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Ear Infections: Symptoms and Treatment

Ear infections, also known as acute otitis media (AOM), are the most common reason children are brought to the doctor every year, and they have easily noticeable symptoms and standard treatment options. Though rarely severe, these nasty illnesses and the pain associated with them cause quite a bit of distress for children and their parents.

So, when should your child be seen by your pediatrician, and what treatment should you expect? Here’s a brief introduction to what your doctor is thinking about when he or she sees your child for an ear infection. 


What’s an Ear Infection?

Acute otitis media is an infection in the middle ear. This space is separated from the external ear by the eardrum and is connected to the throat and nasal passages by the Eustachian tube. Because the only entrance to the middle ear is the Eustachian

tube, problems arise when it is closed off. Inflammation in the upper respiratory tract, like during a cold, has the potential to narrow or close this tube. When the middle ear continues to make fluid as it normally does, it has no way to drain. This buildup of fluid is a breeding ground for the viruses and bacteria that are already present in these spaces. Their growth causes more inflammation with greater fluid secretion and, ultimately, an increase in pressure in the middle ear. This increase in pressure is what causes the pain associated with ear infections. 


What Causes Ear Infections?

Several viruses and bacteria are typically to blame for ear infections. Many microbes are present naturally in the middle ear, but their overgrowth is what can result in infection. Recent research has found that most ear infections are caused by viruses. Certain bacteria are also common. Fortunately, childhood vaccines such as the pneumococcal, HiB, and annual influenza vaccines have helped to reduce the frequency of ear infections due to some of these organisms.




Children with ear infections can have a variety of symptoms. Ear pain is an important symptom, which may be demonstrated by young children tugging at or holding the ear. A fever of 100.4 degrees or greater is also typically present, along with increased fussiness or decreased activity. Some additional signs are hearing loss, decreased appetite, vomiting, and diarrhea. 

As a parent, you might wonder when you should bring your child to their pediatrician for their ear pain. In accordance with the American Academy of Pediatrics, we suggest that all children under the age of 2 years be seen by a pediatrician if they have symptoms of ear infection, as mentioned above. For older children who are 2 to 17 years old, we recommend only visiting the clinic if they have one or more of the following symptoms: 

  • Moderate to severe ear pain
  • Ear pain that lasts for at least 48 hours
  • A temperature of 102.2 or greater


When to Seek Care

If your child has had any drainage of fluid from their ears or has had worsening symptoms, you should also seek medical care. A child with mild ear pain for less than 48 hours and a temperature of less than 102.2 may not require medical attention or antibiotics. 



Treatment Options

For children in the 2 to 17 age group, uncomplicated AOM can be treated in two ways: immediate antibiotic therapy or initial observation. Antibiotic therapy requires immediate treatment of AOM with prescribed antibiotics at the time of diagnosis by the physician. The benefits to this strategy include only a slight increased likelihood of more rapid resolution of AOM and its associated symptoms. However, the risks and the potential side effects attributed to antibiotic use include diarrhea, diaper dermatitis, and allergic reactions to the medication.

Additionally, overuse of antibiotics can lead to increased bacterial resistance, resulting in future difficulty treating bacterial infections. Antibiotic therapy of AOM does not provide pain relief in the first 24 hours, and pain may even persist 3 to 7 days after antibiotic initiation. However, pain-relievers such as ibuprofen and acetaminophen help to relieve pain associated with AOM and should be used whether or not antibiotic therapy is prescribed. 

The initial observations treatment option primarily manages AOM with symptomatic pain relief. Antibiotic therapy is considered later on only if the child’s condition worsens at any time or does not show improvement within 48 to 72 hours after diagnosis. Joint decision making and conversations between the parent and physician is critical and a plan must be in place to ensure adequate follow-up and initiation of antibiotics if symptoms fail to improve after one to two days.

Initial observation results in decreased side effects of antibiotics, and decreased potential for development of bacterial resistance. Many cases of AOM are viral in nature, and, therefore, antibiotics will not always result in a more rapid resolution of symptoms, since antibiotics do not treat viral illnesses. However, there is a chance that a child will require antibiotics later on if the symptoms worsen or don’t improve. 

If your child has been displaying symptoms of an ear infection, we encourage you to contact your child’s pediatrician and ask questions. Setting up an appointment with your child’s pediatrician will help them determine what the best course of action is to relieve your child of their pain.