Health Tips

It is an enormous task to raise a child. If you’re a parent, it is no wonder that you're constantly worried about your child’s well-being and health. Such worries happen for a good reason– children are still developing their immunity and are susceptible to various infections. In this article, we’re going to talk about ear infection.

What is an ear infection?

As an adult, you probably won’t be concerned with ear infection a lot, but it is a fairly common problem in children. Ear infection is also known as acute otitis media (otitis = ear, media = middle). Otitis media is an infection of the middle ear. 

Image credit: BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons

Most of the time, it is caused by bacteria that nearly all children have in their nose and throat at one time or another. Occasionally, viruses can cause ear infections too. In some cases, both bacteria and viruses are detected in children with ear infections.

The most common bacteria that cause ear infections are:

•  S. pneumoniae

•  nontypeable H. influenzae (NTHi), and 

• Moraxella catarrhalis. 

Whereas the viruses most commonly associated with ear infections are:

• respiratory syncytial virus (RSV), 

• picornaviruses (eg, rhinovirus, enterovirus), 

• Coronaviruses (erhem, the family where SARS-CoV-2 belongs to)

• influenza viruses, 

• adenoviruses, and 

• human metapneumovirus. 

How does ear infection develop?

Ear infections most often develop after a viral respiratory tract infection, such as a cold or the flu. These infections can cause swelling of the mucous membranes of the nose and throat. As a result, the normal host defenses–such as clearance of bacteria from the nose– are affected, thus increasing the amount of bacteria in the nose. These bacteria make their way up to the ear and cause infections.

Alternatively, viral respiratory tract infection is also known to affect the ear’s ability to maintain normal pressure (called the Eustachian tube function). This leads to changes of the pressure in the middle ear (like when you are flying in an airplane). Fluid (called an effusion) may form in the middle ear and bacteria and viruses follow, resulting in inflammation in the middle ear. The increased pressure causes the eardrum to bulge, leading to the typical symptoms of pain and fussiness in young children or even rupture resulting in draining fluid in the ear canal.

Signs and symptoms of ear infections

In infants and young children, symptoms of an ear infection are nonspecific. Many of the symptoms of an ear infection may be caused by a simultaneous viral respiratory tract infection. The symptoms of an ear infection can include:

• Fever (temperature higher than 100.4°F or 38°C, see the table for how to measure a child's temperature) 

• Pulling on the ear

• Fussiness, irritability, or restless sleep

• Decreased activity

• Lack of appetite or difficulty eating

• Vomiting or diarrhea

• Draining fluid from the outer ear (called otorrhea)

If you suspect your child is having ear infections, consult a doctor immediately.

(No, I don’t want to see the doctor!)

Treatment of ear infections

1. Medications to treat pain and fever

To ease the pain and fever in the child (and also to restore your peace), doctors would prescribe medications for pain and fever, such as ibuprofen and paracetamol to the child. You can also buy them from pharmacies, but do consult a healthcare professional on the amount of medicine and frequencies that are individualized to your child’s age and body weight.

2. Watchful waiting (or observation)

This is not a medication per se, but rather the doctor recommends that you watch your child at home before starting antibiotics. This is because in some cases the child may quickly improve without needing any antibiotics treatment. Such observation can help to determine whether antibiotics are truly needed. This is important as unnecessary use of antibiotics can lead to antimicrobial resistance. Of course, not every case of ear infections are suitable for watchful waiting. Your doctor will determine which case is suitable for such a measure. Usually such recommendations will only be offered to older children with mild symptoms. 

3. Antibiotics treatment

If the child is too young (younger than 2 years old) or with concerning signs and symptoms, your doctor is likely to give an antibiotic treatment. Remember to strictly follow your doctor’s instructions on the antibiotic regimen to ensure a successful treatment and to prevent resistance. 

When to call the doctor

If your child does not improve after 48 hours whether or not antibiotics were prescribed, or gets worse at any time point, consult your doctor for advice. Although fever and discomfort may continue even after starting antibiotics, the child should improve every day. If your child appears more ill than when seen by his or her health care provider, contact the provider as soon as possible.

The image shows the bulging of the eardrum, which is characteristic of acute otitis media. Image credit: B. Welleschik, CC BY-SA 3.0, via Wikimedia Commons

Prevent hearing loss and speech development problems

If ear infections in children are not treated properly, they can lead to rupture of the eardrum or even hearing loss. The fluid that collects behind the eardrum (called an effusion) can persist for weeks to months after the pain of an ear infection resolves. An effusion causes trouble hearing, which is usually temporary. If the fluid persists, however, it may interfere with learning and/or speech.

Therefore, children who are younger than two years and those with underlying speech, hearing, or developmental problems should have a follow-up ear examination two to three months after being treated for an ear infection. These children are at risk for delays in learning to speak. This follow-up helps to ensure that the fluid collection (which can affect hearing) has resolved. Consult your doctor on how often you should bring your child for further examination and monitoring.

A word from Doc2Us

If you have any questions related to ear infections, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.  For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download Doc2Us app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

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Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. UpToDate - Acute otitis media in children: Epidemiology, microbiology, and complications

2. UpToDate - Patient education: Ear infections (otitis media) in children (Beyond the Basics)

3. BMJ Best Practice - Acute otitis media

4. American Family Physician - Acute Otitis Media in Children

Cover image credit: Photo: Simone D. McCourtie / World Bank. Source: https://www.flickr.com/photos/10816734@N03/3962721177

Written By

Ms Joyce Toh

Reviewed By

Doc2us Medical Board