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Published on November 20, 2012

The Tricky Business of Ear Infections

It’s 3:30 a.m. and your 9-month-old wakes up screaming. After verifying that there are no major injuries and no one is trying to abduct him, you try to figure out what is wrong. One of the first questions is probably, “Could this be an ear infection?”

First, let’s talk about what an ear infection is. The middle ear normally produces fluid that is drained to the back of the throat down the Eustachian tubes. In adults, the tubes are angled downwards so they typically drain well. In children, these tubes lie more flat and sometimes don’t drain as well. The longer the fluid sits there, the more likely the fluid is to get infected. Also, if a child gets a cold, those tubes can swell shut and then the fluid doesn’t drain at all.

What symptoms should you watch for? The most common symptoms are fussiness, decreased appetite, change in sleep (especially not wanting to lie flat) and fever. Some children will play with their ears but most will do that even when they don’t have an infection.

Unfortunately, there is only one way to know whether your child has an ear infection and that is for an experienced physician or midlevel to look inside his or her ears. As any medical student will tell you, determining whether or not an ear is infected is not an easy task. We have to decide whether the eardrum has a normal shape and normal color and whether there is any fluid behind the eardrum.

If you think your child has an ear infection, take them in to be seen by a medical professional. There is no way to diagnose an ear infection over the phone. Not all ear infections require antibiotics. Some infections are caused by viruses and can go away on their own. Sometimes it is just “clear fluid” that causes discomfort but is not truly infected.

Once an ear infection is diagnosed, we have to decide what to do with it. One option is a “wait and see approach.” A prescription for an antibiotic is given, but parents are instructed to wait to fill it unless the symptoms don’t go away over 2-3 days or if the symptoms get worse. In the meantime, parents can use medications such as acetaminophen or ibuprofen (depending on the child’s age) to help with pain. There are also prescription eardrops that can help with the pain—ask your doctor about them.

If your child does require antibiotics, symptoms should start to improve within 2-3 days. If you do not see improvement, contact your doctor’s office. Your doctor may switch antibiotics or he or she may want to take another look to make sure there isn’t anything else going on.

For children who get frequent ear infections (more than three in six months, or four in one year), you should discuss options with your doctor. The most common solution is to see an ear specialist to have tubes inserted into the eardrum. This provides a way for the fluid to drain out when the Eustachian tubes aren’t working like they should.

Although the majority of children will have at least one ear infection at some point in their lives, they usually do not cause long-term harm. However, repeated ear infections or long-standing ear infections that do not clear can lead to hearing loss. If you have any concerns about your child’s hearing, be sure to bring it up at your child’s next visit.

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