Why do middle ear infections happen?

Ear infections occur in either the outer ear or in the middle ear (anatomically these infections are different).  Outer ear infections, “swimmer’s ear”, occur when water stagnates in the outer ear canal.  Middle ear infections occur when stagnant fluid in the middle ear becomes infected with bacteria.  Fluid from the middle ear normally drains through the Eustachian tube into the throat.  When the Eustachian tube is obstructed during a cold or allergy attack, fluid collects in the middle ear.  Some children carry fluid around in this space for several months until the Eustachian tube reopens.  Sometimes, bacteria that live in the mouth reach this fluid before it drains, leading to a middle ear infection.  The bacteria then cause redness, pus, pressure, & pain similar to an aggravated pimple.

When should I suspect an ear infection?

This is very difficult to accomplish without actually physically examining the ear.  However, if your child displays fever, fussiness, and/or ear pain several days after the beginning of a cold, we recommend you bring your child in to have their ears examined.

How are middle ear infections treated?

In young children, antibiotics are prescribed to kill the bacteria trapped in the middle ear.  Anti-inflammatories such as Tylenol or ibuprofen can alleviate much of the pain that comes with an ear infection. Studies show that in children over 2 years of age, 80% of ear infections will resolve without antibiotics.

How long will it take for improvement?

If there is no relief of pain after two to three days we may need to reexamine the ear and possibly change the type of antibiotic we are using.  One in ten ear infections will need a change of antibiotics because some bacteria are resistant to many of the antibiotics currently available.

Can we prevent all ear infections from happening by treating all colds with antibiotics?

This method is neither safe nor practical.  First, only a very small percentage of colds result in a middle ear infection.  Second, after the cold is gone, fluid and therefore the potential for infection still persist. Third, unnecessary antibiotics can lead to unnecessary diarrhea, rashes, allergic reactions, and  most importantly antibiotic-resistant bacteria.  It is safest to treat ear infections only when they occur.

Why do infants get so many more ear infections than adults?

Children’s Eustachian tubes are much smaller in diameter and more horizontal than those of adults.  Some families have smaller Eustachian tubes than others.  Also, children get more colds than adults. The good news is that the tubes grow, become more vertical, and are challenged less by viruses as children age. However, some children with recurrent ear infections may need tubes placed in their eardrums temporarily until this happens.

 Are ear infections contagious?

No.  The cold which precedes the ear infection is caused by a virus.  This virus itself is contagious, however the ear infection is not.

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