Ear pain in babies

Ear Infections in Babies and Toddlers

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Ear infections in babies and toddlers are extremely common. In fact, according to the National Institutes of Health, five out of six children will experience an ear infection before their third birthday.

"Many parents are concerned that an ear infection will affect their child's hearing irreversibly—or that an ear infection will go undetected and untreated," says David Tunkel, M.D., Johns Hopkins Medicine pediatric otolaryngologist (ENT). "The good news is that most ear infections go away on their own, and those that don't are typically easy to treat."

Childhood Ear Infections Explained

Ear infections happen when there is inflammation— usually from trapped bacteria—in the middle ear, the part of the ear connects to the back of the nose and throat. The most common type of ear infection is otitis media, which results when fluid builds up behind the eardrum and parts of the middle ear become infected and swollen.

If your child has a sore throat, cold, or an upper respiratory infection, bacteria can spread to the middle ear through the eustachian tubes (the channels that connect the middle ear to the throat). In response to the infection, fluid builds up behind the eardrum.

Children are more likely to suffer from ear infections than adults for two reasons:

Their immune systems are underdeveloped and less equipped to fight off infections.
Their eustachian tubes are smaller and more horizontal, which makes it more difficult for fluid to drain out of the ear.

"In some cases, fluid remains trapped in the middle ear for a long time, or returns repeatedly, even when there's no infection," Tunkel explains.

Ear Infection Signs and Symptoms

The telltale sign of an ear infection is pain in and around the ear. Young children can develop ear infections before they are old enough to talk. That means parents are often left guessing why their child appears to be suffering. When your child can't say "my ear hurts," the following signs suggest an ear infection could be the culprit:

Tugging or pulling the ear
Crying and irritability
Difficulty sleeping
Fever, especially in younger children
Fluid draining from the ear
Loss of balance
Difficulty hearing or responding to auditory cues

Signs that require immediate attention include high fever, severe pain, or bloody or pus-like discharge from the ears.

Pediatric Otolaryngology

Our pediatric otolaryngologists provide compassionate and comprehensive care for children with common and rare ear, nose, and throat conditions. As part of the Johns Hopkins Children's Center, you have access to all the specialized resources of a children's hospital.

Learn more about Pediatric Otolaryngology

Ear Infection Treatments

Most ear infections go away without treatment. "If your child isn't in severe pain, your doctor may suggest a 'wait-and-see' approach coupled with over-the-counter pain relievers to see if the infection clears on its own," Tunkel says.

The reason: Treating an infection with antibiotics may cause the bacteria causing the infections to become resistant to those antibiotics—and that makes treating future infections more difficult. Equally important, in most cases antibiotics aren't necessary. Otitis media tends to get better without them. While you may be tempted to treat your child's ear infection with homeopathic or natural medicine, Tunkel warns they aren’t well studied.

Your best bet is to work with your child's health care provider to determine the appropriate course of action. In nearly every case, treatment decisions depend on the child’s age, degree of pain and presenting symptoms.

Under 6 months

Babies under six months almost always receive antibiotics. At this age, children are not fully vaccinated. Equally important, there's no research about the safety of skipping antibiotics for babies under 6 months of age — and complications from ear infections can be more severe when they occur in young babies. Bacteria trapped behind the eardrum can spread to other parts of the body and cause serious infections.

6 months to 2 years

For children between the ages of 6 months and 2 years, the American Academy of Pediatrics (AAP) recommends shared decision-making between parents and providers about whether to treat ear infections that are not severe. The best course is often to watch the child for two to three days before prescribing antibiotic treatment. If the child is in pain, or the ear infection is advanced, your child's doctor may suggest immediate antibiotic treatment.

Over 2 years

With children over the age of 2, ear infections that are not severe are likely to clear on their own, without treatment. "In the meantime, you can treat pain with over-the-counter medications, such as ibuprofen or acetaminophen," Tunkel says. If there's no improvement after two to three days, antibiotics may be warranted.

Unfortunately, some children suffer from recurrent ear infections, sometimes up to five or six a year. Kids who get repeated infections may benefit from a surgical procedure where doctors insert small tubes in the eardrums to improve air flow and prevent fluid buildup. "Tubes don't prevent all ear infections, but they make managing them significantly easier," Tunkel explains.

