Ear Infection in Kids: Ear Canal & Middle Ear | Kids Clinic Singapore


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Ear Infections in Kids (Acute Otitis)

Ear Infections in Children

Ear infections can be typically categorized into two types depending on which part of the ear becomes infected, either in the ear canal or in the middle ear. Here, we explain these in detail.
Ear Infections In Children
Ear infections in kids can occur in the ear canal or the middle ear.

1. Acute Otitis Externa (Ear Canal Infection)

Acute otitis externa is a condition that occurs when the ear canal becomes irritated/infected. The ear canal is the part of the ear that leads from the outer ear to the ear drum. Acute otitis externa can develop as a result of an infection, allergy, or skin problem. “Swimmer’s ear” is the name for acute otitis externa that occurs in a person who swims frequently. Acute otitis externa is different from acute otitis media (middle ear infection). When a person says that they have an ear infection, they usually mean that they have otitis media.

What are the Risk Factors for Acute Ear Infection?

Several factors can increase your risk of developing acute ear canal infection:
  • Cleaning the ear canal removes ear wax. Ear wax serves to protect the ears from water, bacteria, and injury. Excessive cleaning or scratching can injure the skin, potentially leading to infection.
  • Swimming on a regular basis removes some of the ear wax, allowing water to soften the skin. Bacteria, which normally live in the ear canal, can then enter the skin more easily.
  • Wearing devices that block the ear canals, such as hearing aids, headphones, or ear plugs, can increase the risk of acute ear canal infection (if worn frequently) by injuring the skin.

What are the Symptoms of Acute Ear Infection?

The most common symptoms of acute ear infection include:
  • Pain in the outer ear, especially when the ear is pulled or moved
  • Itchiness of the ear
  • Fluid or pus leaking from the ear
  • Difficulty hearing clearly

How is Acute Ear Infection Diagnosed?

If you think your child could have an external ear infection, you should bring him/her to see a doctor, who will examine the outside and inside of the ear to confirm the diagnosis.

What is the Treatment for Acute Ear Infection?

Treatment of acute ear infection aims to reduce pain and eliminate the infection. Most children with acute ear infection can be treated at home. If the infection is severe or your eardrum is ruptured, your child will be referred to an ear, nose, and throat specialist (an otolaryngologist) for an examination and treatment. Ear drops (containing antibiotics and/or anti-inflammatory medications) are usually prescribed to treat the infection and reduce pain/swelling caused by acute otitis externa. It is important to apply the ear drops for your child correctly so that they reach the ear canal:
  • Lie your child on the side or ask him/her to tilt his/her head towards the opposite shoulder.
  • Place the ear drops in the ear canal.
  • Lie on the side for 20 minutes
Finish the entire course of treatment, even if your child begins to feel better within a few days. Your child should begin to feel better within 36 to 48 hours of starting treatment. If your pain worsens or does not improve within this time period, call your child’s doctor. Pain medications, such as Paracetamol or Ibuprofen, can be used to reduce the pain/discomfort caused by acute ear infection. During treatment, you should avoid getting the inside of your child’s ears wet, with the exception of administering the ear drops. Your child should not swim for 7 to 10 days after starting treatment. Avoid wearing hearing aids and in-ear headphones until pain improves.

How to Prevent Acute Ear Infection?

The old saying, “Don’t put anything smaller than your elbow in your ear” to clean the ear is true. The ear is self-cleaning; fingers, towels, cotton-tipped applicators, and other devices should not be used to clean the inside of the ears. If you feel that you need to clean excessive wax from your child’s ears, talk to your child’s doctor. They may want to examine your ears to see if the ear wax is excessive. It is normal to have some ear wax (also called cerumen). If your child has an excessive amount of ear wax, talk to your child’s doctor about safe ways to clean your ears. If your child swims frequently, experts recommend the following tips to reduce the chance of developing acute ear infection:
  • Ask your child to shake his/her ears dry after swimming.
  • Blow-dry your child’s ears on a low setting, holding the dryer 12 inches away.
  • Consider wearing ear plugs made for swimming.

2. Acute Otitis Media (Middle Ear Infection)

Middle ear infections, also called otitis media, are a common problem in children. Ear infections can cause pain in the ear, fever, and temporary hearing loss, and general signs such as loss of appetite and irritability. Some children get better without specific antibiotic treatment, but most young children benefit from use of an antibiotic.

What is a Middle Ear Infection?

Middle ear infection, also known as acute otitis media (otitis = ear, media = middle), is an infection of the middle section of the ear. Most of the time, it is caused by bacteria, which nearly all children have in their nose and throat at one time or another. They most often develop after a viral respiratory tract infection, such as a cold or the flu. These infections can cause swelling of the mucous membranes of the nose and throat and diminish normal host defenses such as clearance of bacteria from the nose, increasing the amount of bacteria in the nose. Viral respiratory tract infections also can impair Eustachian tube function. Normal Eustachian tube function is important for maintaining normal pressure in the ear. Impaired Eustachian tube function changes the pressure in the middle ear (like when you are flying in an airplane). Fluid (called an effusion) may form in the middle ear and bacteria and viruses follow, resulting in inflammation in the middle ear. The increased pressure causes the eardrum to bulge, leading to the typical symptoms of fever, pain, and fussiness in young children.

