Ear infections in children: Frequently asked questions

How common are ear infections in young children?

Very. Between 60 and 80 percent of infants have at least one episode by 1 year of age. By age 3, it's 80 to 90 percent.

Are all ear infections alike?

No. They come in two types: outer ear and middle ear. Outer ear infections usually occur when children get water in the ear (swimmer's ear). Inner ear infections tend to occur where children congregate in large numbers, such as daycare centers.

When do middle ear infections typically occur?

Usually a week or two after the child has an upper respiratory tract infection. This can cause inflammation and fluid to build up behind the ear drum. This fluid can become infected with bacteria and your child will likely develop ear pain, fever, and irritability and may be tugging at his or her ears.

How can you be sure if the child has an inner ear infection?

Your health care practitioner can tell by checking the ear drum. If it is reddish and bulging with pus, that's likely an infection. However, there are other conditions that can make an ear drum look red, including fever or just crying a lot. Therefore, your primary care provider should check the ear drum's ability to move. An ear drum that is red from crying or because of a fever will still move when tested. A special instrument called a tympanogram can also be used to test for ear drum mobility.

How should ear infections be treated?

They can be treated with antibiotics although some may improve on their own. Unfortunately, ear infections are becoming more difficult to treat as the bacteria responsibile for them become antibiotic-resistant (the antibiotics don't work anymore). The unnecessary use of antibiotics actually contributes to this problem, so health care professionals are becoming more cautious about prescribing them.

What if the infection is mild?

Many parents insist on antibiotics when their child has a mild ear infection. But many of these mild infections are caused by viruses that cause the common cold. Viruses do not respond to antibiotic treatment, so prescribing antibiotics will not help.

After a middle ear infection, how long will fluid remain behind the eardrum?

Typically one to three months before clearing up on its own. This fluid is not an infection and does not usually require antibiotics. In young children, your health care provider will typically recheck your child's ears every four to six weeks until the fluid is gone.

What if my child's ear infection continues despite antibiotics?

Generally, if the child has fluid in both ears for more than three to six months and it is affecting their hearing, or if they have recurrent ear infections, then they may need to see an otolaryngologist (ear nose and throat specialist) for the placement of ear tubes (tympanostomy tubes).

How do ear tubes work?

Ear tubes are usually placed as an outpatient surgical procedure with a brief general anesthetic. They usually stay in the ear for about a year and then fall out by themselves. While not common, complications can include drainage from the ear, surgery to remove a tube that doesn't come out, development of a skin growth behind the eardrum (cholesteatomas), and persistently torn ear drums.