A two-year-old child with cold symptoms for over a week presents to his pediatric healthcare provider. His symptoms have recently worsened with fever and night wakening with inconsolable crying. He has been pulling on his ear. After an examination in the office, the parents are told, “Your child has an ear infection.” Most parents have experienced this at least once, but why?

Middle ear infection or otitis media is common among young children, as their eustachian tube is shorter and straighter than an older child’s. The eustachian tube, which runs from the throat to the middle ear, is filled with air and equalizes pressure (think popping your ears in a tunnel).

With a cold, the congestion and fluid builds into the middle ear causing infection, pressure, and pain. The pain can increase with chewing or swallowing. The pressure can interfere with hearing. Ear infections are not contagious, but the viral illness (cold) certainly is contagious.

Ear infections are most common in toddlers and young children. Exposure to smoke from cigarettes or fire (fireplaces, fire pits) can increase the risk of ear infections, as can daycare exposure (increased exposure to illness). Family history of ear infections can be significant.

Breast feeding results in a lower risk for ear infection. Vaccinating your child is also protective against ear infection. The PCV-13 (pneumococcal vaccine) protects your child against several bacterial strains which can cause ear infections, as well as preventing meningitis, pneumonia, and blood infections. Handwashing is a simple way to decrease the risk of viral infections.

If you are concerned that your child may have an ear infection, see your pediatric healthcare provider, who will examine your child’s ear with an otoscope, which allows visualization of the tympanic membrane (eardrum). Your provider will discuss appropriate treatment options with you, which may include antibiotic therapy and acetaminophen (for pain). 

If your child is prescribed an antibiotic, she should complete the full course of antibiotics even if she is feeling better in a few days. It is dangerous to partially treat an infection. A follow-up exam in three weeks is recommended to be certain that the infection has completely resolved.

If your child has recurrent otitis media, you may be referred to an ear, nose, and throat (ENT) specialist. The specialist may consider ear tubes (PE tubes), which are hollow tubes placed surgically under anesthesia to allow the middle ear to drain. This decreases ear infections.

The good news is that kids generally outgrow ear infections. Warmer weather (c’mon summer) is also helpful as children get fewer viral illnesses.

For more information, please visit www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/ear-infection.html