Ear Infections


Common childhood ailment can cause hearing loss

By Amy Diede, M.D.

From Minnesota Healthcare News

“My ear hurts!” How many parents have heard that cry from their young children? Ear infections are one of the most common ailments in young children. The National Institute on Deafness and other Communication Disorders, one of the National Institutes of Health, estimates three out of four children have had at least one ear infection before they are three years old. Fortunately, most are not serious and actually clear up on their own in a few days. By the time children reach school age, the occurrence of ear infections lessens dramatically. Nevertheless, they can make children uncomfortable and are the most common cause of hearing loss in children. More serious cases can lead to a ruptured eardrum, meningitis, epidural or brain abscesses, mastoiditis, or facial nerve paralysis.

What is an ear infection?

Infections of the middle ear are called otitis media. The middle ear, or the space behind the eardrum, is connected to the back of the throat through the Eustachian tube. Middle ear infections often occur when congestion blocks that tube, causing fluid and pressure to build up. Bacteria or viruses can then multiply and cause an ear infection. Ear infections are common in younger children because the Eustachian tube is more horizontal, inhibiting movement of the fluid. Ear infections often begin with a simple cold. Children who are exposed to secondhand smoke or high levels of air pollution have a higher risk of getting an ear infection, as do those with a family history of such infections. Studies also have found that babies who lie down while drinking from a bottle have more ear infections than those who are kept in a sitting position
to drink.

What are the symptoms?

The most common symptoms of ear infections in children are pain and decreased hearing. Some children tug at their ears; others do not. Many develop fever, headache, dizziness, or general body discomfort. Others have trouble sleeping or cry more than usual. Infants may vomit or have diarrhea. If a child’s ear discomfort lasts more than 24 hours or is accompanied by a discharge of blood or pus from the ear, or if the child is experiencing severe pain, it’s time to see a physician. A discharge could indicate a ruptured eardrum. One test a physician might perform on a patient with earache, tympanometry, measures eardrum movement through a soft plug in the opening of the ear. The plug contains a device that changes air pressure inside the ear. Another test might be acoustic reflectometry, during which a physician projects sounds into the ear, measuring how the sounds are reflected.

What is “swimmer’s ear”?

Swimmer’s ear, or acute otitis externa, is an infection of the outer ear and ear canal. One way it occurs is with excessive exposure to water, which dilutes the acidity that normally prevents infection. It can also occur when the lining of the ear canal is cut, allowing bacteria to break through the skin, or with a middle ear infection if the eardrum ruptures. Swimmers exposed to infectious organisms in polluted waters may also experience swimmer’s ear.

Conditions that weaken the immune system, such as diabetes, also place individuals at a higher risk for developing swimmer’s ear. Sometimes patients will experience symptoms of swimmer’s ear that have actually been caused by using cotton swabs to clean their ears. These swabs can break through the skin.

Most people feel the symptoms of swimmer’s ear within a few days of exposure. These symptoms might include severe pain when the outer ear is moved, itching of the outer ear, swelling in the ear or in the lymph nodes in the neck, a feeling of stuffiness in the ear, pus drainage, or decreased hearing. In some cases, the outer ear is red and flaky.

While swimmer’s ear usually isn’t serious, it can lead to complications if it isn’t treated. Complications include hearing loss, recurring outer ear infections, bone and cartilage damage, and generalized infections.

When should ear infections be treated?

A physician should be called immediately if cloudy or foul smelling discharge is seen from the ear, or if there is hearing loss. Other signs that point to a physician visit include fever, swelling, tenderness or redness behind the ear, severe ear pain, dizziness, headache, confusion, or facial weakness.

In some cases, the only treatment for an ear infection might be pain relief and watchful waiting. In fact, the American Academy of Pediatrics and the American Academy of Family Physicians both recommend watchful waiting for the first 72 hours when children are older than six months, generally healthy, and have mild symptoms. Sometimes physicians will prescribe a decongestant or antihistamine to decrease swelling in the Eustachian tube, and holding a warm, moist cloth over the ear often provides some relief.

When a child is younger than six months or suffers from recurrent ear infections, especially when fluid buildup doesn’t go away, antibiotics are often recommended. Approximately 80 percent of children with acute otitis media recover without antibiotics, however, and antibiotics won’t help if the infection is caused by a virus.

What about ear tubes?

The use of ear tubes continues to be controversial. A long running study at the Children’s Hospital of Pittsburgh is finding that fluid in the middle ear does not impair development in children up to age 11. Thus, some physicians are suggesting that no intervention is necessary for most otherwise healthy infants and young children.

Drainage tubes are generally recommended if the fluid in a child’s ear affects his or her hearing, or if the child is experiencing frequent ear infections that don’t respond to antibiotics. They are not a failsafe cure, however. Some children continue to get ear infections, even with ear tubes.

Ear tubes are placed through the eardrum during a procedure called a my ringotomy, which is performed with the child under general anesthesia. Within a year or so, the tubes fall out, and the drainage holes heal. In the meantime, children may need to protect their ears with ear plugs when they are in the water, even the bathtub.

Can ear infections be prevented?

Simple precautions, such as keeping a child away from sick children and secondhand smoke, can reduce the risk of ear infections. Parents should also ask their child’s physician about a pneumococcal vaccine called Prevnar, which is designed to prevent life-threatening infections such as pneumonia and meningitis. It also has been found to reduce the risk of ear infections and is recommended for children under the age of two.

By watching and listening for the signs of ear infection and treating symptoms early, parents can prevent pain and misery for their children. As a result, they are less likely to hear, “My ear hurts!”


Tympanometry is a test used to detect disorders of the middle ear. Air pressure in the ear canal is varied to test the condition and mobility (movement) of the eardrum (tympanic membrane).

How the test is performed

Initially, your health care provider will examine your ear canal with an otoscope to make sure there is a clear path to your ear drum. Then a device is inserted in your ear that will change the pressure in your ear, produce a pure tone, and measure your body‘s responses to the sound and different pressures.

How to prepare for the test

During the test, it is important not to speak, move, swallow, or startle. All these actions can alter the pressure in the middle ear, invalidating the test results. The sounds heard during the test may be loud, so a conscious effort is required to avoid a startle reflex. If your child is to have this test performed, it may be helpful to explain how the test will feel, and even to practice or demonstrate on a doll. The more familiar your child is with what will happen and why, the less anxiety he or she will feel.

How the test will feel

There may be some discomfort while the probe is in the ear, but no harm will result. You will hear a loud tone as the measurements are taken.

Why the test is performed

This test determines how well the tympanic membrane is working by observing its response to waves of pressure, and measuring the pressure of the middle ear.

Tympanometry may reveal any of the following:

  • Fluid in the middle ear
  • Perforated ear drum
  • Impacted ear wax
  • Scarring of the tympanic membrane
  • Lack of contact between the conduction bones of the middle ear
  • A tumor in the middle ear

Source: National Library of Medicine

Amy Diede, M.D., is a family practice physician at Apple Valley Medical Clinic.