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Ear Infections

Some children get ear infections with most of their colds; others never do. The ears are much more likely to be infected in the first three or four years of life. In fact, there is a slight inflammation of the middle ear in a majority of colds at this age, but it usually comes to nothing and the child has no symptoms.

What is an ear infection?

An ear infection (otitis media) is an infection of the middle ear, caused by a bacteria or a virus. The middle ear is a small chamber, behind the eardrum, that is connected to the back of the throat by a channel called the eustachian tube. When this tube is blocked for any reason - such as mucus from a cold or swelling from an allergy or enlarged adenoids - the fluid in the middle ear cannot drain into the back of the throat. Bacteria or viruses in the back of the throat then travel up the eustachian tube and infect the stagnant fluid in the middle ear. Pus forms and the middle ear becomes inflamed and painful.

Usually the ear doesn't become inflamed enough to cause pain until a cold has been going for several days. The child over two can tell you what the matter is. A baby may keep rubbing his ear or just cry piercingly for several hours. He may have a fever.

If your child has an earache, get in touch with the doctor or nurse practitioner the same day, particularly if there is fever. The antibiotics that are used when necessary work much better in the early stages of ear infections.

Suppose it will be several hours before you can reach the doctor. What can you do to relieve the pain? Lying down aggravatesear pain, so keep the child's head propped up. A hot-water bottle or an electric heating pad may help, but small children are often impatient with them. (Don't let a child fall asleep on a heating pad; he could be burned.) Paracetamol or ibuprofen will, relieve the pain somewhat. What will help even more is a dose of a cough medicine containing codeine that the doctor has prescribed for that child. (A medicine prescribed for an older child or adult might contain too much of the drug.) Codeine is an efficient painkiller as well as cough remedy. If the earache is severe, you can use all these remedies together, but never use more than one dose of the codeine cough medicine without talking to your doctor.

Once in a while, an eardrum breaks very early in an infection and discharges a thin pus. You may find the discharge on the pillow in the morning without the child ever having complained of pain or fever. Usually, however, the drum breaks only after an infection has been developing for several days, accompanied by fever and pain. Since the ear infection causes pressure on the eardrum, when it bursts, the pain is much improved. The pus now has a way to drain and sometimes this indicates cures the infection. So while a discharge of pus from the ear almost certainly indicates an ear infection, it can also indicate that the infection is on the road to recovery or will be easier to manage with antibiotics. The eardrum usually heals nicely in just a few days and will not cause further problems.

If your child's ear discharges, the most you should do is to tUck a loose plug of absorbent cotton wool into the opening to collect the pus, wash the pus off the outside of the ear with soap and water (don't put water in the ear canal) and get in touch with the doctor. If the discharge leaks out anyway and irritates child's skin, gently wash the pus off the skin around the ear. Never insert a cotton bud into the ear canal.

Chronic ear infections

Some children have repeated ear infections in the first years of life; a thick fluid accumulates behind the eardrum. Your doctor or nurse practitioner may deal with this in one of three ways, especially if the ear infections are interfering with the child's hearing. First, she may prescribe an antibiotic to be taken daily, often for months. The purpose of the antibiotic is to prevent the fluid in the middle ear from becoming infected, even when it cannot drain through the Eustachian tube. This works well for some children, less well for others. (As we have become increasingly aware of the risk of antibiotic­resistant bacteria, the routine use of antibiotics has dropped.) Second, the doctor may look for allergies that cause fluid to remain in the ear and encourage infections. Finally, she may refer the child to an ear specialist, who will consider inserting tiny plastic tubes through the eardrums. This allows the air pressure to be the same in the middle ear as in the outer canal, which may reduce the chances of further infection or accumulation of fluid and return the child's hearing to normal. Secondhand exposure to cigarette smoke increases the risk of ear infections another powerful reason to stop smoking or never start.