Ear infections are more common in children than adults, mainly because children engage in more activities that can provoke an ear infection, such as drinking from a baby bottle or sippy cup while lying down or failing to remove water that’s lodged in the ear canal promptly. The Eustachian tubes and immune systems of kids who are six months to two years also are still developing and growing. They may also be in a situation, such as nursery school or group childcare, with kids who are sick but still present at the school, transmitting infections to their peers.
An ear infection is caused by viruses or bacteria that lodge in the middle ear. It typically occurs when the sufferer has the flu, cold or an allergy, causing congestion and nasal passage swelling that can back up into the Eustachian tubes as the nose and throat swell. The Eustachian tubes run from the middle ear to the back of the throat, behind the nasal passages. The tubes are used to regulate air pressure in the middle ear, refresh the ear’s air and drain secretions from the area. When the tubes close as a result of swelling, mucous or inflammation, the accumulated fluids have nowhere to go but back into the middle ear. Children suffer the most because their tubes are narrow and more easily blocked, making them more difficult to drain.
Adenoids May Be the Culprits
Adenoids are two small pads of tissues in the higher regions of the back of the nose that are responsible for immune system activity. That makes them especially vulnerable to inflammation and infection. Because they are located near the Eustachian tube openings, they are key to ear infections. When they enlarge because of infection or inflammation, they block the tubes, thus backing up fluids into the middle ear. Children’s adenoids are larger than adult versions, making them particularly susceptible to this problem.
In some cases, there’s a condition known as otitis media with effusion, which means there is inflammation and fluid build-up without a bacterial infection or virus. This occurs when fluid remains in the middle ear after the infection subsides or if the Eustachian tubes aren’t back to normal function and remain blocked. There is also a condition known as chronic suppurative otitis media, which is a stubborn ear infection that can perforate or tear the eardrum.
Symptoms of an Ear Infection
Acute pain is the primary feature of ear infections, and relief can’t be found sitting or standing. Children will have difficulty sleeping, and the pain will cause them to cry or be cranky. They may have difficulty hearing or walking, have a high fever, headache and loss of appetite. They also may experience ear canal drainage. Adults have many of the same symptoms.
Ear infections are more common in the fall and winter months, i.e., cold and flu season. Those with seasonal allergies may also see a spike when pollen counts rise or other conditions occur, like Santa Ana winds carrying dust and debris from the desert. Air pollution can be a significant factor in aggravating the risk of ear infections, particularly if the child is persistently around smokers.
Complications of Ear Infections
Beyond the pain experienced by the child and the helplessness of the parent, most ear infections don’t result in any lasting issues. But if the ear infections are frequent, it can impair the hearing by maintaining fluids in the ear, causing some permanent pressure damage to the eardrum or other middle ear structures.
Any resulting hearing impairment could affect a child’s speech, intellectual development or social skills. In addition, frequent infections in the ear have the potential to spread to nearby tissues. In some cases, there’s a condition called mastoiditis, or infection of the mastoid, which is damage to the bone behind the ear. Pus-filled cysts can form with frequent infections, and there is potential for infections to spread to other areas of the head, including the brain.
In rare cases, inner ear pressure is so great that the eardrum tears and requires surgical repair.
Diagnosis and Treatment
An office exam is usually sufficient for a doctor to diagnose an ear infection. The doctor will use an otoscope to look at the ears, nose and throat and listen for breathing issues with a stethoscope.
There are also more complicated tests that may be performed if the initial tests don’t provide a firm diagnosis. These include tympanometry, which measures the movement of the eardrum; acoustic reflectometry, which measures sound emitted from a device and bounced back from the eardrum; and tympanocentesis, which is a tiny tube that will pierce the ear drum to drain fluid and test it.
Most parents will be advised to treat the issue with warm compresses on the infected ear and over-the-counter medications like Tylenol or Advil to help with pain issues. Doctors may also recommend ear drops (Aurodex) that can help with ear pain in those who don’t have a perforated eardrum.
Fortunately, the trauma of an ear infection will soon go away, and your child will eventually mature and have larger Eustachian tubes that drain more effectively. Removal of the adenoids and tonsils may be necessary to help stop too-frequent ear infections. But rest assured, in most cases, ear infections are minor annoyances that soon will be unhappy but uneventful memories for the child and parents.