Ear Infection Prevention

There are several steps you can take to reduce your child's risk of developing ear infections, including:

Vaccinate your child: Children who are up-to-date on their vaccines get fewer ear infections than their unvaccinated counterparts. The 13-valent pneumococcal conjugate vaccine (PCV13) protects against 13 types of infection-causing bacteria.
Consider breastfeeding: Breast milk contains antibodies that may help reduce the risk of ear infections and a host of other ailments. Whether you feed milk or formula, make sure your child sits up during feedings to prevent fluid from flowing into the middle ear.
Wash your hands frequently: The best way to protect your child against cold and flu is to keep your hands clean. Wash your hands with soap and water and scrub them clean for a full 20 seconds each time you visit the sink.
Steer clear of sick people: Don't allow your child to spend time with children or adults who are sick.
Avoid secondhand smoke: Studies show that children who are exposed to secondhand smoke are up to three times more likely to develop ear infections than those who don't have those exposures.

Whether your child has ear infections or not, it's important to ensure they're able to hear well. "No child is too young to have a hearing test," Tunkel says. "We use a variety of techniques to test infant hearing and we can identify a hearing problem even in newborns."

Ear Pain: Is Your Baby Hurting?

Your baby keeps tugging at their ear. They seem fussy and are crying more than usual. They stop breastfeeding, or turn away from the bottle or food.

If your infant could talk, they might be trying to say, “my ear hurts.”

Symptoms

Sooner or later, nearly every child gets an infection in their middle ear. By age 3, 5 out of 6 kids have had one. The infection, also called acute otitis media, is the most common reason for trips to the pediatrician and the top cause of ear pain in babies.

Sgins that your child’s ear might need attention include if they:

Cry a lot and seem fretful
Don’t sleep well
Have a fever of 100 F (37.8 C) or higher
Pull at one or both ears
Leak fluid from the ear
Have trouble with balance
Show signs that their hearing isn’t as sharp as usual

Ear Pain Causes

Ear infection. If your child has a sore throat or another bacterial infection, the germs can reach the middle ear and set off an infection in there. Tissue around their eardrum can redden and swell. Fluid can build up.

If your baby has a cold, that, too, can lead to stuffiness and swelling in the ear that may invite an infection.

Eustachian tube dysfunction. This tube between your child’s throat and middle ear is much smaller and less angled than yours. It can make it harder for fluid to drain. If the tube swells or gets clogged with mucus, the resulting pressure buildup can trigger ear pain. This can often happen with colds and other viral infections.

Other Possible Reasons

Less common causes of baby ear pain include:

An outer ear infection, aka swimmer’s ear, which can happen if the ear canal gets scratched and becomes infected. You’ll usually need prescription antibiotic drops.

Airplane ear. This common condition happens when big changes in cabin air pressure during takeoffs or landings trigger an earache. The best way to prevent or relieve it is to help your child drink or swallow something.

What You Can Do

Doctors aren’t as quick to prescribe antibiotics these days because ear infections often clear up on their own.

If your baby is older than 6 months, their doctor might choose to hold off for a couple of days to see if the symptoms pass. In the meantime, ask your pediatrician if it would help ease your child’s discomfort if you:

Give them over-the-counter infant pain relievers.
Use saline drops or spray to lower swelling and stuffiness from a cold. If the blocked ear drain doesn’t open up, your doctor may suggest putting in small ear tubes for a while.
If your baby is prescribed antibiotics, finish all the medicine even if they get better. Otherwise, the infection can come back quickly.

When to Call the Doctor

Call your baby’s doctor if you think they might have an ear infection, and:

They’re younger than 6 months.
Symptoms don’t go away after 1-2 days.
They have a fever.
You can tell their ear pain is severe.
Your baby stays restless and whiny after getting over a cold or chest infection.
Fluid, pus, or bloody discharge comes out of the ear.
Your baby is not eating or drinking enough.

Article "When babies have ears hurt"

Yulia Selskaya,

otorhinolaryngologist, head of the otorhinolaryngology clinic, doctor of the highest category, Ph.D.

