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Ear Infections



Ear infections are one of the most worrisome illnesses for both parents and children to go through, especially if they frequently recur. They also are the most common reason for antibiotic prescriptions.

Here's a guide to help you understand why ear infections occur, how to best treat them, and most importantly, how you can prevent them from happening too often.



Your child may have 2 or more of these symptoms:


  1. Cold symptoms – keep in mind that ear infections are almost always preceded by a cold.
  2. Often a clear runny nose will turn yellow or green before an ear infection sets in.
  3. Complaining of ear pain or hearing loss
  4. Night-waking more frequently
  5. Unwillingness to lie flat
  6. Fever – usually low grade (101º - 102º); may not have a fever.
  7. Sudden increase in fussiness during a cold
  8. Ear drainage – if you see blood or pus draining out of the ear, then it is probably an infection with a ruptured eardrum. DON'T WORRY! These almost always heal just fine, and once the eardrum ruptures the pain subsides. 



  1. No cold symptoms – if your child has some of the above symptoms but does not have a cold, an ear infection is less likely, unless your child has had an ear infection in the past without a cold.
  2. Pulling at the ears or batting the ears in infants less than 1 year of age. Infants less than one are unable to precisely localize their ear pain. This means that they cannot tell that the pain is coming from the ear or from structures near the ear. Infants can pull on or bat at their ears for two other common reasons:
  3. Teething – Baby thinks the pain from sore gums is coming from the ears.
  4. No complaints of ear pain in a child who is old enough to tell you, usually by age two or three.



Are you tired of taking your fussy baby into the doctor just to check her ears, only to be told its probably just teething? ....To help you decide



  1. Pain usually starts at four months of age and will come and go until the two-year molars are in.
  2. Tugging or digging at the ears with no cold symptoms or fever
  3. Fussiness or night waking with no cold symptoms or fever
  4. May have low fever less than 101
  5. Teething does not cause a runny nose, only drool.




Anatomy lesson. The ear is divided into three parts: the outer ear canal, the middle ear space where infections occur, and the inner ear where the nerves and balance center are. A thin, membranous eardrum divides the outer and middle ear. The middle ear space is also connected to the back of the nose via the Eustachian tube.

  1. Immature Eustachian tube. In infants and young children this tube is much shorter and is angled. It is therefore much easier for bacteria to migrate from the nose and throat up into the middle ear space. As the child grows this tube becomes more vertical, so germs have to travel "up hill" to reach the middle ear. This is one-reason children "outgrow" ear infections.
  2. Colds. When your child has a cold, the nasal passages get swollen and mucus collects in the back of the nose. This environment is a breeding ground for the bacteria that normally live in the nose and throat to begin to overgrow. Mucus is also secreted within the middle ear space just as it is in the sinuses.
  3. Bacterial invasion. Germs migrate up through the Eustachian tube and into the middle ear space where they multiply within the mucus that is stuck there. Pus begins to form and soon the middle ear space is filled with bacteria, pus and thick mucus.
  4. Ear pain. This pus causes the eardrum to bulge causing pain. It is this red, bulging pus-colored eardrum that the doctor can see by looking into the ear canal.
  5. Diminished hearing. The discharge that collects in the middle presses on the eardrum preventing it from vibrating normally. This is what the doctor means by "fluid in the middle ear." Also the fluid plugs the eustachian tube and dampens the sound like the sensation in your ears during air travel.
  6. ARE EAR INFECTIONS CONTAGIOUS? No, the bacteria inside the ear causing the infection are not contagious. The cold virus that can lead to an ear infection is contagious. Oftentimes, if the ear infection occurs a week after the cold begins, the child is no longer contagious.


Is it difficult for parents to learn to do ear exams?


This is one of those questions that has two answers....yes and no. The key to doing ear exams is practice. It is important to begin doing otoscope exams on a willing adult as opposed to a child. The ear canals are larger and the eardrum is easier to see in an adult. The key is to look into as many adult ear canals as possible to get a feel for what normal eardrum looks like. When you visualize an eardrum that is red, has fluid behind it, or is simply abnormal you will quickly recognize this.

The old saying practice makes perfect could not apply more to any situation than it does to doing ear exams.

It is also always important to always go slow and never ever force or pry the otoscope in an ear canal in any way shape or form. Always look to see what is in front of you through the viewing window of the otoscope before advancing it into an ear canal. Never push the specula tip into the ear canal unless you are certain it is clear.

Realize that in some children and even adults it is impossible to see the eardrum. Some children and even adults have very small ear canals and/or also filled with earwax and debris which make it impossible to see theeardrum. Even as a physician it is impossible to see into some ears.

It is also advisable especially with pediatric exams to get the help of your local pediatrician. Many pediatricians today are very supportive of home ear exams and recognize the value of parents being able to monitor for the earliest signs of ear infection. Pediatricians also recognize the importance of the early recognition of earwax occlusions that can cause hearing loss. If not recognized early this hearing loss can go on to affect the speech development in young children.






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