Health Matters | Understanding your child’s ear infection

If your child is over the age of 3 and hasn’t had an ear infection yet, consider yourself very lucky. If, like most people, this common illness has visited your home at least once, you are definitely not alone.

In fact, two out of three children will have at least one ear infection by age 1, and eight out of every 10 children will have one by 3. Next to the common cold, an ear infection (acute otitis media) is the most frequent diagnosis made by pediatricians.

The ear consists of three main compartments: the outer ear or external canal, the middle ear and the inner ear. Imagine if you were traveling down your child’s ear from the outside. You would start in the external canal before coming to a thin, tight piece of tissue called the tympanic membrane or the eardrum that separates the middle ear from the external canal.

The middle ear is the location of acute otitis media. Think of the middle ear like a little room. When you step in, the eardrum is behind you, the inner ear which contains the nerves and balance center is in front of you and there’s a long hallway on one side called the eustachian tube. The eustachian tube connects the middle ear to the inside of the nose. That’s why your ears may “pop” when you sneeze or blow your nose, or with a change in altitude in an airplane or elevator.

The most common age for ear infections is between 6 and 12 months old and the eustachian tube is the main reason. In very young children it is short and angled in a way that makes it easy for bacteria and viruses to travel from inside the nose to the ear. As children grow, the eustachian tube lengthens and becomes more vertical, making it harder for germs to travel that route.
What to watch for

The main symptom is an ear ache, but many children will also have a fever, become fussy or may tug on their ears. Some will have ear stuffiness or changes in balance. The infected middle ear fluid can build up enough pressure behind the ear drum so that the drum actually bursts (ruptures) and pus spills into the outer ear canal. The eardrum will usually repair itself, but sometimes an operation may be needed to close the tear.


It’s not possible to completely avoid ear infections, but here are some tips to minimize your child’s chances of getting one:

  • If possible, breastfeed your child during their first 6 to 12 months. Breastfeeding provides antibodies that can help fight off bacteria and so children who are breastfed have a lower risk for ear infections.
  • Keep your baby’s immunizations up to date because they can prevent some of the germs that cause ear infections.
  • Feed your baby at a 45-degree angle (sitting up) instead of lying down. When babies drink lying down, fluids can more easily flow into the eustachian tube and can promote infection.
  • Keep your baby away from secondhand tobacco smoke. Passive smoking can increase the frequency and severity of infections.
  • Control allergies. If you suspect your baby has an allergy to milk or another substance, it’s best to avoid that item.

Otitis media is diagnosed by looking in a child’s ear. The fluid is often visible behind the eardrum and the drum may be red and swollen. The doctor may also push a little puff of air into the ear canal to see if the eardrum moves normally.

Acute otitis media can be caused by bacteria (which are responsive to antibiotics) or viruses (which are not). It is not possible to know which one is causing the infection just by looking in the ear so treatment will be based on your doctor’s judgment. If antibiotics are prescribed, your child usually feels better in a day or two, but you should complete the full course of antibiotics to avoid re-infection.

The fluid in the ear may take much longer to resolve, but it usually drains back down the eustachian tube in a few weeks. During that time, a child’s ear remains stuffy and their hearing is muffled, which can contribute to speech delay in young children, especially if there are multiple infections or if the fluid persists for months. In a child with multiple ear infections, hearing may also be decreased because of scarring of the eardrum.

The worst part of otitis media is usually the pain. An earache can be excruciating. Your pediatrician can prescribe ear drops to minimize the pain.

Some children will require ear tubes (myringotomy tubes) to allow for constant fluid drainage from the middle ear to the external canal. For some children, there is definitely a role for ear tubes while others can get by without them. The decision about whether ear tubes are right for your child or when they should be placed is determined by a discussion between you and your health practitioner.


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