Guide to Ear problems in Children

Ear infections are common in children, and many children suffer one at least once during their childhood. Children are more susceptible to ear infections as compared to adults because the structure of the ear changes as one is growing up. This article will help you further understand ear infections in children.

Children can suffer temporary deafness when pus or fluid accumulates in the the ear canal at the back of an eardrum. They may even experience their ear drum bursting, followed by a fluid oozing out and a sensation of relief. This may sound dramatic, but the eardrums usually heal up normally without needing much attention.

However, antibiotics may become necessary if the infection is serious or lasts a long time.

What are the types of ear infections?

The two common types of inner infections are middle ear infections and outer ear infections.

Middle ear infection

This infection occurs when bacteria or viruses infiltrate the ear through the Eustachian tube. In children, this structure is short and narrow, running from the throat to the middle ear. This small size makes younger people more susceptible to infections as compared to adults, who, in contrast, have longer tubes.

An infection can also arise when a sinus allergy induces swelling and blocks the Eustachian tube. This eventually leads to fluid accumulation and a rise in pressure accompanied by pain. In most cases, the fluid will drain by itself after a few days, and treatment is not necessary.

However, in cases where the fluid is not discharged fast enough, the pressure can build up enough to cause a burst eardrum. The pressure relief reduces pain, and the eardrum should begin to heal by itself. Still, it is worthwhile to get medical attention as soon as possible.

Outer ear infection

Also known as otitis externa or swimmer’s ear, it occurs due to high moisture levels in the ear canal. The most common cause is swimming in dirty water, which is a vector for pathogens.

Other causes include damage to the ear canal from the insertion of foreign objects, most commonly cotton buds. 

In both cases, the ear canal gets exposed to possible physical injury and the introduction of infectious pathogens.

What are the symptoms of an ear infection?

Ear infections can be categorised into 3 types, each with various traits.

Acute otitis media (AOM)

Children usually go through this in their childhood. The inner parts can swell up, and fluid builds up behind the eardrum. Symptoms may include fever or pain in the ear.

Otitis media with effusion (OME) 

It usually happens when an ear infection has ceased, but the fluid is still confined behind the eardrum. Moreover, it is hard to identify as the child may show no symptoms. The doctor will have to use special apparatus to determine if there is fluid at the back of the eardrum.

Chronic otitis media with effusion (COME)

COME is marked by the persistent or recurring presence of fluid in the middle ear without an apparent infection. This makes the child vulnerable to further infections and can even present a risk to their hearing.

How can I tell if my child has an ear infection?

Most ear infections occur before a child has learned to talk. As such, your children may be unable to effectively communicate their pains even if they have an ear infection. 

Check if your infant has a fever, is agitated and crying, or has trouble sleeping, hearing, and responding to soft sounds. A child with an ear infection will constantly have fingers in their ear and might also keep pulling their ears. Moreover, ear infections can also affect the balance in children.

What causes an ear infection?

In children, it usually starts with a pain in the throat, cold, or infection in the upper respiratory tract. Ear infections are caused mainly by bacteria and viruses. Bacterias travel through the upper respiratory tract into the ear, causing an infection. In case of a viral infection, like the common cold, it may also attract bacteria and lead to a secondary infection. This leads to fluid buildup behind the eardrum.

To understand the functionality of an ear throughout this process, let us first start by considering the three basic parts of the ear; the outer, middle, and inner ear. 

The outer ear

Medically, the term auricle or pinna is used for the outer ear. It includes whatever can be seen outside, like the curved part of the ear that ends at the earlobe. It also involves the ear canal, which starts at the small opening of the ear and leads to the eardrum, a transparent grey membrane. It serves as a barrier between the outer ear and the middle ear.

The middle ear

This is between the eardrum and the inner ear. Also, there are 3 small bones within the middle ear that are responsible for carrying sound vibrations from the eardrum to the inner ear. These bones have air all around them and are known as stapes, malleus, and incus. 

