Ear Infection Questions

Is this your child’s symptom?

• Your child was diagnosed with an ear infection
• Your child’s ears were recently looked at by a doctor
• You are worried that the fever or ear pain is not getting better fast enough
• Your child is still taking an antibiotic for the ear infection

Symptoms of Ear Infections

• The main symptom is an earache.
• Younger children will cry, act fussy or have trouble sleeping because of pain.
• About 50% of children with an ear infection will have a fever.
• Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.

Cause of Ear Infections

• A bacterial infection of the middle ear (the space behind the eardrum)
• Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
• Blockage results in middle ear fluid (called viral otitis).
• If the fluid becomes infected (bacterial otitis), the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
• Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
• The onset of ear infections is often on day 3 of a cold.
• How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.

When to Call for Ear Infection Questions

Call 911 Now

• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Stiff neck (can’t touch chin to the chest)
• Walking is not steady
• Fever over 104° F (40° C)
• Ear pain is severe and not better 2 hours after taking ibuprofen
• Crying is bad and not better 2 hours after taking ibuprofen
• Pink or red swelling behind the ear
• Crooked smile (weakness of 1 side of the face)
• New vomiting
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Taking antibiotic more than 48 hours and fever still there or comes back
• Taking antibiotic more than 3 days and ear pain not better
• Taking antibiotic more than 3 days and ear discharge still there or comes back
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Ear infection on antibiotic with no other problems
• Normal hearing loss with an ear infection
• Prevention of ear infections
• Ear tube (ventilation tube) surgery questions

Care Advice

Treatment for an Ear Infection

1. What You Should Know About Ear Infections:
   • Ear infections are very common in young children.
   • Most ear infections are not cured after the first dose of antibiotic.
   • Often, children don’t get better the first day.
   • Most children get better slowly over 2 to 3 days.
   • Note: For mild ear infections in older children, antibiotics may not be needed. This is an option if over 2 years old and infection looks viral.
   • Here is some care advice that should help.
2. Keep Giving the Antibiotic:
   • The antibiotic will kill the bacteria that are causing the ear infection.
   • Try not to forget any of the doses.
   • Give the antibiotic until it is gone. Reason: To stop the ear infection from flaring up again.
3. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
4. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
5. Cold Pack for Pain:
   • Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
   • Note: Some children prefer heat for 20 minutes.
   • Caution: Heat or cold kept on too long could cause a burn or frostbite.
6. Limits on Activity:
   • Your child can go outside and does not need to cover the ears.
   • Swimming is fine as long as there is no drainage from the ear. Also, do not swim if there is a tear in the eardrum.
   • Air Travel. Children with ear infections can travel safely by aircraft if they are taking antibiotics. For most, flying will not make their ear pain worse.
   • Give your child a dose of ibuprofen 1 hour before take-off. This will help with any pain they might have. Also, during descent (coming down for landing) have your child swallow fluids. Sucking on a pacifier may help as well. Children over age 6 can chew gum.
7. Return to School:
   • Your child can go back to school when any fever is gone.
   • Your child should feel well enough to join in normal activities.
   • Ear infections cannot be spread to others.
8. What to Expect:
   • Once on antibiotics, your child will get better in 2 or 3 days.
   • Make sure you give your child the antibiotic as directed.
   • The fever should be gone by 2 days (48 hours).
   • The ear pain should be better by 2 days. It should be gone by 3 days (72 hours).
9. Ear Infection Discharge:
   • If pus is draining from the ear, the eardrum probably has a small tear. This can be normal with an ear infection. Discharge can also occur if your child has ear tubes.
   • The pus may be blood-tinged.
   • Most often, this heals well after the ear infection is treated.
   • Wipe the discharge away as you see it.
   • Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)
10. Call Your Doctor If:
    • Fever lasts more than 2 days on antibiotics
    • Ear pain becomes severe or crying becomes nonstop
    • Ear pain lasts more than 3 days on antibiotics
    • Ear discharge is not better after 3 days on antibiotics
    • You think your child needs to be seen
    • Your child becomes worse