If the child has a fever, does not sleep, tosses and turns, cries, and when you try to check the ears, the crying intensifies, the baby may have otitis media.

Features of the structure of the ears in children

nine0002 In terms of the frequency of diseases in babies, otitis media (ear inflammation) is in second place after a cold. At the age of up to a year, 62% of children suffer from otitis media once, 17% - three or more. Most often, children are prone to this disease in the period from three months to three years.

Why do children get sick so often? There are many reasons. It is during this age period that the child has an incompletely formed immune system, it is difficult for the body to resist infections. The anatomical features of the structure of the middle ear contribute to the disease. In newborns and young children, the ear canal is short, the closer to the eardrum, the narrower. The border of the outer and middle ear is the tympanic membrane. The middle ear is located in the temporal part and consists of several elements. The most important is the auditory tube, which connects the nasopharynx and the inner ear. Unlike adults in babies, it is short, wide and more horizontal. This structure contributes to the penetration of infection from the nasopharynx into the middle ear, where instead of a smooth thin mucous membrane and air, there is loose gelatinous connective tissue with a small number of blood vessels. An ideal environment for the development of microorganisms. Acute otitis media develops when inflammation passes from the mucous membrane of the nasal cavity and nasopharynx to the auditory tube. Ventilation and drainage functions are disturbed, and bloody fluid accumulates in the tympanic cavity. nine0003

The reason for the violation of the patency of the auditory tube can be adenoids, which clog its mouth, congenital anomalies, allergic reactions.

Pneumococci, streptococci and acute eating disorders also cause otitis media. With improper feeding of the baby, the ingress of mixture or breast milk from the nasopharynx can cause inflammation.

Depending on the location of the lesion, otitis media can be external, medial, or internal. The most common at this age is acute otitis media, which develops against the background of SARS, tonsillitis, scarlet fever, measles. According to disease statistics, acute otitis media occurs in 70% of cases, external - about 20%, internal - up to 10% of the total number of otitis media. In young children, acute otitis media is even more common, up to 90%.

Breast-fed children are twice as likely to develop acute otitis media as artificial children. The causes of impaired patency of the auditory tube may also be associated with mechanical blockage of its mouth by adenoids, may be associated with congenital anomalies, allergic reactions.

Diagnosis of otitis in a child

The disease begins suddenly, the temperature rises to 39-40C. The baby is restless, cries a lot, sleeps poorly, sucks sluggishly at the breast. During feeding, it breaks away from the breast with a cry and cries. From the age of four months, the child closes the sore ear with a pen or rubs it against the pillow. If the inflammatory process has affected the eardrum, mucus, pus, and ichor are released from the ear. In a severe form of otitis media in infants, vomiting and diarrhea are possible. The kid throws back his head, strains his arms and legs, his neck does not bend. nine0003

Moms ask: how to quickly see a doctor with symptoms of otitis media? Do you need a specialist or will a pediatrician prescribe treatment? You need to see a doctor immediately or within a few hours after the first symptoms appear: emergency care should be provided without an appointment. Only an ENT doctor should diagnose the disease, he will also prescribe treatment.

But there are situations when it is necessary to act without delay. Swelling behind the ear, the child lies with his head thrown back, legs bent to the tummy and convulsions, this may indicate dangerous complications - meningitis or meningoencephalitis. "Ambulance" in such cases is called immediately. Complications are treated in a pediatric ENT hospital, if necessary, an incision in the tympanic membrane is made - myringotomy or tympanostomy (simultaneously with the incision of the tympanic membrane, the tympanic cavity is sanitized and ventilation tubes-aerators are installed). The surgeon performs the operation using a microscope under general or local anesthesia. The purpose of the procedure is to ensure the free outflow of pus from the middle ear cavity. After the operation, the child's condition improves. nine0003

Under the supervision of an ENT doctor

An ENT doctor prescribes treatment - antibiotic therapy, painkillers, local procedures and physiotherapy. Recovery usually occurs within 5-10 days. After the baby has recovered, rehabilitation therapy is carried out.

