptoms at all. Ear fluid or infection are sometimes found during routine well child checks.

Why do children, especially babies and toddlers, get ear infections so frequently? Is there a cause?
Ear infections are very common in young children. In fact, it is uncommon for a child to go without an ear infection when they are young. Most children will have a hand full of infections, but they never become problematic.

Some children, however, have recurrent infections that do become problematic. In this case, the culprit tends to be the Eustachian tube, an anatomic structure than travels from the back of the nose – also called the nasopharynx – to the middle ear. The Eustachian tube’s job is to equalize pressure in the middle ear space; this happens when muscles attached to the tube function, usually by yawning or swallowing. Poor Eustachian tube function leads to pressure buildup, fluid accumulation, and sometimes infection.

In children, the Eustachian tube has not developed enough to properly function. This may cause issues until the Eustachian tube is fully developed. Enlarged or chronically inflamed adenoids, located in the nasopharynx, may impact the Eustachian tube. Environmental allergies and acid reflux may have an impact, but that is controversial.

Why do ear infections recur?
Until the Eustachian tube is fully developed, children tend to be prone to ear infections. This will improve as the child grows. Sometimes children have underlying issues that need addressing; these include chronic sinusitis and allergies. In rare circumstances, a child may have an immune deficiency that causes recurrent ear infections.

How are ear infections treated?
The majority of ear infections will actually resolve on their own. When they do not, antibiotics are commonly prescribed. When the ear infections become recurrent, ear tubes may be considered.

What are ear tubes?
Ear tubes are tiny tubes placed into the ear drum to prevent ear infections. Also known as ventilation tubes, tympanostomy tubes, or pressure equalization tubes, they work by equalizing the pressure behind the ear drum. An inner and outer flange hold them in place. The most popular style of tube looks like a grommet with a hole in the middle.

How many ear infections should prompt a referral to an ear, nose, and throat surgeon?
If a child has three ear infections in six months, four in a year, or a chronic infection lasting two to three months, he or she should be referred to an ENT surgeon, also known as an otolaryngologist.

What are the benefits of tubes?
Tubes help decrease the incidence of ear infections by preventing pressure and fluid buildup behind the ear drum. They also make treating ear infections much easier.

How are ear tubes placed?
In children, placing tubes requires a brief general anesthetic. This is because the procedure requires the use of a microscope, and the patient must be absolutely still. The procedure itself is very quick, and after a short wake up time, the child and family are discharged from the hospital.

What do I need to know now that my child has tubes?
Children with tubes should prevent water going into their ears by wearing ear plugs for bath time and swimming. Recently, there is evidence that this is not absolutely necessary when the water is not grossly contaminated, such as bath water and swimming pools. This is left up to the surgeon and the family.

When children have tubes, ear infections usually occur as drainage from the ears. Antibiotic drops are prescribed to clear the infection when it occurs.

Tubes usually fall out of the ear drum after about a year or so. Parents and children often do not see the tubes when they do – they are tiny! The primary care doctor or otolaryngologist will let you know when the tubes are out.

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