Signs and Symptoms
The signs and symptoms of ear infections range from the subtle to the glaringly obvious, and depend somewhat on the child's age. Infants can get irritable and often have trouble sleeping due to the different pressure put on ears when they're lying down. They may cry when trying to feed, as sucking and swallowing tug on the Eustacian tube and put tension on a sore ear. Fever may or may not be present at any age, but can be as high as 104 degrees Fahrenheit. An older infant may scratch or bat at his ears. Toddlers and older children can usually begin to talk about ear pain, pressure, or fullness.
If the pressure created by infected fluid within the ear gets high enough, the ear drum may eventually burst, draining the fluid out of the ear. This discharge can look blood-tinged, watery, or like frank pus. While scary, this usually brings significant pain relief (as the pressure is now gone) and almost always heals well on its own within a few days. Any time fluid builds in the middle ear, whether infected or not, hearing will be mildly reduced but returns to normal once that fluid is cleared.
If you do suspect an ear infection in your child, it's important to have him checked by a healthcare provider, sooner rather than later if he is under 2 or appears sick. To treat these infections properly, they must first be properly diagnosed. Though it may be tempting to jump to this diagnosis, other problems can also present as ear pain, such as throat infections, jaw, and dental problems.
Though many ear infections require antibiotics to clear, not all do. Mild-appearing infections in an older child can sometimes just be watched as many clear spontaneously. Very young children (under 2) and sick children with severe ear infections are treated with antibiotics as well as other measures to reduce pain, fever, and plenty of liquid to replace lost fluid. When a course of antibiotics is prescribed, it is important to give them exactly as directed and to finish the entire course. Though children usually feel better within 72 hours, the full course of medicine is needed to eliminate all the responsible bacteria.
If a child is not feeling better in 72 hours, a return visit to the doctor is necessary. More than one type of bacteria can cause ear infections, and while a single course of antibiotic usually covers all the common offenders, a second or stronger antibiotic is sometimes needed. If the first medicine is to work, it should begin doing so within three days. Since ear infections themselves are not contagious, children don't need to remain at home once they feel better but are still on an antibiotic, as long as the medicine can be given on schedule.
Clearing the infection doesn't usually take as long as clearing the fluid buildup that preceded the infection, which the body does over time. Three weeks after treatment, over half of children still have fluid buildup in their ears. This causes a mild hearing loss and becomes a problem if it begins to impede language development, or if the fluid gets repeatedly infected. Either of those situations is cause to consider the surgical option of ear tube insertion. This is a fairly simple surgical procedure where a small set of hollow tubes are inserted through the ear drum, creating an artificial channel through which fluid building up behind the ear drum can drain. Tubes don't prevent infections but create a drainage system for as long as they last. The procedure does require general anesthesia but is same day surgery. Most tubes fall out after several months and don't alter the ear in terms of function or hearing.
Avoiding Ear Infections
Of course the best situation is to avoid ear infections altogether. The best preventive measures include good hygiene to prevent the spread of colds, never propping a baby or allowing him to drink lying flat, treating allergy symptoms if they are leading to ear infections in an older child, and being alert to early signs of a developing ear infection. Though frustrating for both parents and children, ear infections tend to become less frequent after the age of 2 or 3, and only very rarely lead to permanent ear changes.