Frequently Asked Questions about Ear Infections
Answered by Dr Janice Woolley
It’s two in the morning and one year old Hannah is crying inconsolably and tugging on
her ear. Her mother recognizes the symptoms as probably indicating another ear
infection. Q: What causes ear infections?
A: Middle ear infections are usually associated with a viral upper respiratory infection or
cold. Infants and preschoolers are especially vulnerable as their immune systems are
immature. Until they have had exposure to several infections they will not have
antibodies to those viruses. Some children appear to have a hereditary problem with the
way their eustachian tubes function. The average child can have as many as eight upper
respiratory infections a year. If a child is especially vulnerable to ear infections that can
mean very frequent illnesses. Q: My child has had repeated ear infections since she was six months old. What can
A: Do what you can to protect her from exposure to respiratory illness. If she is in a
preschool or day care, look for a program with a class size of six children or fewer and
one that doesn’t allow children to attend when they are ill. If she uses a pacifier, restrict it
to nap and bedtime. When a child has a pacifier in and out of her mouth all day there are
lots of opportunities to pick up germs. The same is true for bottles. Don’t allow a toddler
to carry a bottle around. Bottle fed infants should be held in a semi upright position while
being fed so fluids don’t flow into the eustachian tube. If your child has a constant stuffy
or runny nose check with your pediatrician to see if nasal allergies are a factor. Q: How would I know if my son has an ear infection?
Should I purchase a home
otoscope so I can examine his ears?
A: Symptoms include ear pain, irritability, pulling at his ears, waking at night, or
drainage from the ear. Most of the otoscopes marketed for home use are inadequate. Also
it takes some skill and practice to learn to examine ears. If your child has symptoms
suggestive of an infection it is best to have him examined by your doctor. It is not
unusual to find that a child with symptoms of an ear infection also has a throat infection,
sinusitis or bronchitis. A parent could be falsely reassured by seeing what appear to be
normal eardrums and could miss an infection elsewhere. Q: I’m worried about giving my child an antibiotic.
Won’t that make her immune to
A: Antibiotics definitely can be overused. They have only been available for about fifty
years and have made such a dramatic improvement in the management of infectious
disease that doctors and patients were initially eager to benefit from them. We now are
realizing the downside of antibiotic resistance. A child’s body does not become resistant
to antibiotics but bacteria can become resistant. There are now strains of bacteria that are
very dangerous and hard to treat. Parents and doctors are having to re-evaluate the criteria
for using antibiotics. In general the younger the child, the more likely an antibiotic is
needed. An infant’s immune system is not as developed and she may get very ill very
quickly. At any age the appearance of the ear drum and severity of the infection will
influence whether your doctor recommends an antibiotic. Q: Isn’t it just better to get tubes placed in my daughter’s ears and avoid
A: Most children who have ear infections don’t need tubes. While putting tubes into the
eardrums is considered a minor operation, it does require general anesthesia. Tubes are
recommended when a child has multiple bouts of otitis media which do not clear with
appropriate antibiotic treatment. Persistent fluid in the middle ear may affect hearing and
speech development so tubes might be indicated. Some children have very large adenoids
which interfere with eustachian tube function and may even cause sleep apnea. If an
adenoidectomy is being done it might make sense to put in tubes at the same time.
Generally, it is best to try all the preventive measures possible and view tubes as a last
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- Frequently Asked Questions about Ear Infections
- Q: What causes ear infections?
- Q: My child has had repeated ear infections since she was six months old. What can I do?