The
middle ear is the small part of your ear behind your eardrum. It can get
infected when germs from the nose and throat are trapped there.
What causes a middle ear infection?
A small tube
connects your ear to your throat. A cold can cause this tube to swell. When the
tube swells enough to become blocked, it can trap fluid inside your ear. This
makes it a perfect place for germs to grow and cause an infection.
Ear infections happen mostly to young children because their tubes are
smaller and get blocked more easily.
What are the symptoms?
The main symptom is an
earache. It can be mild, or it can hurt a lot. Babies and young children may be
fussy. They may pull at their ears and cry. They may have trouble sleeping.
They may also have a fever.
You may see thick, yellow fluid coming
from their ears. This happens when the infection has caused the eardrum to
burst and the fluid flows out. This is not serious and usually makes the pain
go away. The eardrum usually heals on its own.
When fluid builds
up but does not get infected, children often say that their ears just feel
plugged. They may have trouble hearing, but their hearing usually returns to
normal after the fluid is gone. It may take weeks for the fluid to drain away.
How is a middle ear infection diagnosed?
Your
doctor will talk to you about your child's symptoms. Then he or she will look
into your child's ears. A special tool with a light lets the doctor see the
eardrum and tell whether there is fluid behind it. This exam is rarely
uncomfortable. It bothers some children more than others.
How is it treated?
Most ear infections go away on
their own. You can treat your child at home with an
over-the-counter pain reliever like acetaminophen
(such as Tylenol), a warm washcloth or heating pad on the ear, and rest.
Do not give aspirin to anyone younger than 20. Your
doctor may give you eardrops that can help your child's pain.
Sometimes after an infection, a child cannot hear well for a while. Call
your doctor if this lasts for 3 to 4 months. Children need to be able to hear
in order to learn how to talk.
Your doctor can give your child
antibiotics, but ear infections often get better
without them. Talk about this with your doctor. Whether you use them will
depend on how old your child is and how bad the infection is.
Minor surgery to put tubes in the ears may help if your child has hearing
problems or repeat infections.
Can ear infections be prevented?
There are many
ways to help prevent ear infections. Do not smoke. Ear infections happen more
often to children who are around cigarette smoke. Even the fumes from tobacco
smoke on your hair and clothes can affect them. Handwashing and having your
child immunized can help, too.
Also, make sure your child does not
go to sleep while sucking on a bottle. And try to limit the use of group child
care.
During a
cold, sinus or throat infection, or an allergy attack, the
eustachian tubes, which connect the middle ears to the
throat, can become blocked. This stops fluid from draining from the middle ear.
This fluid is a perfect breeding ground for bacteria or viruses to grow into an
ear infection.
Bacterial infections.
Bacteria cause most ear infections. The most common types are Streptococcus pneumoniae (also called pneumococcus),
Haemophilus influenzae, and Moraxella catarrhalis.
Viral infections.
Viruses can also lead to ear infections. The
respiratory syncytial virus (RSV) and
flu (influenza) virus are the most frequent types
found. These viruses account for the rise in ear infections from January to May
each year.1
Causes of fluid buildup
When swelling from an
upper respiratory infection or allergy blocks the
eustachian tube, air can't reach the middle ear. This
creates a vacuum and suction, which pulls fluid and germs from the nose and
throat into the middle ear. The swollen tube prevents this fluid from draining.
An ear infection begins when bacteria or viruses in the trapped fluid grow into
an infection.
Inflammation and fluid buildup can occur without
infection and cause a feeling of stuffiness in the ears. This is known as
otitis media with effusion.
Drainage from the ear that is thick
and yellow or bloody. If this occurs, the eardrum has probably burst (ruptured). The hole in the eardrum often heals by
itself in a few weeks.
Popping, ringing, or a feeling of fullness or
pressure in the ear. Children often have trouble describing this feeling.
Children may rub their ears trying to relieve pressure.
Trouble
hearing. Children who have problems hearing may seem dreamy or inattentive, or
they may appear grumpy or cranky.
Balance problems and
dizziness.
Some children don't have any symptoms with this
condition.
What Happens
Middle ear infection (acute otitis media)
Middle ear infections usually occur along with an
upper respiratory infection (URI), such as a cold.