Treatment for Hearing Loss with an Ear Infection

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1. Brief Hearing Loss:
   • During an ear infection, fluid builds up in the middle ear space.
   • The fluid can cause a mild hearing loss for a short time.
   • It will slowly get better and go away with the antibiotic.
   • The fluid is no longer infected, but sometimes, may take weeks to go away. In 90% of children, it clears up by itself over 1 to 2 months.
   • Permanent harm to the hearing is very rare.
2. Talking With Your Child:
   • Get close to your child and get eye contact.
   • Speak in a louder voice than you usually use.
   • Decrease any background noise from radio or TV while talking with your child.
3. Call Your Doctor If:
   • Hearing loss not better after the antibiotic is done.

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Prevention of Recurrent Ear Infections

1. What You Should Know:
   • Some children have ear infections that keep coming back.
   • If this is your child’s case, here are some ways to prevent future ones.
2. Avoid Tobacco Smoke:
   • Contact with tobacco smoke can lead to ear infections.
   • It also makes them harder to treat.
   • No one should smoke around your child. This includes in your home, your car or at child care.
3. Avoid Colds:
   • Most ear infections start with a cold. During the first year of life, try to reduce contact with other sick children.
   • Try to put off using a large child care center during the first year. Instead, try using a sitter in your home. Another option might be a small home-based child care.
4. Breastfeed:
   • Antibodies in breast milk lower the rate of ear infections.
   • Breastfeed your baby during the first 6 to 12 months of life.
5. Do Not Prop the Bottle:
   • During feedings, hold your baby with the head higher than the stomach.
   • Feeding while lying down flat can lead to ear infections. It causes formula to flow back into the middle ear.
   • Having babies hold their own bottle also causes milk to drain into the middle ear.
6. Get All Suggested Vaccines:
   • Vaccines protect your child from serious infections.
   • The pneumococcal and flu shots also help to prevent some ear infections.
7. Control Allergies:
   • Allergies may lead to some ear infections.
   • If your baby has a constant runny or blocked nose, suspect an allergy.
   • If your child has other allergies like eczema, ask your child’s doctor about this. The doctor can check for a milk protein or soy protein allergy.
8. Check Any Snoring:
   • Large adenoids can cause snoring or mouth breathing. Suspect this if your toddler snores every night or breathes through his mouth.
   • Large adenoids can contribute to ear infections.
   • Talk to your child’s doctor about this.

Ear Tube Surgery Questions

1. Ear Tubes:
   • Ear tubes are tiny plastic tubes that are put through the eardrum. They are placed by an ENT doctor.
   • The tubes allow fluid to drain out of the middle ear space. They also allow air to re-enter the space.
   • This lowers the risk of repeated ear infections and returns the hearing to normal.
2. Ear Tubes – When Are They Needed?
   • Fluid has been present in the middle ear nonstop for over 4 months. Both ears have fluid.
   • Also, the fluid has caused a hearing loss greater than 20 decibels.
   • Hearing should be tested first. Some children have nearly normal hearing and tubes are not needed.
   • Ear infections that do not clear up after trying many antibiotics may need tubes.
   • Prevention should be tried before turning to surgery.
   • Talk to your child’s doctor about when ear tubes are needed.
3. What to Expect:
   • In most cases, the tubes come out after about a year. They fall out of the ear on their own. This happens with the normal movement of earwax.
   • If the tubes stay in over 2 years, talk with your child’s doctor. The surgeon may need to take them out.
4. Risks of Ear Tubes:
   • After the tubes come out, they may leave scars on the eardrum. They may also leave a small hole that doesn’t heal. Both of these problems can cause a small hearing loss.
   • Because of these possible problems, there is a small risk with ear tubes. There is also a small risk when giving anesthesia to young children.
   • Therefore, doctors suggest ear tubes only for children who really need them.

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

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Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

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