Ear Infections in Children: Insights from an ENT Specialist
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Ear Infections in Children: Symptoms, causes & Treatment

Young children often complain of sudden ear pain inconveniently setting in towards the end of the day, sometimes in addition to a viral infection or a common cold. This can be quite distressing for the parents and the child, as painkillers may not be effective immediately. It might even warrant an agonizing trip to the nearest emergency room in the middle of the night. While it may just be a simple case of ear wax impaction, it could be a warning sign of an impending or ongoing ear infection.

Table of Contents

  • What is an ear infection?
  • What are the symptoms of an ear infection?
  • How can I tell if my child has an ear infection?
  • What causes ear infections in children?
  • Why are children more likely than adults to get an ear infection?
  • How does a doctor diagnose ear infections in children?
  • How long will it take my child to get better?
  • What happens if my child keeps getting ear infections?
  • Can ear infections be prevented?
  • Where can I find additional information about ear infections?
  • Conclusion

What is an ear infection?

Ear infections are medically termed as Otitis Media. This signifies inflammation of the mucosal lining of the middle ear, due to the blockage of the Eustachian tube. In the initial stage, it is sterile fluid building up in the middle ear, but stagnation results in viral or bacterial infection which presents as acute pain in the ear. Fluid in the middle ear persisting for 3 weeks is termed Otitis Media with effusion (OME) and sudden painful discharging ear is known as Acute Suppurative Otitis Media (ASOM).

What are the symptoms of an ear infection?

  • Acute onset of ear pain
  • Blood-stained ear discharge
  • A recent history of cold/sore throat

How can I tell if my child has an ear infection?

When trying to determine if your child has an ear infection, there are several signs to watch for. One common indicator is a change in their responsiveness to verbal cues, which may suggest a temporary hearing loss. Some children may be tugging on their ears frequently, in an attempt to “unclog” the blocked feeling inside. This might progress to moderate to severe ear pain, making your child irritable and uneasy. Interestingly, some children report a decrease in pain after ear discharge occurs. By paying attention to these symptoms, you can better identify whether your child may be experiencing an ear infection and seek appropriate medical attention.

What causes ear infections in children?

Middle ear infections in children are often preceded by specific signs and symptoms. These indications typically arise following a viral illness, persistent cold, or even after air travel, and they can be attributed to dysfunction of the Eustachian tube. This tube serves as a connection between the middle ear and the nasopharynx, which is located at the back of the nose. When the Eustachian tube becomes blocked, negative pressure builds up, leading to the accumulation of fluid in the middle ear. Healthcare professionals usually label this condition as Otitis Media Effusion. One common presentation of this condition is hearing loss, which may go unnoticed by children since they may not perceive a sound reduction when both ears are affected. Some children might complain of a blocked sensation in the ear or describe sounds as if they are heard “underwater.” It is important to take these complaints seriously and consult your pediatrician or an ENT doctor.

In approximately 80% of cases, the fluid collection resolves spontaneously within a few weeks. However, in some instances, the prolonged presence of fluid can result in an infection, particularly when a viral infection occurs concurrently. This can cause sudden pain and ear discharge.

Why are children more likely than adults to get an ear infection?

Children are more prone to these infections than adults, especially in the age group of 2-5 years. Recent studies indicate that Indian children have at least one such episode of ear pain/infection by the time they reach 10 years of age. This can be attributed to immature Eustachian tubes in children – which are straighter when compared to more angled adult tubes. This kind of anatomy makes it easier for mucus to travel upstream from the nose and throat to the ear. Air travel also helps precipitate pressure changes which block the tube and cause fluid collection.

Additionally, children in the age group of 3-5 years are more prone to viral illnesses contracted from play school, daycare, and playing in dusty environments. It is common for toddlers to have 8-10 viral infections per year, resulting in inflammation of the mucosa of the ear, nose, and throat, hence, predisposing them to these infections.

Children with known allergies and acid reflux are usually more prone to these infections as well.

How does a doctor diagnose ear infections in children?

When you take your child to your pediatrician or an ENT specialist, they will elicit a history of recent infection and frequency of infections or air travel to understand the possible causes. This will be followed by an examination of the ears using an otoscope. Depending on this examination, the doctor will diagnose the type of infection. A dull or amber-colored ear drum is suggestive of otitis media whereas an acute suppurative otitis media will present itself as a “fire engine red” ear drum or blood-stained discharge in the ear canal.

Further examination may show some discharge in the nose as well. The child may have a congested throat or tonsils – indicative of a recent or concurrent infection.

How long will it take my child to get better?

Theoretically, otitis media effusion is a self-limiting disease and it resolves spontaneously in 2-3 weeks. However, it can cause significant distress to the child, warranting treatment to provide relief from the symptoms. If your child complains of decreased hearing, ear pain, or ear discharge – it is best to consult a doctor at the earliest possible.

What happens if my child keeps getting ear infections?

Recurrent ear infections are a cause for concern because long-standing fluid or negative pressure in the ears can affect the child’s hearing. It can also affect the child’s psychosocial awareness and daily life.

Eustachian tube dysfunction is the main cause of these recurrent episodes. Children have lymphoid tissue at the back of their nose – similar to tonsils in the throat. This tissue grows in size from 3-5 years of age and eventually recedes after 5 years of age. During an acute illness or allergy, this tissue enlarges and blocks the Eustachian tube opening. It is also a harbinger of common viruses and bacteria (called biofilms) which are a continuous source of infections to the nose and ear.

Recurrent, frequent ear infections necessitate a need to investigate adenoid and tonsil enlargement/infection and thus, please take your child to the doctor to get this checked and diagnosed!

Can ear infections be prevented?

Ear infections, or otitis media, are fairly common in the toddler age group, usually peaking between 2-5 years of age. Air travel can often precipitate an episode, which can be prevented by using decongestant drops in the nose, before taking off and landing. Avoiding air travel during an acute illness will also help. Secondary cigarette smoke inhalation predisposes kids to such an infection. Secondary risk factors like adenoid and tonsil hypertrophy may require surgical intervention – but it is not necessitated in every case. Early medical management of colds will prevent the progression of ear infections.

Where can I find additional information about ear infections?


In conclusion, when it comes to ear infections in children, a single episode can typically be managed with appropriate medications prescribed by a pediatrician or ENT doctor. However, it is crucial to pay attention to recurrent episodes of ear pain in young children as they may indicate an underlying issue. Neglected and long-standing cases can potentially lead to the development of Chronic Otitis Media, which can cause damage to the eardrum and the small bones within the middle ear, potentially resulting in the need for a hearing aid. Additionally, it is important to consider the possibility of adenoid and tonsil enlargement in these children.

To prevent such infections and ensure optimal growth and well-being, it is highly recommended to adhere to the National Immunization Schedule, which includes vaccinations designed to protect children from infections during their developmental stages. By following these preventive measures, you can safeguard your child’s health and promote their overall growth and well-being.

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