During a URI, the lining of the
eustachian tube can swell and block the tube. Fluid
builds up in the middle ear, creating a perfect breeding ground for bacteria or
viruses to grow into an ear infection.
Pus develops as the body
tries to fight the ear infection. More fluid collects and pushes against the
eardrum, causing pain and sometimes problems hearing. Fever generally lasts
about 1 to 2 days. And pain and crying usually last for 3 to 4 hours. After
that, most children have some pain on and off for up to 4 days, although young
children may have pain that comes and goes for up to 9 days.
Antibiotic treatment may shorten some
symptoms.2 But about 80% of the time the
immune system can fight infection and heal the ear
infection without the use of these medicines.2
In severe cases, too much fluid can increase pressure on the eardrum
until it
ruptures, allowing the fluid to drain. When this
happens, fever and pain usually go away and the infection clears. The eardrum
usually heals on its own, often in just a couple of weeks.
Sometimes
complications, such as a condition called chronic
suppurative otitis media (an ear infection with chronic drainage), can arise
from repeat ear infections.
Middle ear fluid buildup (otitis media with effusion)
Most children who have ear infections still have some fluid behind the
eardrum 2 weeks after the infection is gone. For some children, the fluid
clears in 1 month. And a few children still have fluid buildup (effusion) 3
months after an ear infection clears.3 This fluid
buildup in the ear is called otitis media with effusion. Hearing problems can
result because the fluid affects how the middle ear works. Usually, infection
does not occur.
Otitis media with effusion may occur even if a child
has not had an obvious ear infection or upper respiratory infection. In these
cases, something else has caused
eustachian tube blockage.
In rare cases,
complications can arise from middle ear infection or fluid buildup. Examples
include hearing loss and ruptured eardrum.
What Increases Your Risk
Some factors that increase
the risk for
middle ear infection (acute otitis media) are out of
your control. These include:
Age. Children ages 3
years and younger are most likely to get ear infections. Also, young children
get more colds and
upper respiratory infections. Most children have at
least one ear infection before they are 7 years old.
Birth defects or other medical conditions. Babies with
cleft palate or
Down syndrome are prone to ear
infections.
Weakened immune system. Children
with severely
impaired immune systems have more ear infections than
healthy children.
Family history. Children
are more likely to have repeat middle ear infections if a parent or sibling had
repeat ear infections.
Allergies. Allergies
may be a risk factor for ear infections. Allergies cause long-term stuffiness
in the nose that can affect how the
eustachian tube works. Blocking this tube, which
connects the back of the nose and throat with the middle ear, can cause fluid
to build up in the middle ear.
Other factors that increase the risk for ear infection
include:
Repeat colds and upper respiratory infections. Most ear infections develop from colds or other
upper respiratory infections.
Exposure to cigarette smoke. Babies who are around cigarette smoke are more likely to have ear
infections than babies who are not. Also, ear infections seem to last longer in
babies who are near cigarette smoke.1
Bottle-feeding. Babies
who are bottle-fed are more likely to develop ear infections within the first
year of life than are babies who are breast-fed. Also, bottle-fed babies may be
more likely to get ear infections if they drink their bottles lying down rather
than being held in an upright position.4
Child care centers.
Children who are around many other children, such as in child care centers, are
more likely to have repeat ear infections than children who are not exposed to
many other children.2
Pacifier use. A young child who uses a
pacifier is more likely to get ear infections.2
Factors that increase the risk for repeated ear infections
also include:
Ear infections at an early age. Babies who have their first ear infection before 6 months of age
are more likely to have other ear infections.
Persistent fluid in the ear. Fluid behind the eardrum that
lasts longer than 2 to 10 weeks after an ear infection increases the risk for
repeated infection.
Prior infections.
Children who had an ear infection within the previous 3 months are more likely
to have another ear infection, especially if the infection was treated with
antibiotics.
When To Call a Doctor
Call your doctor immediately if:
Your child has a severe injury to the
ear.
Your child has sudden hearing loss, severe pain, or
dizziness.
Your child seems to be very sick with symptoms such as a
high fever and stiff neck.