The inner ear

This part of the ear carries the hearing and balance apparatus. The labyrinth in the inner ear helps us keep our balance. A small portion of the inner ear, the cochlea, is a snail-shaped organ responsible for converting sound vibrations into electrical signals. 

The cochlear nerve further transmits these signals to the brain. 

These are only the major parts of the ear. There are other parts of the ear that aid in its functionality, such as the Eustachian tubes. It helps clear out the fluid in the middle ear, while supplying fresh air and maintaining a steady pressure between the nose and the ear. 

Adenoids, on the other hand, are the mass of enlarged lymphatic tissues located between the back of the nose, and the throat,  neaR the Eustachian tubes. They mostly consist of immune cells that can fight off infections that may enter through the mouth via a trapping action.

Why are children more likely than adults to get ear infections?

Children in their early years do not have a fully developed immune system, which makes them vulnerable to infections. Adenoids can sometimes come in handy in preventing infections. Still, bacteria often gets stuck in the adenoids, resulting in a chronic infection that eventually transmits to the middle ear through the Eustachian tubes.

Children have short and narrow Eustachian tubes, which cause difficulty clearing out fluid even under normal circumstances. Moreover, the blockage of Eustachian tubes due to several conditions also causes them to swell, which hinders fluid drainage.

How does a doctor diagnose a middle ear infection?

As part of an initial diagnosis, doctors might ask the following questions.

• Is he/she having sound sleep?
• Did your child catch a fever?
• Is the child experiencing pain in the throat?
• Is the child tugging or rubbing the ears?

After this, the doctor will check for infection and fluid using a special apparatus called an otoscope.

If an eardrum is swollen and red, it clearly indicates an infection. Tympanometry helps in the evaluation of proper middle ear functioning. It looks like a tiny plug that uses a microphone and speaker. It also has a tool that uses different air pressures to test the eardrum’s flexibility.

Furthermore, the fluid behind an eardrum is hard to identify. Therefore, a doctor might use a pneumatic otoscope. It blows air into the ear canal to check for the trapped fluid behind the eardrum. If everything is fine, the eardrum will easily move back and forth, and if fluid is trapped there, the eardrum will be more rigid.

How is an acute middle ear infection treated?

Doctors typically recommend to start an antibiotic course within 2 to 3 days if there is no improvement in the condition, after symptoms first appear. Antibiotics such as amoxicillin need to be taken for a course of 7 to 10 days. Some pain relievers such as acetaminophen or ibuprofen are also prescribed. Most often, the doctor also gives ear drops to relieve fever and pain. 

Ensure a proper diagnosis of your child. In some cases, doctors unable to diagnose the condition might ask you to wait a day or two to see if the earache goes away. As per the guidelines of the American Academy of Paediatrics issued in 2013, it is important to treat ear infections on time, especially in children aged between 6 months to 2 years of age.

An infection is not the only cause of an earache, and it often gets better on its own without any treatment or the use of antibiotics. 

It’s essential that you complete the full course of antibiotics in precisely the same way as prescribed by your doctor. It may initially look like the condition has resolved itself, but the infection can still be lurking inside. After completing the medication course, take your children to the doctor for a follow-up to check if the infection is eliminated or if further treatments are necessary.

Getting GP Help for Ear Infections in Children

Small children are prone to ear infections, and it is important for parents to get proper treatment on time. Children might get various types of ear infections too. 

The build-up of fluid at the back of the eardrum causes a glue ear (fluid buildup). Usually, it does not require treatment. However, the consistent presence of fluid behind the ears for a long time can negatively impact hearing development. If the infection worsens, minor surgery may be required to clear out the fluid using grommets.

Moreover, doctors prescribe antibiotics for inner ear infections, whereas ear drops are recommended for outer ear infections. Get in touch with a GP who can treat ear infections when you notice a child may need help.