Ear Infection Questions

• Your child was diagnosed with an ear infection
• Your child's ears were recently looked at by a doctor
• You are worried that the fever or ear pain is not getting better fast enough
• Your child is still taking an antibiotic for the ear infection

Symptoms of Ear Infections

• The main symptom is an earache.
• Younger children will cry, act fussy or have trouble sleeping because of pain.
• About 50% of children with an ear infection will have a fever.
• Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.

Cause of Ear Infections

• A bacterial infection of the middle ear (the space behind the eardrum)
• Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
• Blockage results in middle ear fluid (called viral otitis).
• If the fluid becomes infected (bacterial otitis), the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
• Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
• The onset of ear infections is often on day 3 of a cold.
• How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.

Call 911 Now

• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Stiff neck (can't move neck normally)
• Walking is not steady
• Fever higher than 104° F (40° C)
• Ear pain is severe and not better 2 hours after taking ibuprofen
• Crying is bad and not better 2 hours after taking ibuprofen
• Pink or red swelling behind the ear
• Crooked smile (weakness of 1 side of the face)
• New vomiting
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Taking antibiotic more than 48 hours and fever still there or comes back
• Taking antibiotic more than 3 days and ear pain not better
• Taking antibiotic more than 3 days and ear discharge still there or comes back
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Ear infection on antibiotic with no other problems
• Normal hearing loss with an ear infection
• Prevention of ear infections
• Ear tube (ventilation tube) surgery questions

Care Advice

Treatment for an Ear Infection

What You Should Know About Ear Infections:

• Ear infections are very common in young children.
• Most ear infections are not cured after the first dose of antibiotic.
• Often, children don't get better the first day.
• Most children get better slowly over 2 to 3 days.
• Note: for mild ear infections in older children, antibiotics may not be needed. This is an option if over 2 years old and infection looks viral.
• Here is some care advice that should help.

Keep Giving the Antibiotic:

• The antibiotic will kill the bacteria that are causing the ear infection.
• Try not to forget any of the doses.
• Give the antibiotic until it is gone. Reason: to stop the ear infection from flaring up again.

Fever Medicine:

• For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Note: fevers less than 102° F (39° C) are important for fighting infections.
• For all fevers: keep your child well hydrated. Give lots of cold fluids.

Pain Medicine:

• To help with the pain, give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Use as needed.

Cold Pack for Pain:

• Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
• Note: some children prefer heat for 20 minutes.
• Caution: heat or cold kept on too long could cause a burn or frostbite.

Limits on Activity:

• Your child can go outside and does not need to cover the ears.
• Swimming is fine as long as there is no drainage from the ear. Also, do not swim if there is a tear in the eardrum.
• Air Travel. Children with ear infections can travel safely by aircraft if they are taking antibiotics. For most, flying will not make their ear pain worse.
• Give your child a dose of ibuprofen 1 hour before take-off. This will help with any pain they might have. Also, during descent (coming down for landing) have your child swallow fluids. Sucking on a pacifier may help as well. Children over age 6 can chew gum.

Return to School:

• Your child can go back to school when any fever is gone.
• Your child should feel well enough to join in normal activities.
• Ear infections cannot be spread to others.

What to Expect:

• Once on antibiotics, your child will get better in 2 or 3 days.
• Make sure you give your child the antibiotic as directed.
• The fever should be gone by 2 days (48 hours).
• The ear pain should be better by 2 days. It should be gone by 3 days (72 hours).

Ear Infection Discharge:

• If pus is draining from the ear, the eardrum probably has a small tear. This can be normal with an ear infection. Discharge can also occur if your child has ear tubes.
• The pus may be blood-tinged.
• Most often, this heals well after the ear infection is treated.
• Wipe the discharge away as you see it.
• Do not plug the ear canal with cotton. Reason: retained pus can cause an infection of the lining of the ear canal.

