Why Do Children Have So Many Ear Infections?

If your child has frequent ear infections, you are not alone. The American Speech-Language-Hearing Association says it is the most common childhood illness (other than colds) for infants and young children. Ear infections occur most frequently between the ages of 3 months and 3 years, but are common until the age of 8. Five out of six children will have at least one ear infection before their third birthday and nearly 40% of children will have three or more ear infections before that age.

Why are ear infections so common?

Basically, ear infections are common because the tubes and spaces in children’s ears are so small. When a child gets a cold, sore throat or upper respiratory infection, bacteria from those illnesses can spread to the middle ear. The bacteria causes fluid to build up in the middle ear (the space behind the ear drum), it becomes infected, the eardrum becomes inflamed, and bingo, you have an ear infection.

The pathway that the bacteria takes to get to the ear is called the Eustachian tube. It runs from the top of the back of the throat to the ear and is designed to clear fluid from the ear. However, in infants and children, this tube is nearly horizontal so it fills up with fluid easily. As we age, the tube becomes more vertical, works more effectively and that is why the older we are, the fewer ear infections we get.

3 types of ear infections

Medically speaking, an ear infection is called Otitis Media and there are three types:

1. Acute Otitis Media is the most common type of ear infection. Parts of the middle ear are infected and swollen and fluid gets trapped behind the eardrum.
2. Otitis Media with Effusion can occur after the ear infection has run its course, but fluid stays trapped behind the eardrum. There may be no symptoms, but a physician can see the fluid.
3. Chronic Otitis Media with Effusion occurs when fluid in the middle ear remains for a long time, or recurs multiple times. Even though there is no infection, the fluid in the ear can make it harder for children to fight new infections and may impact their hearing.

In addition to contracting a cold or upper respiratory infection, there are two other reasons why your child may get frequent ear infections:
A young immune system: A child’s immune system is young and not as strong as that of an adult. That can make it difficult fight off infection.

Tonsils and adenoids: The adenoids are a flap of tissue at the top and back of the throat, considered the uppermost tonsil. Bacteria can get trapped in the adenoids and when it does it can cause an infection that moves through the Eustachian tubes to the middle ear.

Symptoms of an ear infection

If your child gets frequent ear infections you probably know the symptoms well:

• Fussiness and fever
• Fluid draining from the ear
• Tugging or pulling at the ear
• Problems with balance
• Trouble hearing
• Inability to respond to low volume sounds

What are the best treatments for ear infections?

Some ear infections get better on their own. Others need to be treated with an antibiotic. Always discuss antibiotic use with your ENT doctor to make sure that your child is taking them only when needed. There is always the risk that bacteria will develop a resistance to frequently used antibiotics.

• Acute Otitis Media (AOM-described above) may get better without treatment. If the infection doesn’t improve in 2-3 days, antibiotics may help. However, some types of AOM are caused by viruses which don’t respond to antibiotic treatment.
• Otitis Media with Effusion (OME) almost always goes away on its own without the use of antibiotics. Fluid may remain in the ear for a while but the infection will recede well before that.

Treatments for ear infections can include:

1. Observation: Once your doctor determines that your child has a middle ear infection, he or she will recommend the best treatment based on the type and severity of the infection.
2. Antibiotics: Your physician may need to prescribe antibiotics to fight your child’s ear infection. If so, issue the medication as prescribed. Do not stop administering the medication when your child begins to feel better. The entire dose must be taken to kill the bacteria causing the infection and to prevent it from flaring up again. Consult with your ENT to confirm.
3. Pain relief: Children’s pain relievers like acetaminophen or ibuprofen may be suggested until the antibiotics can take effect to reduce pain and fever. Aspirin should not be taken when a child has a fever in order to avoid the risk of Reye’s Syndrome. Consult with your ENT to confirm.
4. Tubes in the ear: If fluid remains in your child’s ear for more than 3 months, your ENT doctor may recommend inserting small tubes into the eardrum to allow fluid to drain from the ear. The procedure, called the Grommet Procedure, is done under general anesthetic and lasts 15-20 minutes. The tubes usually remain in the ear for 6 to 18 months and then fall out on their own as the Eustachian tubes grow and become larger.

Can frequent ear infections be prevented?

Sometimes. The key to preventing frequent ear infections is to make sure that the home environment is as clean as possible and that your child is not exposed to a lot of colds during the first year of life. Other preventions that you can take include:

• Do not let your child near smoke. Second-hand smoke can cause your child to have more infections. Make sure no one smokes in your house, car or your child’s day care center.
• Check your child’s allergies: When allergies cause inflammation, an ear infection can result.
• Try not to expose your child to a lot of colds during his or her first year of life. Your child’s immune system is in its infancy, as well, and it may not be strong enough to fight off infection.
• Don’t put your child to bed with a bottle. Always feed your child and hold the bottle at a 45-degree angle to avoid formula flowing through the upper part of the mouth into the Eustachian tube and then into the ear.
• If your child breathes through the mouth or snores it may be caused by large adenoids. Larger than normal adenoids can attract the bacteria that causes ear infections. Inform your doctor so that the size of the adenoids can be checked.
• Wash your hands frequently. Wash your hands and teach your children to wash their hands frequently. It is the #1 way to stop the spread of illness and infection.

Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are working to further understand ear infections, their prevention, diagnosis and treatment. They are trying to find better ways to predict which children are at higher risk for ear infections in order to prevent them.

In the meantime, the pediatric ENT doctors can help treat your child’s ear infections. We are trained in diagnosing and treating pediatric ear infections, chronic runny nose, recurrent sore throats and snoring. We will discuss with you the best treatments to reduce frequent ear infections, whether it is medication, imaging or surgery. We can place ear tubes to reduce fluid buildup and we can remove tonsils and adenoids.

References
Causes of Hearing Loss in Children
Ear Infection Overview
Ear Infections in Children