Pediatric Middle Ear Infections (Otitis Media)

Middle ear infections typically occur in infants and toddlers.  Many children outgrow these infections by the age of 3. However, eighty percent (80%) of children will have two or more episodes of otitis media by their second birthday.

Otitis media is an infection involving the middle ear space, which is behind the eardrum. Usually, this space is dry. When the Eustachian tube (a small area that connects the back of the nose to the actual middle ear) doesn’t work well, mucus or thick fluid develops in the middle ear space. The fluid can cause pressure in the ear, mild to moderate temporary hearing loss, and viral or bacterial infections.

Symptoms of a Middle Ear Infection in Children

Symptoms may include:

  • Fussiness
  • Irritability (you might see them tugging at their ear to address the pain)
  • Difficulty hearing
  • Fever
  • Fluid draining from the ear
  • Changes in dietary and sleep habits
  • Problems with hearing and balance

Occasionally, the fluid and the infection will quickly resolve with intervention, but typically examination and treatment by a doctor are needed.  The onset of symptoms is usually rapid.

Treating a Middle Ear Infection

The first line of therapy for otitis media is typically antibiotics and treatment of the nasal congestion. No matter what is given, it can take more than a few days for the infection to resolve and weeks for the fluid to resolve. When the infections become very frequent, or are repetitively painful, or the fluid is persistent and the hearing loss not improving, then more intervention is usually needed.

Tube Insertion

An alternative to medical management of otitis media is a procedure called tube insertion. This is where a small 3mm soft silicone coated plastic tube is inserted through the ear canal, into the eardrum allowing air to get into the middle ear space and fluid to drain outward. The procedure only takes about five to 10 minutes, it’s done under a light general anesthetic in a carefully monitored operating room. The children experience no discomfort during the procedure and only mild irritation for a few hours afterwards. The tubes last for about six to 12 months and they usually do not need to be reinserted, and the children can still enjoy a chlorinated swimming pool without concern.

Pre- and post-operative instructions

Outer Ear Infections/Swimmer’s Ear

Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but since the cause of the infection is water trapped in the ear canal, bathing or showering or moisture from earplugs or even hearing aids may also cause this common infection. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply.  This may cause infection and irritation of the ear canal. If the infection progresses it may involve the outer ear.

Symptoms of Outer Ear Infections/Swimmer’s Ear

Symptoms may include:

  • Ear canal discomfort
  • Ear canal itchiness
  • Muffled hearing
  • Blockage
  • Drainage
  • Occasionally fever

Treatment for Outer Ear Infections/Swimmer’s Ear

The treatment for mild infections can include drying of the canal, and applications of slightly acidic drops or even antibiotic drops that are prescribed. More significant infections usually require an ENT physician to clean the canal, occasionally applying suction or placing a tiny sponge in the canal for 24 or 48 hours soaked in special medication. Advanced infections may require even more assistance and medical intervention.