Ear infections are among the most common reasons for doctor’s visits among young children. Matthew Howard, MD, Pediatrician at NorthShore, answers questions on this condition and provides some helpful advice on treatment for parents.

What are the symptoms of ear infections?

The symptoms of ear infections can vary based on age:  

• In toddlers and children who are able to tell parents about their symptoms, they might complain of ear fullness, sharp or dull ear pain, difficulty hearing out of the affected ear, fever of 100.4°F or higher, or even sharp intense pain followed by drainage from the ear.
• In infants, symptoms can include increased fussiness, especially when lying down, fevers of 100.4°F or higher, vomiting, pulling at the ears, restlessness, difficulty sleeping or drainage coming from the ear.

Babies and toddlers are prime candidates for ear infections. Can you offer any tips on how to tell between teething and an ear infection?

Babies and toddlers are prime candidates for ear infections because of the angle at which their ear canals sit. The ear canals of an older child or adult drain much more easily than a younger child’s canals. When babies get viral infections (such as head colds), the fluid gets backed up in the ear which sometimes allows an infection to occur.

Because babies are more prone to ear infections and some symptoms include only irritability, this can be confusing for parents to differentiate between an ear infection and just irritability from teething.

Some signs that irritability might be just from teething include:

• They are comforted/soothed by teething rings
• A one-time dose of Tylenol helps
• You can feel teeth breaking through the gums

Some signs that irritability might be from an ear infection include:

• Ear pulling
• Fever (100.4°F or greater)
• Not easily consoled
• Irritability worsens while lying down

Irritability alone as a symptom can be very confusing and frustrating for parents, so please know that your child's doctor is always happy to see them in the office to rule out an ear infection or any other infection.

Are ear infections contagious?

Ear infections are either caused by a virus or caused by a bacteria, but ear infections themselves are not contagious. This is because the infection is behind the eardrum, which is usually not exposed to the outside world. It is always recommended to provide treatment with either age/weight-appropriate ibuprofen or acetaminophen for pain control. Ask your doctor which method is best for your child at his/her visit!

Any other tips that don’t include use of medicine?

If the patient is an infant, sucking on a pacifier might be soothing. There are many over-the-counter topical solutions available that aid in soothing ear pain, but doctors don’t recommend these unless a physician has examined the patient's ears. Putting a liquid/medicine into an ear without a physical examination by a physician could be potentially dangerous because it is important to evaluate if there is a rupture (break) in the eardrum before using any drops.

What’s your gauge for determining whether a child is having a chronic problem with ear infections?

When determining if a patient is possibly having chronic problems with ear infections, physicians rely heavily on the history of the ear infections and the patient's physical exam. Physical exam findings or information presented with a history that are consistent with persistent discharge from the ears, persistent pain in the ears or any concern for any hearing loss, would prompt the physician to think about other complications from an ear infection.

In general, if a child has four or more ear infections within 12 months, a physician might think about referring the patient to a specialist for evaluation. Children with cranial or facial anomalies are also at higher risk of developing ear infections.

After a child has had a few infections, some parents wonder about tubes. Who benefits from tubes and can you explain a bit how they work?

Tympanostomy tubes (ear tubes) are small plastic tubes that are surgically inserted into the eardrums of patients who qualify for the procedure to help prevent further ear infections. They work by allowing excess fluid that would normally build up behind an eardrum to flow out through the tube and hopefully prevent fluid buildup which would then prevent an ear infection. Physicians think about referring a patient to a specialist for evaluation for tube placement if they have the same ear infected greater than or equal to three times within six months or greater than or equal to four times within 12 months. After discussion with an ENT doctor, the parents/guardians and doctors decide if it would be best to proceed with placement or to monitor symptoms.