Acute and chronic ear infections are one of the most common reasons parents take their children to the doctor. An acute ear infection is a single, isolated case that starts over a short period and is painful. A chronic ear infection lasts a long time (they do not heal) or they recur three times or more in a 6-month period or four times a year.

An ear infection is caused by the swelling and infection of the middle ear (otitis media). It develops when fluid builds up in the eustachian tube.

The eustachian tube is the canal that links the middle ear with the throat. This tube allows air into the middle ear and drainage of fluid.

The eustachian tube may not work properly due to:

•  Viral illness
•  Exposure to allergens or tobacco smoke (leads to swelling of the eustachian tube resulting in fluid build up in the   middle ear)
•  Poor eustachian tube function (often the result for children with a cleft palate and craniofacial syndromes like Down’s   Syndrome)

An infection in the middle ear often accompanies a common cold, the flu, or other types of respiratory infections. Other causes may include allergies to pollen, dust, animal dander, or food, which can produce the same effect as a cold or flu, as can smoke, fumes, and other environmental toxins.

With an ear infection, the eustachian tube, a tube that normally drains fluid from the middle ear, becomes plugged and infected. This buildup of fluid presses on the eardrum, causing pain. Eustachian tubes in children are smaller and more horizontal, so they can become plugged more easily. This is why ear infections occur more commonly in children.

For infants, the main sign of an ear infection is acting irritable or crying inconsolably. Other symptoms include fever or trouble sleeping.

For older children, symptoms may include:

• Ear pain or an earache
• Fullness in the Ear
• Malaise (a feeling of general illness)
• Vomiting
• Diarrhea
• Hearing loss in the affected ear

Your doctor will use an instrument called an otoscope to check for signs of an ear infection, which may include:

• Areas of dullness or redness
• Air bubbles or fluid behind the eardrum
• Bloody fluid or pus inside the middle ear
• A hole (perforation) in the eardrum

Your doctor may also recommend a hearing test, especially if there is a history of ear infections.

For acute ear infections, your doctor may advise that you try one or more of the following for your child:

• Apply a warm cloth or warm water bottle to the affected ear.
• Use over-the-counter pain relief drops or prescription eardrops for ears.
• Take over-the-counter medicines for pain or fever (ibuprofen or acetaminophen). Do not give aspirin to children.

If there is no improvement, schedule an appointment with your doctor to determine if antibiotics are needed.

• Is younger than 6 months with an ear infection
• Is older than 6 months, has a fever higher than 102 degrees Fahrenheit, appears sick and does not improve in 24 to 48 hours.

•  A feeling of pressure in the ear
•  Mild ear pain
•  Fluid draining from ears
•  Low fever
•  Hearing loss
•  Trouble sleeping

Treatment options for recurring ear infections may either be surgery or antibiotic treatment. Healthcare providers follow established guidelines to determine which patients should be considered for surgery, and which patients can continue to receive antibiotics for their infections.

A myringotomy is a procedure in which your doctor creates a small hole in the eardrum so fluids such as water, blood, or pus can drain out. In many cases, your doctor will put in tympanostomy tubes, known as ear tubes or PE tubes, so the eardrum won’t get backed up again. Before surgery, the doctor will conduct a through examination and order a hearing test to determine if your child has a hearing loss. After surgery, your child will undergo another hearing test to determine if his or her hearing has improved. Follow up care is also provided to manage children for the length of time they have ear tubes to make sure they remain free of ear infections and complications.

In placing the tubes in your child’s ear(s), they:

• Allow air to re-enter middle ear space
• Reduce the number and severity of infections
• Improve hearing loss caused by middle ear fluid

Tubes usually fall out of the ear in 6 months to 2 years. If they remain in longer than 2 to 3 years, they are sometimes removed.

If chronic ear infections are left untreated, it may result in hearing loss. If hearing loss affects both ears, the damage to the middle ear may slow language and speech development. While permanent hearing loss is rare, the risk increases with the number and length of infections.

Besides hearing loss, other complications such as a ruptured eardrum may occur if chronic ear infections are left untreated.

There are several things you can do to prevent your child from getting chronic ear infections including:

• Vaccinate your child against the flu.
• Keep your child away from sick children.
• Wash your hands frequently to prevent the spread of germs.
• Avoid exposing your baby to cigarette smoke.
• Seek prompt treatment for an acute ear infection.
• Request follow-up exams with your provider after an ear infection has been treated to make sure that the infection is completely cured.