You notice redness, swelling, or pain
behind or around your child's ear, especially if your child does not move the
muscles on that side of his or her face.
Call your doctor if:
You can't quiet your child who has a severe
earache with home treatment over several hours.
Your baby pulls or
rubs his or her ear and appears to be in pain (crying,
screaming).
Your child's ear pain increases even with
treatment.
Your child has a fever of
101
°F (38.3
°C) or higher with
other signs of ear infection.
You suspect that your child's eardrum
has burst, or fluid that looks like pus or blood is draining from the
ear.
Your child has an object stuck in his or her
ear.
Your child with an ear infection continues to have symptoms
(fever and pain) after 48 hours of treatment with an
antibiotic.
Your child with an ear tube
develops an earache or has drainage from his or her ear.
Watchful Waiting
Watchful waiting is when you and your doctor
watch symptoms to see if the health problem improves on its own. If it does, no
treatment is necessary. If the symptoms don't get better or get worse, then
it's time to take the next treatment step.
If your child is age 6
months or older and has a mild earache, you might try watchful waiting. Most
ear infections get better without antibiotics. But if your child's pain doesn't
get better with nonprescription children's pain reliever (such as
acetaminophen) or the symptoms continue after 48 hours, call a doctor.
With a middle ear infection,
the eardrum, when seen through a
pneumatic otoscope, is red or yellow and bulging. In
the case of fluid buildup without infection (otitis media with effusion), the
eardrum can look like it's bulging or sucking in. In both cases, the eardrum
doesn't move freely when the pneumatic otoscope pushes air into the ear.
Other tests can include:
Tympanometry, which tests the movement
of the eardrum. The tip of a hand-held tool is placed just inside the ear. It
changes the air pressure inside the ear. Then, the tool measures how the
eardrum responds.
Hearing tests. A hearing test is
recommended for children who have had fluid in one or both ears (otitis media with effusion) for a total of 3 months.
Hearing tests may be done sooner if hearing loss is
suspected.
Tympanocentesis. When fluid stays
behind the eardrum (chronic otitis media with effusion) or infection continues
even with
antibiotics, tympanocentesis can remove the fluid. The
doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is
usually tested for
culture and sensitivity. These tests reveal what kind
of bacteria is causing the infection and which medicine is best for treatment.
Blood tests, which are done if there are signs of immune
problems.
If a child with an ear infection appears very ill, is younger than age
2, or is at risk for complications from infection, the doctor may prescribe
antibiotics.
In children age 2 and older with simple ear
infections, more options are available. Some doctors prescribe antibiotics for
all ear infections because it's hard to tell which ear infections will clear up
on their own. Other doctors ask parents to watch their child's
symptoms for a couple of days, since more than 8 out
of 10 ear infections get better without treatment. Antibiotic treatment has
only minimal benefits in reducing pain and fever. The cost of medicine and
possible side effects are factors doctors consider before giving antibiotics.
Also, many doctors are concerned about the growing number of bacteria that are
developing
resistance to antibiotics because of frequent use of
antibiotics.
Follow-up exams with a doctor are important to check
for persistent infection, fluid behind the eardrum
(otitis media with effusion), or repeat
infections.
If your child has ongoing ear pain, a fever
[101
°F (38.33
°C) or higher], or
is grumpy or vomiting after 48 hours of treatment, see your
doctor.
Children younger than 3 should have a follow-up visit in
about 4 weeks, even if they seem well. If fluid behind the eardrum persists for
3 months, the child should have his or her hearing tested.1
Initial treatment
The first treatment of a middle
ear infection focuses on relieving pain. The doctor will also assess your child
for any risk of
complications. If your child has an ear infection and
is not very sick, your doctor may ask you to watch your child's symptoms for a
couple days before deciding whether to give antibiotics.
If your
child has an ear infection and appears very ill, is younger than 2, or is at
risk for complications from the infection, your doctor may give
antibiotics right away.
If your child's
condition improves in the first couple of days, treating the symptoms at home
may be all that is needed. Up to 8 out of 10 ear infections get better without
treatment. Some steps you can take at home to treat ear infection
include:
Using pain relievers. Pain relievers such as
nonsteroidal anti-inflammatory medicines (such as
Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol) can help make
your child more comfortable. Giving your child something for pain before
bedtime is especially important. Do not give aspirin to anyone younger than 20 because its use has been linked to
Reye syndrome, a serious illness that needs emergency
treatment.
