February is Kids Ear, Nose and Throat Health Month. Learn what to expect the next time your little one experiences ear pain.  

“Ow, my ear hurts!”

Parents of young children have probably heard this refrain more times than they can count. Those with infants or toddlers have likely stayed awake many a late night trying to comfort a little one experiencing ear pain. “Ear infections are the No. 1 reason children have a sick visit to the pediatrician, and the No. 1 reason children are prescribed antibiotics,” says Ryan Murray, MD, a pediatric otolaryngologist at Inova Children’s Hospital.

Ear infections are most common in children ages one to three, according to the American Academy of Pediatrics (AAP). Around 80 percent of children will have an ear infection before age four, Dr. Murray says.

Below are seven essential facts about ear infections, from why they occur to the standard treatment options.

1. Ear infections are more common in children because of their anatomy.

“When we are born, our eustachian tube, which connects the back of our nose to our ear, is not fully developed,” Dr. Murray says. “It is short and flat. As we grow older and our heads develop into their full size, the eustachian tube grows longer and more vertical. A child’s eustachian tube, being flat, is more prone to having fluid back up into the ear, and it is harder for that fluid to drain,” he says.

2. Unfortunately, there is not much parents can do to prevent ear infections.

Dr. Murray says the biggest risk factor for ear infections is being exposed to colds and respiratory diseases at daycare or other places where kids may be surrounded by ill children, making them more susceptible to ear infections. “Unfortunately, that is a practical part of most people’s lives,” he says.

One preventive measure parents can take is to encourage children to blow their noses. Parents can also clean out their child’s nose with a suction bulb or saline rinse following an upper respiratory infection.

Dr. Murray says eliminating pacifiers can also be beneficial, as some research has shown pacifier use is associated with ear infections. Breastfeeding can also be protective against ear infections in infants.

3. It is difficult to determine whether a child has an ear infection without the help of a medical professional.

Ear pain and tugging at the ears may only indicate ear fluid, not an infection. And restless sleep, fever and congestion can also be indicative of an upper respiratory infection. Dr. Murray says the only way to determine if a child has an ear infection is to have a medical professional look at the ear with an otoscope to confirm whether an is infection present.

4. Antibiotics are not always prescribed for acute ear infections.

Doctors may prescribe antibiotics based on the child’s age and the severity of the infection. However, they might recommend 24 to 48 hours of watchful waiting to see whether the child improves. Dr. Murray says this protocol is part of a larger movement toward avoiding unnecessary antibiotic exposure in children.

5. Some children will experience chronic ear infections, which can present in two ways.

  • Children will get an ear infection, take antibiotics and get better, and then have another ear infection a few weeks or months later. This is referred to as recurrent otitis media.
  • Children with an ear infection will be prescribed antibiotics, but the fluid in their ear never drains. This fluid sticks around and gets re-infected over time. This is often referred to as chronic otitismedia with effusion, even if it hasn’t been acutely infected.

It’s important to be on the lookout for chronic otitis. “Fluid in the ears for more than three months could put the child at risk for some speech and language delays because of the muffled hearing,” Dr. Murray says.

6.  For children with chronic ear infections, ear tube surgery may be recommended.

Ear tube surgery is often recommended by pediatric otolaryngologists as a way to minimize antibiotic exposure in children with chronic ear infections, improve quality of life or avoid speech and language delays. The procedure takes about 10 minutes, and children can typically resume full activity the next day, Dr. Murray says. The tubes, which ventilate the ear, stay in the eardrum for about two years and then fall out on their own.

7. Even if your child cannot vocalize how they feel, they’re likely in significant pain.

Dr. Murray says ear infections can be very painful, which is why it’s important to alleviate a child’s symptoms with over-the-counter pain medications like Tylenol or Motrin — especially if they are not on antibiotics.

“If you talk to adults who’ve had ear infections, they say it is pretty miserable,” Dr. Murray says. “I think we may dismiss the pain because kids do not have the words to articulate how uncomfortable it is.”

Learn more about Inova’s treatment of pediatric ear infections.

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