Call Your Doctor If:

• Fever lasts more than 2 days on antibiotics
• Ear pain becomes severe or crying becomes nonstop
• Ear pain lasts more than 3 days on antibiotics
• Ear discharge is not better after 3 days on antibiotics
• You think your child needs to be seen
• Your child becomes worse

Treatment for Hearing Loss with an Ear Infection

Brief Hearing Loss:

• During an ear infection, fluid builds up in the middle ear space.
• The fluid can cause a mild hearing loss for a short time.
• It will slowly get better and go away with the antibiotic.
• The fluid is no longer infected, but sometimes, may take weeks to go away. In 90% of children, it clears up by itself over 1 to 2 months.
• Permanent harm to the hearing is very rare.

Talking With Your Child:

• Get close to your child and get eye contact.
• Speak in a louder voice than you usually use.
• Decrease any background noise from radio or TV while talking with your child.

Call Your Doctor If:

• Hearing loss not better after the antibiotic is done.

Prevention of Recurrent Ear Infections

What You Should Know:

• Some children have ear infections that keep coming back.
• If this is your child's case, here are some ways to prevent future ones.

Avoid Tobacco Smoke:

• Contact with tobacco smoke can lead to ear infections.
• It also makes them harder to treat.
• No one should smoke around your child. This includes in your home, your car or at child care.

Avoid Colds:

• Most ear infections start with a cold. During the first year of life, try to reduce contact with other sick children.
• Try to put off using a large child care center during the first year. Instead, try using a sitter in your home. Another option might be a small home-based child care.

Breastfeed:

• Antibodies in breast milk lower the rate of ear infections.
• If you are able to, consider breastfeeding your baby during the first year of life or longer.

Do Not Prop the Bottle:

• During feedings, hold your baby with the head higher than the stomach.
• Feeding while lying down flat can lead to ear infections. It causes formula to flow back into the middle ear.
• Having babies hold their own bottle also causes milk to drain into the middle ear.

Get All Suggested Vaccines:

• Vaccines protect your child from serious infections.
• The pneumococcal and flu shots also help to prevent some ear infections.

Control Allergies:

• Allergies may lead to some ear infections.
• If your baby has a constant runny or blocked nose, suspect an allergy.
• If your child has other allergies like eczema, ask your child's doctor about this. The doctor can check for a milk protein or soy protein allergy.

Check Any Snoring:

• Large adenoids can cause snoring or mouth breathing. Suspect this if your toddler snores every night or breathes through his mouth.
• Large adenoids can contribute to ear infections.
• Talk to your child's doctor about this.

Ear Tube Surgery Questions

Ear Tubes:

• Ear tubes are tiny plastic tubes that are put through the eardrum. They are placed by an ENT doctor.
• The tubes allow fluid to drain out of the middle ear space. They also allow air to re-enter the space.
• This lowers the risk of repeated ear infections and returns the hearing to normal.

Ear Tubes - When Are They Needed?

• Fluid has been present in the middle ear nonstop for over 4 months. Both ears have fluid.
• Also, the fluid has caused a hearing loss greater than 20 decibels.
• Hearing should be tested first. Some children have nearly normal hearing and tubes are not needed.
• Ear infections that do not clear up after trying many antibiotics may need tubes.
• Prevention should be tried before turning to surgery.
• Talk to your child's doctor about when ear tubes are needed.

What to Expect:

• In most cases, the tubes come out after about a year. They fall out of the ear on their own. This happens with the normal movement of earwax.
• If the tubes stay in over 2 years, talk with your child's doctor. The surgeon may need to take them out.

Risks of Ear Tubes:

• After the tubes come out, they may leave scars on the eardrum. They may also leave a small hole that doesn't heal. Both of these problems can cause a small hearing loss.
• Because of these possible problems, there is a small risk with ear tubes. There is also a small risk when giving anesthesia to young children.
• Therefore, doctors suggest ear tubes only for children who really need them.