Applying heat to the ear, which may help relieve the
earache. Use a warm washcloth or a heating pad. Do not allow your child to go
to bed with a heating pad, because he or she could get burned. Use a heating
pad only if your child is old enough to tell you if it's getting too
hot.
Encouraging rest. Encourage your child to rest to let his or
her body fight the infection. Arrange for quiet play
activities.
Using eardrops. Doctors often prescribe pain-relieving
eardrops for earache. Don't use eardrops without a doctor's advice, especially
if your child has ear tubes. For more information, see
the safest way to insert eardrops.
If your child isn't better after a couple of days of home
treatment, call your doctor. He or she may prescribe antibiotics.
Decongestants, antihistamines, and other
over-the-counter cold remedies do not often work for
treating or preventing ear infection. Antihistamines that cause sleepiness may
thicken fluids, which can make your child feel worse. Check with the doctor
before giving these medicines to your child. Experts say not to give
decongestants to children younger than 2.
If your child with an
ear infection must take an airplane trip, talk with your doctor about how to
cope with ear pain during the trip.
Fluid behind the eardrum after
an ear infection is normal. And in most children, the fluid clears up within 3
months without treatment. Test your child's hearing if the fluid persists past
that point. If hearing is normal, you may choose to continue monitoring your
child without treatment.
Ongoing treatment
If a child has repeat ear infections (three or more
ear infections in a 6-month period or four in 1 year),
you may want to consider treatment to prevent future infections.
One option used a lot in the past is long-term oral antibiotic treatment.
There is debate within the medical community about using antibiotics on a
long-term basis to prevent ear infections. Many doctors don't want to prescribe
long-term antibiotics because they are not sure that they really work. Also,
when antibiotics are used too often, bacteria can become
resistant to antibiotics. Some studies show no
difference between using antibiotics and
placebos (fake treatments) to prevent ear
infections.2 Having tubes put in the ears is another
option for treating repeat ear infections.
If your child has fluid
buildup without infection, you may try watchful waiting. Fluid behind the
eardrum after an ear infection is normal. In most children, the fluid clears up
within a few months without treatment. Have your child's hearing tested if the
fluid persists past 3 months. If hearing is normal, you may choose to keep
watching your child without treatment.
If a child has fluid behind
the eardrum for more than 3 months and has significant hearing problems,
treatment is needed. Sometimes short-term hearing loss occurs, which is
especially a concern in children ages 2 and younger. Normal hearing is very
important when young children are learning to talk.
Doctors may
consider surgery for children with repeat ear infections or those with
persistent fluid behind the eardrum. Procedures include inserting ear tubes or
removing
adenoids and, in rare cases, the tonsils.
Inserting tubes Inserting tubes into the eardrum (myringotomy or
tympanostomy with tube placement) allows fluid to drain from the middle ear.
The tubes keep fluid from building up and may prevent repeat ear infections.
These tubes stay in place for 6 to 12 months and then fall out on their own. If
needed, tubes are inserted again if more fluid builds up. About 8 out of 10
children need no further treatment after tubes are inserted for otitis media
with effusion.5
You can use antibiotic eardrops for ear infections
while tubes are in place. In some cases, antibiotic eardrops seem to work
better than antibiotics by mouth when tubes are present.6
While tubes are in place, keep water from
getting in the ear when your child takes a bath or a shower or goes swimming.
The ear could get infected if any germs in the water get into the ear.
Removing adenoids and/or tonsils As a treatment for chronic ear infections, experts
recommend removing adenoids and tonsils only after tubes and antibiotics have
failed. Removing adenoids may improve air and fluid flow in nasal passages.
This may reduce the chance of fluid collecting in the middle ear, which can
lead to infection. Tonsils are removed if they are frequently infected. Experts
do not recommend tonsil removal alone as a treatment for ear
infections.7 See a picture of the
adenoids and tonsils.
