Ear infections are very common in children. In fact, they're the most common bacterial illness in children.
Otitis media, or a middle ear infection, is the infection or inflammation of the middle ear space behind the eardrum. From the ages of 6 months to 3 years, about 50-85% of children can have one or more ear infections.
Ear infections are one of the most common reasons children visit the pediatrician outside of wellness checks. Children typically get them more often in the winter months.
What are the signs and symptoms of ear infections?
The most common symptoms of ear infections in children are fever and ear pain. They also may have trouble sleeping or feel overall more tired.
In more severe cases, ear infections can lead to rupture of the ear drum. This causes a drainage of infected fluid (pus) that can be seen in the ear canal.
Older kids might tell you that they're having trouble hearing and their speech may not be as clear. Toddlers who have ear infections may have trouble with their balance, as well.
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At what age do ear infections typically go away?
Ear infections are most common in children under 2 years old. They typically start to outgrow ear infections by about ages 3-5.
Middle ear infections are more common in infants and toddlers. That's because the parts inside the ear are not as well developed. Their immune systems are also still developing.
Kids outgrow ear infections because they're finally able to clear the fluid from behind the ear drum by popping their ears. Their immune systems have also matured and can fight the infection better.
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What's the difference between swimmer's ear and a regular ear infection?
External ear infection (otitis externa), like swimmer's ear, happens when moisture gets trapped in the ear canal. This happens often when children go swimming, and water gets caught in little spaces in the outer part of the ear. This is the most common type of ear infection seen in the summer.
It can be tricky to distinguish between swimmer's ear and middle ear infections. That's because if there's just drainage, health care providers don't know if it started in the middle or outer ear. Sometimes it takes some guess work to find out where the drainage originated.
Swimmer's ear occurs more in older children because they stick their heads under water more. Younger kids often don't dunk their heads when they get in a pool, for example.
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How do you treat an ear infection in a child?
Ear infections can be viral or bacterial. Many of them will resolve on their own without antibiotics. You can first see if the ear infection gets better without medication, especially if it's not a severe infection. Check with your child's pediatrician if you're wondering whether to bring them in to be seen.
If the child has a very red ear drum, pus in the middle ear space, a fever and ear pain, then antibiotics might be prescribed.
Amoxicillin is the first-line medication. If that's been used multiple times and isn't working as well, providers may prescribe a stronger antibiotic called Augmentin. This can get tricky because some kids find out they have an amoxicillin or penicillin allergy during treatment. There are other medications that are also commonly prescribed.
If your child has had a lot of ear infections, then it's time for a referral to pediatric ear, nose and throat (ENT) specialist to discuss ear tubes.
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How do ear tubes work, and how can they help treat my child's ear infections?
Ear tubes are the most common elective surgical procedure. The goal of ear tubes is to get your child through the age when they're prone to ear infections.
An ear tube is a small device placed in the ear drum. It looks like a tiny sewing bobbin with a hole in the center. Ear tubes keep the space behind the ear clean and dry. Children who've had a lot of ear infections or concerns for fluid in the ears and hearing loss may need ear tubes. Ear tubes also allow health care providers to use antibiotic ear drops rather than oral antibiotics (for recurrent infection).
Children with ear tubes have no activity restrictions. They are able to swim and get their ears wet with no problems. One bonus for children with ear tubes is that they typically do better with altitude changes than children who don't. For example, the change in altitude in an airplane won't bother them as much.
What the procedure for placing an ear tube in my child's ear?
Although ear tubes are done under general anesthesia, it's a very short and easy general anesthetic. Your child goes to sleep with a mask, is asleep for about 5 minutes and goes home the same day. They typically don't have any pain, and most kids recover quickly. Parents usually say that their children are back to normal by the time they get home from the procedure.
How long do ear tubes usually stay in the ear?
On average, ear tubes last about a 1-2 years and fall out on their own. There's no need for a second procedure.
After ear tubes are placed, what should parents look out for?
For kids who have long-term fluid that's been affecting their hearing, this can be immediately improved. Occasionally, there is some drainage from the ears after ear tube placement. This typically happens if there's been a recent ear infection.
When should I take my child to the doctor if I suspect an ear infection?
If your child has ear pain and a fever, check with your child's pediatrician to see if you should take them in to be seen. If your child has a lot of ear infections, it's also best to see your child's pediatrician.
Children with multiple ear infections may referred to an ENT specialist. Standard recommendations are to be seen by an ENT specialist if your child has:
- three ear infections in 6 months or
- four in the last year (one of those being within the last 6 months)
An evaluation by an ENT specialist can be helpful to determine next steps.
Additionally, if the fluid behind the ear drum remains for more than 3 months, it's a good idea to see an ENT specialist. The prolonged fluid could have effects on hearing.
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Are there ways to prevent ear infections in children?
Prevention for ear infections includes general hand hygiene and the things you should do when any kid is sick. These include:
- not sharing utensils
- hand washing
- keeping children home when they're sick (to prevent spread)
Studies have shown that children in daycare are at increased their risk of ear infections.
Parents should also be careful when sticking anything in their child's ear canal. Don't clean ear wax out of the ear because you could push it in further, causing fluid to get trapped. There's always a risk of damage to the ear drum if you go in too far with any object.
This blog was medically reviewed by pediatric otolaryngologist Jamie Funamura.
