Ear Infections
Diagnosing and treating ear infections are pretty much the bread and butter of pediatrics other than well visits, and the reason for that is they happen all the time. Most kiddos will get at least 1 or 2 ear infections by the time they are 5 years old. The 2 big types of ear infections that we deal with in pediatrics are ear infections that happen behind the ear drum, called otitis media, and ear infections that happen in the ear canal in front of the eardrum, called otitis externa.
Otitis media, ear infections behind the eardrum, are much more common. These occur due to fluid and bacterial buildup behind the eardrum.
Why does fluid and mucus hang out behind the eardrum, you ask? Great question. Before a child is 5 or 6, they have 2 things that work against them when it comes to ear infections. The first is that they don’t have large sinuses to hold extra snot and mucus like older kids and adults do. So, when they are sick with colds, the mucus needs to come out the nose or go down the throat to cause those hacking coughs. If it doesn’t make it out fast enough, the body looks for places to store the mucus, and it just so happens that the space in the middle ear can hold a lot of extra mucus. The second thing that puts kids behind the 8 ball is that the tubes meant to drain fluid from the ears are not in the best orientation at first and don’t drain fluid as well as they can when they are older and the tubes turn downward. When the excess mucus is stored in the middle ear and then just sits because it can’t drain well, bacteria are free to grow and grow and grow and then bam! You have a red angry painful eardrum that will wake a toddler up at 2 in the morning, often with a fever. This is when we see the kiddo the next day to look at their ears and give antibiotics if needed. But, just because a kiddo has an ear infection, it does not necessarily mean they have to take antibiotics to get rid of it. Your pediatrician will discuss with you the likelihood that the fluid will drain on its own or if they think it is time to get some extra antibiotic help.
Sometimes the eardrum can be pushed to the limits and can develop a small tear or actually rupture. This usually occurs a few days into an ear infection and if a kiddo coughs and sneezes at the same time, causing acute pain and immediate relief with snot coming out of the ear. This can also occur if they are going up or down large altitude changes and the ears pop. It happens all the time, and the eardrum heals up well 99% of the time. But for eardrum ruptures, we will treat with antibiotics to make sure we clear the mucus out to allow for healing.
Now like I said before, otitis media is very common, but how many ear infections are ok, and how many is too much? Oftentimes pediatricians are okay with 3-4 ear infections in the same cough and cold season, but we get worried that there is a problem with the drainage system in the kiddo’s ear if we get more than 4 or we keep having to up the strength of the antibiotic with each ear infection. If this is the case, then we often have the child visit their friendly neighborhood ENT (ear, nose, and throat) doctor to talk about possible ear tubes to help drain the middle ear and prevent recurrent ear infections that can affect hearing and ear function over time.
The good news is that the number and tendency for ear infections go down dramatically once a kiddo starts developing larger sinuses, around ages 5-7 years, to hold a lot more snot when they are sick. Though the bad news is that those older kiddos will now develop sinus infections instead of ear infections, but because of the larger space in the sinuses in comparison to the middle ear, it is much harder to develop sinus infections than ear infections.
Now the other type of ear infection is called otitis externa and occurs when the canal itself is infected. The ear canal can get infected if it is constantly in a wet or humid environment. This is why otitis externa is often called swimmer’s ear. We most often see it in the summer with kids in pools all day or in patients with long hair that is always covering their ears, even after bath time. The constant humidity allows an abundance of fungus/yeast/bacteria to grow in the ear canal. On physical exam, it can readily differentiate itself from the other ear infections in that a kiddo will often say that touching or pulling their ear hurts, and parents will often note that the ear smells funny or there is discharge or debris coming out of the ear. To treat otitis externa, we often use ear drops that are a combination of antibacterial, antifungal, and anti-inflammatory medications to treat the possible bugs that have started to grow and to decrease the irritation that causes the ear pain. To help prevent these types of ear infections, picking up over-the-counter swimmer’s ear drops or making your own mixture of half rubbing alcohol and half vinegar to instill a few drops after long swimming sessions can help keep the bugs away and dry out the ear canal. If your child has longer hair, make sure to put the hair up during and after swimming (so it is not covering the ears) and also dry the hair and/or put the hair up away from the ears after bath and shower time.