Caring for ruptured eardrums If your child has a
ruptured eardrum, keep water from getting in the ear
when your child takes a bath or a shower or goes swimming. The ear could get
infected if any germs in the water get into the ear. If your doctor says it's
okay, your child may use earplugs. Or your doctor may have other advice for
you. He or she can tell you when the hole in the eardrum has healed and when
it's okay to go back to regular water activities.
If a ruptured eardrum hasn't healed in 3 to 6
months, your child may need surgery (myringoplasty or tympanoplasty) to close
the hole. This surgery is rarely done because the eardrum usually heals on its
own within a few weeks. If a child has had many ear infections, you may delay
surgery until the child is 6 to 8 years old to allow time for
eustachian tube function to improve. At this point,
there is a better chance that surgery will work.
If amoxicillin-the most
commonly used antibiotic for ear infections-does not improve symptoms in 48
hours, your doctor may try a different antibiotic.
When taking
antibiotics for ear infection, it is very important that your child take all of
the medicine as directed, even if he or she feels better. Do not use leftover
antibiotics to treat another illness. Misuse of antibiotics can lead to
drug-resistant bacteria.
Most studies
find that decongestants, antihistamines, and other nonprescription cold
remedies usually do not help prevent or treat ear infections or fluid behind
the eardrum.
Children who have fluid behind the eardrum longer
than 3 months (chronic otitis media with effusion) may have trouble hearing and
need a hearing test. If there is a hearing problem, your doctor may also
prescribe antibiotics to help clear the fluid. But that usually doesn't help.
The doctor might also suggest placing tubes in the ears to drain the fluid and
improve hearing.
If your child is younger than 2, your doctor may
not wait 3 months to start treatment because hearing problems at this age could
affect your child's speaking ability. This is also why children in this age
group are closely watched when they have ear infections.
Tubes can
help young children who have fluid that stays behind the eardrum. But having
tubes inserted before age 3 does not help child development.8
Children who get rare but serious problems from
ear infections, such as infection in the tissues around the brain and spinal
cord (meningitis) or infection in the bone behind the ear
(mastoiditis), need treatment right away.
When used along with
other treatments, removing adenoids (adenoidectomy) can help some children with
repeat ear infections.5 But taking out the tonsils
(adenotonsillectomy) is not very helpful.7
Not smoking. Ear infections are more common in
children who are around cigarette smoke in the home. Even fumes from tobacco
smoke on your hair and clothes can affect the child.
Breast-feeding
your baby. There is some evidence that breast-feeding helps reduce the risk of
ear infections, especially if ear infections run in your family. If you
bottle-feed your baby, don't let your baby drink a bottle while he or she is
lying down.
Washing your hands often. Hand-washing stops infection
from spreading by killing germs.
Having your child
immunized. Current immunizations don't specifically
prevent ear infections. But they can prevent illnesses, such as
Haemophilus influenzae (Hib) and
flu (influenza) that may lead to ear infections. Have
your child immunized at the ages suggested by national guidelines. For more
information, see the topic
Immunizations.
Taking your child to a smaller
child care center. Fewer children means less contact with bacteria and viruses.
Children in child care settings can easily spread germs to each other. Try to
limit the use of any group child care. For more information, see the topic
Choosing Child Care.
Not giving your baby
a pacifier. Try to wean your child from his or her pacifier before about 6
months of age. Babies who use pacifiers after 12 months of age are more likely
to develop ear infections.
Home Treatment
Rest and care at home is often all
children with
ear infections need. Up to 8 out of 10 ear infections
get better without treatment.2 If your child is mildly
ill and home treatment takes care of the earache, you may choose not to seek
treatment for the ear infection.
At home, try:
Using pain relievers. Pain relievers such as
nonsteroidal anti-inflammatory medicines (such as
Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol) will help your
child feel better. Giving your child something for pain before bedtime is
especially important. Do not give aspirin to anyone younger than 20 because it is linked to
Reye syndrome, a serious illness that needs emergency
care.
Applying heat to the ear, which may help with pain. Use a
warm washcloth or a heating pad. Do not allow children to go to bed with a
heating pad. They could get burned. Use a heating pad only if your child is old
enough to tell you if it's getting too hot.
Encouraging rest.