What are the Symptoms of Middle Ear Infections?

Symptoms of a middle ear infection in adolescents and older children may include ear aching or pain and temporary hearing loss. These symptoms usually come on suddenly. In infants and young children, symptoms of an ear infection can include:
  • Fever
  • Pulling on the ear
  • Fussiness or irritability
  • Decreased activity
  • Lack of appetite or difficulty eating
  • Vomiting or diarrhea
  • Draining fluid from the outer ear (called otorrhea)

How is a Middle Ear Infection Diagnosed?

If you suspect that your child has an ear infection, bring him/her to see the doctor who will need to examine his/her ears. Although the exam is not painful, most infants and children do not like having their ears examined. To make the process easier, hold your child in your lap and hug your child’s arms and body while the doctor or nurse uses an instrument (otoscope) to look inside the child’s ear. Often cerumen (ear wax) will need to be removed so your child’s doctor can get a good view of the ear drum. The child’s doctor can tell if your child has an ear infection by looking at the ear drum (tympanic membrane) for the typical features of an ear infection.

What is the Treatment for Middle Ear Infection?

Treatment of a middle ear infection may include:
  • Antibiotics
  • Medicines to treat pain and fever
  • Observation
  • A combination of the above
The “best” treatment depends on the child’s age, history of previous infections, degree of illness, and any underlying medical problems. Antibiotics are routinely given to infants who are younger than 24 months or who have high fever or infection in both ears. Children who are older than 24 months and have mild symptoms may be treated with an antibiotic or often are observed to see if they improve without antibiotics. In some cases, your child’s doctor or nurse will recommend that you watch your child at home before starting antibiotics; this is called observation. Observation can help to determine whether antibiotics are needed. Observation may be recommended in these situations:
  • If the child is older than 24 months
  • If ear pain and fever are not severe
  • If the child is otherwise healthy
If your child is being observed rather than treated with antibiotics, you will need to call or go back to your child’s doctor after 24 hours for follow-up. If your child’s pain or fever continues or worsens, antibiotics are usually recommended; observation may continue if the child is improving. Pain-relieving medicines (such as Paracetmol or Ibuprofen) should be given to ease pain and discomfort whether your child is receiving antibiotics or being observed. Cough and cold medicines (which usually include a decongestant or antihistamine) have not been proven to speed healing or reduce complications of ear infections in children. Your child’s symptoms should improve within 24 to 48 hours whether or not antibiotics were prescribed. If your child does not improve after 48 hours or gets worse, bring him/her to see a doctor. Although fever and discomfort may continue even after starting antibiotics, the child should improve every day. If your child appears more ill than when seen by his/her doctor, contact the doctor as soon as possible. Children who are younger than two years and those who have language or learning problems should have a follow-up ear exam two to three months after being treated for an ear infection. These children are at risk for delays in learning to speak. This follow-up helps to ensure that the middle ear fluid collection (which can affect hearing) has resolved.

What are the Potential Complications of a Middle Ear Infection?

One of the common complications of an ear infection is rupture (perforation) of the ear drum, also known as the tympanic membrane. The tympanic membrane can rupture when fluid presses on the membrane, reducing blood flow and causing the tissue to weaken. It does not hurt when the membrane ruptures, and many children actually feel better because pressure is released. Fortunately, the tympanic membrane usually heals quickly after rupturing, within hours to days. Rupture of the ear drum is an indication for antibiotic treatment of an ear infection.

The fluid that collects behind the eardrum (called an effusion) can persist for weeks to months after the pain of an ear infection resolves. An effusion causes troubled hearing, which is usually temporary. If the fluid persists, however, it may interfere with the process of learning to speak. Effusions usually resolve over time without any treatment. However, if the effusion persists for more than three months, the child may need treatment with a surgical procedure. The decision to treat is based upon how much the effusion affects the child’s hearing and the child’s risk of speech problems. Children with underlying speech, hearing, or developmental problems may have worse outcomes related to the fluid and conductive hearing loss. They may need earlier intervention. Children who are not treated for an effusion should be monitored over time. This includes an ear exam and hearing testing every three to six months until the effusion goes away.

How to Prevent Middle Ear Infections?

Some children develop ear infections frequently. Recurrent ear infections are defined as three or more infections in six months, or four or more infections within 12 months. In addition to receiving the pneumococcal and influenza vaccines, as recommended for all children, several interventions can help reduce the risk of recurrent infections. These include avoidance of tobacco smoke, breastfeeding, and/or surgical placement of tubes in the ears.
Some studies show that having surgery to place tympanostomy tubes in the ears helps to prevent recurrent ear infections. Tympanostomy let fluid drain from the middle ear, let air into the middle ear, and keep the pressure in the middle ear and the ear canal the same. Other studies show no benefit of tympanostomy tubes for prevention of recurrences. You can discuss with your child’s doctor who might refer your child to an ear, nose, and throat specialist (an otolaryngologist) for an opinion.
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