Ear infections are painful for babies and toddlers and stressful and frustrating for parents, particularly when they come back again and again, repeatedly causing distress all around. Most are middle ear infections (otitis media). They are most common in children ages 6 months through 5 years and especially common in children under the age of 3.
Dr. Jeff Starke, a pediatrician and Baylor College of Medicine professor in Houston, Texas, explains that small children are more likely to get ear infections–for three reasons.
First, they’re around other children who are sick. “The typical scenario,” says Dr. Starke, “is the child gets a virus infection and the ear tube, called the eustachian tube, gets clogged up, and that’s what leads to an ear infection.”
Second, children are more likely than adults to have “swollen glands” (lymph nodes) in the throat. Parents most often check the neck below the ears for swollen glands, but these glands are located all over the body, and some glands surround the eustachian, or ear, tube. So when children get sick, the gland around the eustachian tube swells. It may tighten or even shut off the tube.
The ear’s eustachian tube, when open, serves to make the air pressure between the outside world and the inside of the ear the same. Once the tube is blocked by swollen glands or clogged with mucus from a cold or flu, it doesn’t drain properly and it’s much more likely to become infected. The middle ear then becomes “a closed system, with bacteria inside,” explains Dr. Starke.
The third reason for ear infections is anatomy. Some families get more ear infections just because their particular anatomy does not promote good drainage of the ear. Dr. Starke says that when a child has a lot of ear infections, very often one or both parents did, too, when they were young. The good news is, as children grow, they often become less susceptible to these infections.
Kinds of Ear Infection
The most common ear infection in children is what doctors call “otitis media”–infection of the middle ear. The middle ear is the part of the ear inside or beyond the eardrum. It includes the eustachian tube. (The middle ear also includes the tiny bones that vibrate, sending sound to the inner ear.) These ear infections often begin with a cold or flu. If your child has otitis media, you will need to see a physician for evaluation and possibly antibiotic treatment.
The second most common cause of earache in children is infection of the outer part of the ear. This is known as “otitis externa.” These infections seem to develop most often after water activities–swimming, or, occasionally, hot tubs.
When you have a case of otitis externa the ear canal tissue is irritated. There may be bacteria already in the ear, or they may come in from outside, in the water, and multiply in the ear, causing the infection. If you hold the ear and then move it and this causes pain, you probably have a case of otitis externa.
Dr. Starke does not recommend putting alcohol or over-the-counter “swimmer’s ear” solutions into the ear, or cleaning the ear canal: “Things are not meant to go in your ear. This causes mischief. It’s a bad idea in general to put things in your ear.” Dr. Starke says earwax should be left in the child’s ear. Earwax lubricates the ear and only becomes a problem if it becomes impacted. This is not normally a problem for children or young adults.
Some earaches are not ear infections. These earaches can be caused by changes in air pressure. The classic example, of course, is going up or down in an airplane and feeling pressure or aching in the ear. The aching can be stopped by equalizing that internal pressure by yawning, swallowing, or, sometimes, chewing. Opening the jaw widely tends to open up the air tubes and release the pressure, making the earache go away.
How You Can Prevent Ear Infections
Anatomy aside, you can take steps to reduce the chance of ear infections in your child. But complete success may be difficult. The most important thing to remember, Dr. Starke says, is that anything you can do to keep your child healthy and free of colds and respiratory illness will help to prevent ear infections. If children frequently suffer from ear infections, they do need to be seen by a physician to see whether a preventive measure–such as putting tubes in the ears–needs to be done. (See: Treating an Ear Infection, below.)
For children who tend to get outer ear infections (otitis externa), doctors will usually prescribe simple medications. Sometimes just stopping swimming for a while will prevent this sort of infection.
Some doctors say they believe the risk of ear infection is reduced by keeping children away from “secondhand smoke,” which harms the mucosal lining of the nose, throat, and eustachian tubes and increases the risk of ear infection. Studies have shown that children living with adults who smoke have more ear infections than the children of nonsmokers do. Also, some studies have shown that children who have been breast-fed have fewer ear infections.
Antihistamines and decongestants have not been shown to prevent ear infections.
But the best way to prevent ear infection, overall, is to help children avoid colds and flu. How?
- Since we now know that most colds and respiratory infections are passed by touch–through the hands, not through the air–hand washing and toy washing become important.
- Contagion passes easily through busy little hands playing with other children and with toys, and hands go onto faces and into mouths. So, wash hands more often–yours and the children’s.
- Wash and disinfect a sick child’s toys.
- Teach children to use tissues one time only and throw them away right after use.
- Teach children to cover their mouths with a tissue when coughing and teach them to blow their noses and throw the tissue away immediately.
- Don’t let children share toys that they put in their mouths.
- Toys that have been in children’s mouths should be disinfected before the next use.
The new pneumococcal vaccine may prevent some middle ear infections, Dr. Starke says, but following basic preventive guidelines is, of course, always preferable.
Treatment of Ear Infections
Common treatments for repeated ear infections are antibiotics or the insertion of “PE tubes,” also called pressure tubes, into the ear. These tubes are inserted through the eardrum to provide drainage and equalize pressure in the ear. Some doctors recommend inserting the tubes if a child has had three ear infections in 6 months or four infections in 1 year. There are a variety of reasons for inserting the tubes so you should discuss this possibility with your child’s doctor to be sure you understand the proposed treatment and the reason for it.
The tube insertion is often performed in an ear-nose-throat surgeon’s office. The tubes usually get pushed out as the child grows or fall out spontaneously after several months, but they can also be removed. Doctors say they do not harm the child’s hearing, and they are thought to be less of a risk to the child than the repeated infections they are meant to prevent.
Article By: Suzanne Batchelor, Medical Writer