Resting will help the body fight the infection. Arrange for quiet play
activities.
Using eardrops. Doctors often suggest eardrops for
earache pain. Don't use eardrops without a doctor's advice, especially if your
child has tubes in his or her ears. For more information, see
the safest way to insert eardrops.
Decongestants,
antihistamines, expectorants, and other
over-the-counter cold remedies usually do not work for
treating or preventing ear infections. Antihistamines that cause sleepiness may
thicken fluids, which can make your child feel worse. Check with the doctor
before giving these medicines to your child. Experts say not to give
decongestants to children younger than age 2.
If your child with
an ear infection must take an airplane trip, talk with your doctor about how to
help your child cope with ear pain during the trip.
If your child
isn't better after a few days of home treatment, call your doctor.
If your child has a
ruptured eardrum or has ear tubes in place, keep water
from getting in the ear when your child takes a bath or a shower or goes
swimming. The ear could get infected if any germs in the water get into the
ear. If your doctor says it's okay, your child may use earplugs. Or your doctor
may have other advice for you. He or she can tell you when the hole in the
eardrum has healed and when it's okay to go back to regular water
activities.
Medications
Antibiotics can
treat
ear infections. But most children with ear infections
get better without them. If the care you give at home relieves pain, and a
child's symptoms are getting better after a few days, you may not need
antibiotics.
In the United States, many doctors use antibiotics
for middle ear infections in children younger than age 2. This is often because
children this young are at higher risk for
complications. For children ages 2 and older, many
doctors wait for a few days to see if the ear infection will get better on its
own. When doctors do prescribe antibiotics, they most often use amoxicillin
(Amoxil) because it works well and costs less than other brands.
Experts suggest a hearing test if a child has had fluid
behind his or her eardrum longer than 3 months. Normal hearing is critical
during the first 2 years when your child is learning to talk. Your doctor may
prescribe antibiotics to help clear the fluid. But that usually doesn't help.
The doctor may also suggest placing tubes in the ears to drain fluid and
improve hearing.
Other medicines that can treat symptoms of ear infection
include:
Acetaminophen (for example, Tylenol) and
nonsteroidal anti-inflammatory medicines (for example,
Advil, Motrin, and Aleve), for pain and fever. Do not give aspirin to anyone younger than 20 because of its link to
Reye syndrome, a serious illness that needs emergency
care.
Pain medicines such as codeine and some eardrops, which
help with severe earache. But do not use eardrops if the eardrum is
ruptured. For more information, see
the safest way to insert eardrops.
Sometimes corticosteroids,
known as steroids, are given with antibiotics to get rid of fluid behind the
eardrum (otitis media with effusion). Steroids are not a
good choice for treating otitis media. Do not use steroids if a child has been
around someone with chickenpox within the last 3 weeks.
Decongestants, antihistamines, expectorants, and other
over-the-counter cold remedies usually do not work
well for treating or preventing ear infections. Antihistamines that may make
your child sleepy can thicken fluids and may actually make your child feel
worse. Check with the doctor before giving these medicines to your child.
Experts say not to give decongestants to children younger than 2.
Medication Choices
Antibiotics may help cure ear
infections caused by bacteria.
What To Think About
Some doctors prefer to treat all
ear infections with antibiotics. Some things to consider before your child
takes antibiotics include:
Risk for antibiotic-resistant bacteria. The
greatest problem with using antibiotics to treat ear infections is the
possibility of creating bacteria that can't be killed by the usual antibiotics
(antibiotic-resistant bacteria). Using antibiotics only
when they're needed can slow down this process.
Side effects of
antibiotics. Mild side effects, such as diarrhea and rash, from taking
antibiotics are common. Severe side effects are rare.
Cost. Most
antibiotics are expensive. You may want to weigh the cost against the fact that
most ear infections clear up without treatment.
If your child still has symptoms (fever and earache)
longer than 48 hours after starting an antibiotic, a different antibiotic may
work better. Call your doctor if your child isn't feeling better after 2 days
of antibiotic treatment.
