Pediatric ear infections (otitis media)

What are the signs and symptoms of pediatric ear infections (otitis media)?

An ear infection, or otitis media, is the number one reason parents bring their child to a doctor.  Although most ear infections eventually go away on their own, it is sometimes necessary to see a health care provider.

Common symptoms of an ear infection include:

• Pulling or tugging at one or both ears
• Crying
• Difficulty sleeping
• Difficulty hearing soft sounds
• Fluid discharge from the ear
• Trouble with balance
• Fever (more common in infants and toddlers)

Take your child to the doctor if he has the following symptoms:

• A temperature above 100.4° F
• Discharge from the ears that includes blood or pus
• Was already diagnosed with an ear infection and his symptoms have either not improved or worsened
• A fever, if he is younger than three months of age

How are pediatric ear infections (otitis media) diagnosed?

Because ear infections most often follow an illness, your child’s doctor will ask you whether your child has recently had a cold or a sore throat. If the answer is yes, the doctor will follow up with questions about the above symptoms. For instance, has your child been tugging at his ears or has he had trouble sleeping?

If the doctor suspects an ear infection, they will use a lighted device known as an otoscope to look at your child's eardrum for signs of redness or bulging. The doctor may also use a pneumatic otoscope, which releases a puff of air into your child's ear canal to see if there is fluid behind the eardrum. An eardrum with fluid behind it will remain more static than a normal eardrum.

If the results of the above tests are inconclusive, your doctor or audiologist may perform a test known as tympanometry. The doctor will insert an instrument called a tympanometer -- a soft plug containing a tiny microphone and speaker -- into your child's ear. The device uses sounds and air pressure to measure the eardrum's flexibility at different pressures.

If your child's earache is not accompanied by severe fever or pain, your child’s doctor may suggest waiting a day or two to see if symptoms go away. Most ear infections (otitis media) do not need treatment. However, if symptoms persist longer than 48 or 72 hours, treatment is most often needed.

What are the causes of pediatric ear infections (otitis media)?

An ear infection usually affects the middle ear and is most often caused by bacteria. The result is a buildup of fluid and mucus behind the eardrum, which causes pressure and, eventually, pain.

Most ear infections occur following a respiratory infection such as a cold or a sore throat. In bacterial infections, the bacterium spreads to the middle ear causing an ear infection. In viral infections, bacteria may be "driven" to the middle ear, resulting in a secondary infection.

How are pediatric ear infections (otitis media) treated?

The Centers for Disease Control and Prevention (CDC) recommends the following in order to help prevent ear infections in children:

• Avoid exposing your child to secondhand smoke or air pollution
• Make sure children are up to date on their immunizations
• Breastfeed babies for 12 months or more (if possible)
• Bottle feed babies in an upright position

If your child's doctor diagnoses an ear infection, she may prescribe an antibiotic. Antibiotics such as Amoxicillin are usually taken over the course of a week to 10 days. It is important that your child takes the exact dosage over the full amount of time, even if symptoms improve.

Your doctor may also recommend over-the-counter pain medications such as ibuprofen or acetaminophen. Ear drops are sometimes used as well.

• Aspirin is not recommended because of its association with Reye's syndrome in certain children.

If a virus caused the infection, antibiotics won't help and may even cause side effects such as diarrhea, rashes or nausea. Viral infections will resolve by themselves. Make sure your child gets plenty of rest. Over-the-counter medications can help with symptoms as well.

No matter the treatment, it is important to take your child to his follow-up appointment so the doctor can make sure the infection has gone away.