Ear pain is the most common symptom of otitis media. Because the pain of otitis media is a result of increased pressure behind the eardrum due to the presence of pus in the middle ear, pain will often be more severe when the child is lying down. In infants, irritability or poor sleeping may be the main symptoms of an ear infection. Fever occurs in many children with ear infections, but is not always present. Its presence is more common in younger patients. Other symptoms of ear infections are hearing loss, loss of balance, and drainage from the ear canal. Not all children who complain of earache have otitis media. Other causes of ear pain are swimmer’s ear, throat or tooth infections, and temporomandibular joint (TMJ) disorders. Ear infections usually do not cause the ear to hurt when touched or pulled; this is more commonly seen in swimmer’s ear.
Although most ear infections are caused by bacteria, about one third are caused by viruses. This explains why some ear infections will resolve on their own without treatment. Unfortunately, it is not possible to tell by physical examination which ear infections are caused by bacteria and which by viruses. Many diagnosed ear infections are treated with antibiotics, although it is also acceptable in some instances to observe without antibiotic treatment. It is important to realize that other than the pain they cause, ear infections are not dangerous or harmful, and there is no danger to waiting even several days before antibiotic treatment. Pain relief can usually be achieved with acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) Other helpful measures are keeping the head elevated with extra pillows and applying a warm compress to the painful ear.
Amoxicillin is usually the antibiotic used to treat ear infections. This is because it is effective in the great majority of ear infections, it tastes good and is easy to use, and it has fewer side effects and is far less expensive than many of the other medicines available. As with all antibiotics, it is important that the medicine be used in the way that it is prescribed. Some ear infections will not respond to Amoxicillin. It is not unusual for the antibiotic to take a few days to work, but if your child is not much improved after two to three days it is probably time to speak again with the doctor. If you feel that your child is not all better after treatment, you should bring him or her back for a re-check. In certain situations, such as when a child has had many ear infections or has not responded well to an antibiotic in the past, your doctor will recommend a follow-up visit.
Ear infections are not contagious, although the colds that often accompany them are. If your child has an ear infection but is in good spirits and acting well, he or she is no more contagious than other children with colds, and can return to day care or school. There is also no restriction on swimming with an ear infection. There is no relation between getting ears or hair wet and ear infections. However, it can be harmful to the ear to dive into deep water with an ear infection. The pressure of deep water can cause an infected ear to be more painful or even perforate a hole in the eardrum. Flying with an ear infection can be painful, and it is possible that changes in cabin pressure can damage an infected ear. Although there is no unanimous opinion among ear specialists, most pediatricians and ear specialists agree that after several days of antibiotics, the risk of damage to the ear from flying is very minimal.
If you think that your child might have an ear infection, give him or her acetaminophen or ibuprofen, and try some of the other comfort measures mentioned above. Pain medications generally take 30-45 minutes before they work. It is necessary for us to examine your child in order to diagnose an ear infection, so we will need to see the child in the office before prescribing an antibiotic if the child does have otitis media. We all feel very strongly that it is not good medical care to prescribe oral antibiotics over the telephone, and we hope that you will understand this policy. It is very rare that the above measures are not successful at keeping a child comfortable until he or she can be seen in the office for a proper diagnosis.