Surgery
Surgery for
middle ear infections (acute otitis media) often means
placing a drainage tube into the eardrum of one or both ears. It's one of the
most common childhood operations. While the child is under
general anesthesia, the surgeon cuts a small hole in
the eardrum and inserts a small plastic tube in the opening (myringotomy or
tympanostomy with tube placement).
The tubes will ventilate the
middle ear after the fluid is gone. And they help relieve hearing
problems.
Doctors consider tube placement for children who have
had repeat infections or fluid behind the eardrum in both ears for 3 to 4
months and have trouble hearing. Sometimes they consider tubes for a child who
has fluid in only one ear but also has trouble hearing.
Adenoid removal (adenoidectomy) or adenoid and tonsil removal (adenotonsillectomy) may help some children who have repeat ear
infections or fluid behind the eardrum. But doctors tend to suggest these
surgeries only after tubes have failed to prevent repeat ear
infections.3 Children younger than 4 don't usually
have their adenoids taken out unless they have severe nasal blockage. Taking
out the tonsils alone is not usually done unless a child has another reason to
have them removed.
What To Think About
Most tubes stay in place for
about 6 to 12 months, after which they usually fall out on their own. After the
tubes are out, the hole in the eardrum usually closes in 3 to 4 weeks. Some
children need tubes put back in their ears because fluid behind the eardrum
returns.
In rare cases, tubes may scar the eardrum and lead to
permanent hearing loss.
Doctors suggest tubes if fluid behind the
ear or ear infections keep coming back. Learn the pros and cons of this
surgery. Before deciding, ask how the surgery can help or hurt your child and
how much it will cost.
Surgeons sometimes operate to close a
ruptured eardrum that hasn't healed in 3 to 6 months,
though this is rare. The eardrum usually heals on its own within a few
weeks.
If your child has a ruptured eardrum or has ear tubes in
place, keep water from getting in the ear when your child takes a bath or a
shower or goes swimming. The ear could get infected if any germs in the water
get into the ear. If your doctor says it's okay, your child may use earplugs.
Or your doctor may have other advice for you. He or she can tell you when the
hole in the eardrum has healed and when it's okay to go back to regular water
activities.
Other Treatment
If a child with an
ear infection has a bad earache, a doctor may perform
tympanocentesis. He or she puts a needle through the
eardrum to remove fluid from behind the eardrum. It helps ease pain. The fluid
is sometimes sent to a lab for testing. A
culture and sensitivity test may find out what is
causing the infection. Then your doctor can choose the antibiotic that will
work best for your child.
Allergy treatment can help children who
have allergies and who also have frequent ear infections. Allergy testing isn't
suggested unless children have signs of allergies.
Some people use
herbal remedies, such as echinacea and garlic oil capsules, to treat ear
infections. There is no scientific evidence that these therapies work. If you
are thinking about using these therapies for your child's ear infection, talk
with your doctor.
Other Places To Get Help
Organizations
American Academy of Family
Physicians
P.O. Box 11210
Shawnee Mission, KS 66207-1210
Web Address:
www.familydoctor.org
The American Academy of Family Physicians produces a variety of
health-related educational materials. Its Web site offers a health library and
bulletin board, news, and comments sections.
American Academy of Otolaryngology-Head and Neck Surgery
(AAO-HNS)
1650 Diagonal Road
Alexandria, VA 22314-2857
Phone:
(703) 836-4444
Web Address:
www.entnet.org
The American Academy of Otolaryngology-Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone:
(847) 434-4000
Fax:
(847) 434-8000
E-mail:
kidsdocs@aap.org
Web Address:
www.aap.org
The American Academy of Pediatrics (AAP) offers a
variety of educational materials, such as links to publications about parenting
and general growth and development. Immunization information, safety and
prevention tips, AAP guidelines for various conditions, and links to other
organizations are also available.
KidsHealth for Parents, Children, and
Teens
4600 Touchton Road East, Building 200
Suite 500
Jacksonville, FL 32246
Phone:
(904) 232-4100
Fax:
(904) 232-4125
Web Address:
www.kidshealth.org
This Web site is sponsored by Nemours Foundation. It has
a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This Web site
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly e-mails about your area of interest.