In the treatment of acute otitis in children under two years of age, the doctor will definitely prescribe antibiotics. These can be tablets, syrups, intramuscular injections, in severe cases - intravenous administration of drugs. nine0003

Antibiotics are prescribed for children older than two years in a serious condition, when the ear hurts a lot and the temperature is above 38C.

Many parents are skeptical about the use of antibiotics for otitis, fearing that the baby's immune system is being harmed. There is no reason to worry: modern drugs are well excreted from the body and the negative consequences of their use are minimal. If otitis media is not treated or done without medical supervision, cicatricial processes in the tympanic cavity, hearing loss, chronic purulent otitis media, which require complex surgical treatment, may occur. In extremely severe cases - mastoiditis, meningitis. nine0003

First aid for otitis media

Mom can give first aid to the baby. If the temperature is elevated, it is worth giving the child antipyretic and analgesic drugs based on paracetamol. Analgin and aspirin can not be used! For sanitation of the nose, spray and drops with sea water are used. Otitis is often accompanied by rhinitis. You can gently remove mucus from the front of the nose. Vasoconstrictor drops are not prescribed for infants.

If the baby is over a year old, with severe swelling of the nasal mucosa, medicines are prescribed for the common cold. nine0003

Compresses, warming and fatty ointments should not be used for otitis media, otherwise the inflammation will increase. For children prone to frequent otitis, parents put cotton wool in their ears, trying to protect them from the disease. This cannot be done - ideal conditions are created in the external auditory canal for the reproduction of microorganisms, including fungi.

When bathing a child, cotton wool with vaseline oil is placed on children who have a perforation of the eardrum, otherwise the water that enters the eardrum can cause inflammation. With a complete membrane, water entering the external auditory canal does not threaten anything; after bathing, simply pat your ears dry with a towel. nine0003

Author: Julia Selskaya, otorhinolaryngologist, head of the Otorhinolaryngology Clinic, doctor of the highest category, Ph.D.

Ear inflammation in a child: how to prevent complications

Otitis is one of the most common diseases in childhood. According to international statistics, 98% of children suffer from ear inflammation at least once, 60% experience the disease twice. What is effective prevention and how otitis is treated, said the otorhinolaryngologist of the Morozov Children's Hospital, Candidate of Medical Sciences, holder of the status of "Moscow Doctor" Alexander Mikhailovich Ivanenko. nine0003

Why does otitis occur?

Depending on the location of the inflammatory process, otitis media can be external, medial or internal. Otitis externa is caused by microbes and fungi, most often manifested by damage to the skin of the ear canal and boils in the auricle.

Acute otitis media is an acute inflammation of the mucous membrane of the middle ear cavity. It develops against the background of respiratory infections. Ear infection occurs through the auditory tube, when mucus from the nasopharynx enters the middle ear and viruses, bacteria, fungal flora freely penetrate from the nasopharynx through the mouth of the auditory tube into the tympanic cavity. nine0003

Due to anatomical features, the smaller the child, the shorter and wider the auditory tube connecting the ear cavity with the nasopharynx. Therefore, in an infant who spends most of his time lying down, and in a younger child who does not know how to clean his nose, mucus can flow at any time. In adolescent children, the auditory tube is a tortuous narrow tube, so the infection from the nasopharynx to the middle ear is less likely to pass.

Adenoid vegetations also contribute to the development of ear inflammation. This is an overgrowth of the nasopharyngeal tonsil, which is the main focus of bacterial infection in the nasopharynx. nine0003

How does the disease manifest itself?

The main symptom of otitis media is pain in the ear. Children under one year old, as a rule, refuse to eat, because sucking movements cause pain. Babies often touch their ears, rub them, and cry. You can suspect otitis media by pressing on the tragus of the child's auricle.

The key method for diagnosing otitis media is otoscopy - an examination by a doctor of the external auditory canal and eardrum using a special instrument.

How to treat otitis?

If the inflammatory process is at the initial stage, outpatient treatment is carried out. The therapy is selected by a pediatrician or an otorhinolaryngologist depending on the child's condition. Be sure to use vasoconstrictor drops in the nose.

If medical assistance is not provided in a timely manner, the inflammatory process turns into acute catarrhal otitis media, and then into acute purulent otitis media, characterized by the appearance of purulent discharge from the ear.