Monday, Feb. 22, 2016 | 2 a.m.
After the common cold, ear infections are the most frequently diagnosed childhood illness in the United States. Most children will have had at least one ear infection by the time they’re 3 years old. A good number of children suffer many more.
What causes ear infections? And can they be prevented?
How can I tell if my child has an ear infection?
Anatomy of an ear
• The outer ear, also called the pinna, includes the curved flap of the ear that leads down to the earlobe and the ear canal, which begins at the opening of the ear and extends to the eardrum.
• The eardrum is a membrane that separates the outer ear from the middle ear. In an infected ear, the ear drum typically appears red and bulging with pus. However, a fever, heavy crying and other conditions also can make an ear drum appear red.
• The malleus, incus and stapes are three tiny bones in the middle ear that transmit sound vibrations from the eardrum to the inner ear. The bones are surrounded by air.
• The middle ear, where ear infections occur, is between the eardrum and the inner ear.
• The inner ear contains the labyrinth, which helps people keep balance.
• The cochlea, part of the labyrinth, is a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals.
• The auditory nerve carries the signals from the cochlea to the brain.
• Adenoids are small pads of tissue behind the back of the nose, above the throat. Adenoids are made up mostly of immune system cells and fight infection by trapping bacteria that enter through the mouth. But bacteria can get trapped there, which can cause a chronic infection that can pass to the eustachian tubes and the middle ear.
• The eustachian tube is a small passageway that connects the upper throat to the middle ear. Its job is to supply fresh air to the middle ear, drain fluid and keep air pressure at a steady level between the nose and the ear. Eustachian tubes are smaller, shorter and more horizontal in children than in adults. This makes it difficult for fluid to drain out of the ear, even when the child is healthy. If the eustachian tubes become swollen or blocked with mucus because of a cold or other respiratory illness, fluid may not be able to drain.
Most ear infections hit children before they can talk. If your child isn’t old enough to say, “My ear hurts,” look for these symptoms:
• Tugging or pulling at the ear(s)
• Fussiness and crying
• Trouble sleeping
• Fever, especially in infants and younger children
• Fluid draining from the ear
• Clumsiness or problems with balance
• Trouble hearing or responding to quiet sounds
Can ear infections be prevented?
To some degree. The best way to prevent ear infections is to reduce the risk factors associated with them.
• Vaccinate your child against the flu every year. Studies have shown that vaccinated children get far fewer ear infections, especially if the child is in daycare.
• Wash hands frequently. Washing hands prevents the spread of germs and can help prevent your child from catching a cold or the flu.
• Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers get more ear infections.
• Never put your baby to sleep with a bottle.
• Don’t allow sick children to spend time together. Limit your child’s exposure to other children when your child or your child’s playmates are sick.
What causes an ear infection?
An ear infection is an inflammation of the middle ear, typically caused by bacteria, that occurs when fluid builds behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. In fact, 5 of 6 children will have at least one ear infection by their third birthday.
The scientific name for an ear infection is otitis media. There are three main types of ear infections.
1. Acute otitis media is the most common. Parts of the middle ear become infected and swell, and fluid gets trapped behind the eardrum. This typically causes an earache.
2. Otitis media with effusion occurs after an ear infection has run its course but fluid remains trapped behind the eardrum. The child may have no symptoms, but with a special instrument, a doctor will be able to see the fluid behind the eardrum.
3. Chronic otitis media with effusion occurs when fluid remains in the middle ear for a long time or returns repeatedly, even though there is no infection. This condition makes it harder for children to fight new infections and can affect their hearing and speech development.
How ear infections are treated
AT THE DOCTOR:
• Many doctors prescribe an antibiotic, such as amoxicillin, to be taken for seven to 10 days. However, ear infections are becoming increasingly difficult to treat as the bacteria responsible for them become antibiotic-resistant.
• The child’s doctor also may recommend over-the-counter pain relievers such as acetaminophen, ibuprofen or eardrops, to help with fever and pain.
• If the infections become chronic and antibiotics don’t help, many doctors will recommend a surgical procedure commonly referred to as ear tubes to improve airflow and prevent fluid backup in the middle ear.
• If a doctor isn’t able to definitively diagnose an ear infection and your child doesn’t have severe ear pain or a fever, the doctor may ask you to wait a day or two. Sometimes ear pain isn’t caused by infection, and some ear infections may get better without antibiotics.
• The American Academy of Pediatrics encourages doctors to observe and closely follow children with possible ear infections that can’t be definitively diagnosed, especially between the ages of 6 months and 2 years. If there’s no improvement within 48 to 72 hours from when symptoms began, guidelines recommend doctors start antibiotic therapy.
AFTER STARTING TREATMENT:
• Even though your child may seem better after a few days on antibiotics, the infection hasn’t completely cleared, and stopping medicine too soon could allow it to return. It’s also important to schedule a follow-up visit with the pediatrician, so the doctor can check to see if the infection is gone.
• Once the infection clears, fluid may remain in the child’s middle ear but typically dissipates within three to six weeks.
How an ear infection affects hearing
Having fluid in your middle ear feels like you are wearing ear plugs. The average hearing loss in ears with fluid is 24 decibels, equivalent to the sound of a very soft whisper. Thicker fluid, however, can cause as much as 45 decibels of hearing loss, equivalent to the sound of conversational speech.
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