Catching a cold or coming down with the flu is no fun for anyone. For babies and children, though, a winter cold or flu can lead to a painful ear infection. Seeking prompt medical care can help ensure that an ear infection is short lived and that hearing and speech development are not affected.
Ear infections are the most common reason that children visit their primary care provider, according to the National Institutes of Health. In fact, five out of six children will have at least one ear infection by their third birthday.
An upper respiratory infection often is the first clue that a child might end up with an ear infection, also known as otitis media. Although a cold or flu is usually caused by a virus, the infection makes the body more vulnerable to other microbial attackers, and bacteria can move into the middle ear as a secondary infection. This causes fluid to build up behind the eardrum, and results in pain.
The anatomy of the ear is partially to blame for the fact that ear infections are more common in children than in adults. The eustachian tubes, which connect the upper part of the throat to the middle ear, are smaller and more level in children. This makes it difficult for fluid to drain out of the ear, especially if the tubes are swollen or blocked with mucus due to a cold or other respiratory illness.
Symptoms of ear infection
When a child is too young to say that their ear hurts, parents can be alert for signs of an ear infection, especially if the child recently had an upper respiratory infection:
▪ Pulling at the ear
▪ Fussiness and crying
▪ Trouble sleeping
▪ Lack of appetite
▪ Fluid draining from the ear
▪ Loss of balance
▪ Trouble hearing quiet sounds
When parents suspect an ear infection, they should make an appointment to have the family physician examine the child. The doctor can use a lighted otoscope to look inside the child’s ear and find out whether the eardrum is red or bulging.
Sometimes, an ear infection will go away on its own. To avoid the possible side effects of antibiotics, the physician may recommend a 24- to 48-hour waiting period. An antibiotic is likely to be prescribed if the ear infection doesn’t go away during that time or if the child is younger than 24 months, has a high fever or has an infection in both ears.
If the doctor approves, parents can give the child ibuprofen or acetaminophen to relieve pain from an earache. Children younger than 2 as well as anyone under age 18 with flu symptoms should never be given aspirin. A warm water bottle held to the ear can also provide comfort.
When a child has frequent middle ear infections and when antibiotics aren’t helping, a physician may recommend surgically placing a small ventilation tube in the eardrum to improve airflow and prevent fluid from accumulating. This procedure can help protect the child’s hearing and minimize the risk of delayed speech development.
Preventing painful earaches
Antibiotics have no impact on most upper respiratory infections, which are caused by viruses, not bacteria, so treating the infection that can lead to an earache is challenging. In addition, inherited ear structure can mean that a particular child is more likely to have frequent ear infections. Still, parents can take simple steps to help prevent the ear infections that can follow a cold or the flu:
▪ Ensure that children are up to date on all immunizations, including annual flu shots.
▪ Keep tobacco smoke out of the home and away from children, especially infants.
▪ Breast feed babies for more than the first three months.
▪ Wash hands frequently to help the child avoid the upper respiratory infections that can lead to ear infections.
▪ Don’t put a baby down to sleep with a bottle.
By taking preventive measures and seeking medical attention when an ear infection occurs, parents are doing their best to protect their children’s hearing and speech development.
Joseph Wiedemer, MD, program director, and Daniel Frankel, MD, resident, are both part of the Penn State Health Family and Community Medicine Residency Program at Mount Nittany Medical Center.