Recurrent Ear Infections

Ear infections

overview

Ear infections occur frequently in children and are among the most common reasons parents take their children to the doctor. By school age, nearly all children will have experienced at least one ear infection.

It is important to distinguish between an ear infection and an effusion. An infection consists of fluid behind the eardrum that causes redness and inflammation of the eardrum, typically caused by a virus or bacteria. An effusion is when fluid is present behind the eardrum, but there is no redness or inflammation of the eardrum; in other words, the fluid is not related to an infection.

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Ear infections

overview

Ear infections occur frequently in children and are among the most common reasons parents take their children to the doctor. By school age, nearly all children will have experienced at least one ear infection.

It is important to distinguish between an ear infection and an effusion. An infection consists of fluid behind the eardrum that causes redness and inflammation of the eardrum, typically caused by a virus or bacteria. An effusion is when fluid is present behind the eardrum, but there is no redness or inflammation of the eardrum; in other words, the fluid is not related to an infection.

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Symptoms

Symptoms of an ear infection can vary, but may include the following:

Ear pain
Fever
Decreased hearing
Dizziness/balance issues
Sleeping difficulties

Causes

Ear infections can be caused by the following:

Viruses: The majority of ear infections are caused by viruses.
Bacteria: Ear infections caused by bacteria tend to present with higher fever or last longer than infections caused by a virus

Risk Factors

Age: Children between 6 months and 2 years of age are more likely to develop ear infections secondary to their developing immune system and the shape of their eustachian tube (see image left). The shape of an infant’s eustachian tube is more horizontally shaped compared to the adult orientation, which is more vertical in nature.
Daycare: Children that attend daycare have a higher propensity of developing ear infections compared to children that stay home due to the exposure to viruses and bacteria in the daycare setting.
Allergies: Children with seasonal allergies are more prone to have fluid levels behind the eardrum during allergy season.
Environment: Second-hand smoke and living in an area of high air pollution have been correlated with a higher incidence of ear infections.
Feeding: Infants who drink a bottle while lying flat, especially at night prior to going to sleep, are at higher risk for developing ear infections.
Anatomy: Infants with a cleft palate or adenoid enlargement tend to have more ear infections than average.

Symptoms

Symptoms of an ear infection can vary, but may include the following:

Ear pain
Fever
Decreased hearing
Dizziness/balance issues
Sleeping difficulties

Causes

Ear infections can be caused by the following:

Viruses: The majority of ear infections are caused by viruses.
Bacteria: Ear infections caused by bacteria tend to present with higher fever or last longer than infections caused by a virus

Risk Factors

Age: Children between 6 months and 2 years of age are more likely to develop ear infections secondary to their developing immune system and the shape of their eustachian tube. The shape of an infant’s eustachian tube is more horizontally shaped compared to the adult orientation, which is more vertical in nature.
Daycare: Children that attend daycare have a higher propensity of developing ear infections compared to children that stay home due to the exposure to viruses and bacteria in the daycare setting.
Allergies: Children with seasonal allergies are more prone to have fluid levels behind the eardrum during allergy season.
Environment: Second-hand smoke and living in an area of high air pollution have been correlated with a higher incidence of ear infections.
Feeding: Infants who drink a bottle while lying flat, especially at night prior to going to sleep, are at higher risk for developing ear infections.
Anatomy: Infants with a cleft palate or adenoid enlargement tend to have more ear infections than average.

Diagnosis

Diagnosis is made by physical exam. An instrument called an otoscope is used to visualize the eardrum. An inflamed or red eardrum with colored fluid behind the eardrum confirms an infection. In addition, tympanometry may be used to determine if the fluid is present behind the eardrum.

Diagnosis

Diagnosis is made by physical exam. An instrument called an otoscope is used to visualize the eardrum. An inflamed or red eardrum with colored fluid behind the eardrum confirms an infection. In addition, tympanometry may be used to determine if the fluid is present behind the eardrum.

Available Treatments

Treatment consists of one or more of the following:

Analgesics/Antipyretics

Tylenol and ibuprofen can be used for both pain and fever.

Adenoidectomy

The adenoids are located in the back of the nose, near the eustachian tube orifice, which connects the ear to the nose. The adenoid tissue can harbor chronic infection that leads to recurrent ear infections or can be enlarged to the point of blocking the eustachian tube opening. Removal of the adenoids may be an indicated step in the treatment of recurrent ear infections or persistent middle ear effusion.

Antibiotics

Indicated in children with moderate to severe ear pain for longer than 48 hrs or with a temperature greater than 102.2°F. Also indicated for children aged 6-23 months with a bilateral ear infection, even without severe ear pain or high fever.

Intranasal Steroid Spray

Indicated in some patients with non-infected fluid behind the eardrum.

Myringotomy and Tube Insertion

Patients with 3 or more ear infections in 6 months, or 4 or more infections in one year, with hearing loss or fluid is seen during the exam, are recommended to have ear tube placement. Another indication for tube placement is non-infected fluid behind the eardrum lasting longer than 3 months.

Treatment