National Institute on Deafness and Other Communication
Disorders
31 Center Drive, MSC 2320
Bethesda, MD 20892-2320
Phone:
1-800-241-1044
TDD:
1-800-241-1055
E-mail:
nidcdinfo@nidcd.nih.gov
Web Address:
www.nidcd.nih.gov
The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The Web site has information about hearing,
balance, smell, taste, voice, speech, and language.
Kelley PE, et al. (2009). Ear, nose, and throat.
In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 437-470. New York: McGraw-Hill.
Bradley-Stevenson C, et al. (2007). Otitis media in
children (acute), search date January 2007. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Klein JO, Bluestone CD (2004). Otitis media. In RD
Feigin et al., eds, Textbook of Pediatric Infectious Diseases, vol. 1, 5th ed., pp. 215-234. Philadelphia:
Saunders.
American Academy of Pediatrics and American Academy of
Family Physicians (2004). Clinical practice guideline: Diagnosis and management
of acute otitis media. Pediatrics, 113(5):
1451-1465.
Rowe LD (2006). Otitis media with effusion section of
Otolaryngology-Head and neck surgery. In GM Doherty, LW Way, eds.,
Current Surgical Diagnosis and Treatment, 12th ed., pp.
943-944. New York: Lange Medical Books/McGraw-Hill.
Macfadyen CA, et al. (2006). Systemic antibiotics
versus topical treatments for chronically discharging ears with underlying
eardrum perforations. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Rovers MM, et al. (2004). Otitis media.
Lancet, 363(9407): 465-473.
Paradise JL, et al. (2007). Tympanostomy tubes and
developmental outcomes at 9 to 11 years of age. New England Journal of Medicine, 356(3): 248-261.
Pneumococcal vaccine (Prevnar) for otitis media
(2003). Medical Letter on Drugs and Therapeutics, 45
(W1153B): 27-28.
Other Works Consulted
Glasziou PP, et al. (2004). Antibiotics for acute
otitis media in children. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Kerschner JE (2007). Otitis media. In RM Kliegman et
al., eds., Nelson Textbook of Pediatrics, 18th ed., pp.
2632-2646. Philadelphia: Saunders Elsevier.
National Guideline Clearinghouse (2008).
Guideline Synthesis: Acute Otitis Media. Available
online:
http://www.guideline.gov/Compare/comparison.aspx?file=OTITIS_AOM4.inc.
National Guideline Clearinghouse (2008).
Guideline Synthesis: Otitis Media With Effusion.
Available online:
http://www.guideline.gov/Compare/comparison.aspx?file=OTITIS_OME3.inc.
Yates PD, Anari S (2008). Otitis media. In AK Lalwani,
ed., Current Diagnosis and Treatment in Otolaryngology-Head and Neck Surgery, pp. 655-665. New York: McGraw-Hill.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Kelley PE, et al. (2009). Ear, nose, and throat.
In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 437-470. New York: McGraw-Hill.
Bradley-Stevenson C, et al. (2007). Otitis media in
children (acute), search date January 2007. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Klein JO, Bluestone CD (2004). Otitis media. In RD
Feigin et al., eds, Textbook of Pediatric Infectious Diseases, vol. 1, 5th ed., pp. 215-234. Philadelphia:
Saunders.
American Academy of Pediatrics and American Academy of
Family Physicians (2004). Clinical practice guideline: Diagnosis and management
of acute otitis media. Pediatrics, 113(5):
1451-1465.
Rowe LD (2006). Otitis media with effusion section of
Otolaryngology-Head and neck surgery. In GM Doherty, LW Way, eds.,
Current Surgical Diagnosis and Treatment, 12th ed., pp.
943-944. New York: Lange Medical Books/McGraw-Hill.
Macfadyen CA, et al. (2006). Systemic antibiotics
versus topical treatments for chronically discharging ears with underlying
eardrum perforations. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Rovers MM, et al. (2004). Otitis media.
Lancet, 363(9407): 465-473.
Paradise JL, et al. (2007). Tympanostomy tubes and
developmental outcomes at 9 to 11 years of age. New England Journal of Medicine, 356(3): 248-261.
Pneumococcal vaccine (Prevnar) for otitis media
(2003). Medical Letter on Drugs and Therapeutics, 45
(W1153B): 27-28.
