Ear Infections in Children

A middle ear infection, also called acute otitis media, is usually caused by bacteria and occurs when infected fluid builds up behind the eardrum. It is quite common in children. Anyone can get a middle ear infection, but most start presenting when a child is between 6 and 24 months old.

“Most children have had a middle ear infection by age 3,” says Nandini Govil, MD, MPH, a pediatric otolaryngologist, or ear, nose and throat (ENT) doctor, at Children’s Healthcare of Atlanta. “Approximately 40% of children have had three or more ear infections by 6 years old.”

What causes middle ear infections in kids?

The younger your child is when they get their first ear infection, the greater the chance they will have repeated ear infections. This is most commonly due to your child’s:

• Immune system: It is just starting to develop.
• Anatomy: The eustachian tube is a natural drainage tube that connects the ear to the back of the throat. In kids, it’s smaller, narrower and more horizontal than in adults. Because of this, it’s easier for pathogens (bacteria) to get stuck in the middle ear and cause an infection.

A child’s middle ear infections may also be caused by:

• Enlarged adenoids (glands that produce white blood cells to help fight infection and are located in the back of the nose, above the soft palate where the nose connects to the throat).
• Seasonal allergies.
• Sinus infections.
• Immunodeficiency.

Other risk factors that may contribute to a child having middle ear infections include:

• Secondhand smoke.
• Drinking bottles or breastfeeding while lying down.
• Day care (one study shows children in childcare centers are more likely to get infections that may lead to an ear infection because they have not yet developed the necessary protective immunities).

What are symptoms of a middle ear infection?

If your child isn’t old enough to say their ear hurts, the most common signs that they may have a middle ear infection include:

• Increased fussiness.
• Loss of appetite.
• Pulling on the ear.
• Fever (a temperature higher than 100.4°F).
• Inability to go to sleep.
• Crying.
• Drainage from the ear (yellow or white fluid, possibly blood-tinged; there may also be a foul odor).
• Trouble hearing.

Do teenagers and young adults get middle ear infections?

Generally, middle ear infections start decreasing as a patient gets older. There are patients, however, who have ear infections and require tubes when they are older; even teens and some adults may require ear tubes. It’s important to see a pediatric ENT who understands how the anatomy of your child’s ear changes as they continue to grow. Thankfully, ear infections are not typically serious and can be treatable with antibiotics if needed. But it’s helpful to have a team like Children’s on hand when your child is experiencing pain and discomfort.

What are treatments for a middle ear infection?

Your child’s pediatrician may prescribe antibiotics to reduce your child’s middle ear infection; however, depending on the frequency of infection, your child may meet the criteria to undergo ear tube surgery.

This procedure is quite common. By age 3, 1 out of every 15 kids has had ear tube surgery. We consider ear tube placement when:

• A child has had at least three ear infections in the past six months.
• A child has had four ear infections in the last year, with one being in the last six months.
• A child has fluid in the ear the day we see them.

What else may cause my child to have ear pain?

If your child doesn’t have a middle ear infection, they might have:

• Swimmer’s ear, which is an outer ear infection of the ear canal.
• Blocked or plugged eustachian tubes as a result of a cold or allergies.
• A sore throat.
• Teething or sore gums.

What causes outer ear infections?

Outer ear infections, also known as otitis externa or, most commonly, swimmer’s ear, are typically caused by bacteria, and less commonly by fungi or a viral infection. Swimmer’s ear is different than middle ear infections because it affects the ear canal rather than the eardrum and the space behind the eardrum. The most common cause of swimmer’s ear is a bacteria called Pseudomonas aeruginosa. It can also be caused by trauma to the ear from cotton swabs or other foreign objects, or water exposure and water retained after swimming.

What are symptoms of swimmer’s ear?

Signs of swimmer’s ear include redness, swelling, pain and/or itching of the ear canal, especially when the outer ear is moved, and sometimes drainage from the ear.

How is swimmer’s ear treated?

Antibiotic ear drops are the most effective treatment for uncomplicated swimmer’s ear.

An inner ear infection, or otitis interna, is the type of ear infection that we hear about most commonly. It is a bacterial infection of fluid behind the eardrum, not the ear canal.

What causes inner ear infections?

“Many bacteria can cause inner ear infections, explains Ashwini Tilak, MD, a pediatric otolaryngologist (ENT) at Children’s. “A cough or a cold can lead to fluid buildup behind the ears. Occasionally, this can then be infected with bacteria, resulting in a bacterial inner ear infection. One of the most common bacteria that can cause this is Streptococcus pneumoniae, which can be defended against with routine childhood vaccination.”

What are symptoms of inner ear infections?

Symptoms to look out for include fever, pain and pressure in the ear, as well as occasionally muffled hearing.

How are inner ear infections treated?

If a patient has an ear tube, the infection may be treated with antibiotic ear drops. Otherwise, oral antibiotics are the most effective treatment.

Kids are not tiny adults and require specialized pediatric care. At Children's, all of our providers, from the otolaryngologists to the audiologists, anesthesiologists and nurses are pediatric trained. Additionally, our clinics use specialized equipment designed specifically for children.