Recognizing and treating ear infections

Ear infections are one of the most common ailments among toddlers and young children, and one of the most common reasons to visit a pediatrician.

But you don’t have to be a small child to have an ear infection. Actually, this condition can be a health concern for all ages, says Dr. Emily Grant, UCI Health pediatrician and health sciences assistant clinical professor.

Grant offers the following guidance to help those suffering from ear infections and to assist parents in recognizing and preventing the ailment.

What are the causes and symptoms of ear infections?

Up to 80 percent of infants will have at least one ear infection by 1 year of age, with most occurring in children six to 18 months. For reasons that aren’t clear yet, ear infections are slightly more common in boys.

Your child is more likely to suffer from ear infections if others in your family had ear infections, if your child attends daycare, if your child feeds from a bottle, if your child is exposed to second hand smoke or if your child uses a pacifier.

A middle-ear infection occurs after a cold when fluid builds up behind the eardrum. If the fluid becomes infected, the eardrum can bulge and cause pain. Infants can’t communicate their discomfort specifically but they may show general signs of illness, such as fever, irritability, loss of appetite, vomiting and diarrhea. This can make the diagnosis challenging. Older children often complain of ear pain, trouble hearing or a sensation of fullness in the ear.  

How should ear infections be treated?

If you think your child has an ear infection, make an appointment to be evaluated by your pediatrician. Any infant under three months of age with a fever 100.4F or higher should be taken immediately to the emergency room. Since middle ear infections can be caused by viruses or bacteria or both, treatment varies because antibiotics don’t kill viruses. Children younger than two years should be treated right away with antibiotics. For children older than two years with mild symptoms, your pediatrician may recommend holding off on antibiotics, opting instead for observation and pain control to see whether the symptoms go away on their own. This method requires close follow-up with your pediatrician.

Standard treatment is a 10-day course of high-dose amoxicillin, but different antibiotics may be recommended if your child has repeated ear infections. Children usually feel better within 48 hours. Your pediatrician will continue to periodically check your child’s ears because fluid in the middle ear can stick around for up to several months after an ear infection. Parents can give oral ibuprofen or acetaminophen for pain or fever. For children over two years of age, pain-relieving ear drops may be prescribed. 

What’s an excessive number of ear infections? Is it appropriate to surgically implant ear tubes?

Surgery to insert ear tubes may be warranted for children who get three or more ear infections in six months, or four or more infections in one year.

After sedation, the surgeon will place a tiny ear tube through a small cut in the eardrum. Most children can go home within a few hours, and most ear tubes fall out on their own after 6 to 18 months.

How can ear infections be prevented?

Ear infections are best prevented by keeping colds away in the first place, through teaching your children good hand hygiene and to not to touch his or her eyes, nose and mouth, which lowers the risk of catching a cold. Keeping your child up to date on recommended vaccinations, including the seasonal influenza vaccine, also helps prevent ear infections. If enlarged tonsils are blocking drainage from the middle ear, the doctor may recommend that the tonsils be removed.

“Ear infections are very common amongst our littlest of patients,” says Grant, “but empowered parents who know what to look out for and when to call their pediatrician for advice can easily overcome this childhood obstacle.”   

Learn more about UCI Health pediatric services.