What causes ear infections and why do kids get them so often?

What causes ear infections and why do kids get them so often?Acute otitis media, or ear infections, occur when bacteria or viruses get into the middle ear space behind the ear drum.  It’s true that children are more susceptible  to ear infections than adults, but in most instances, children eventually outgrow them.

Behind the ear drum is the middle ear space.  There is a small amount of fluid in this space that drains through the eustachian tube, which runs from the middle ear to the back of the throat.  The eustachian tube works as a release valve to equalize pressure between the middle ear and the outside world.  In respiratory infections, the eustachian tube can swell shut so it doesn't open and close the way it's supposed to.   Fluid doesn't drain and pressure doesn't release.  This stagnant atmosphere is perfect for viruses or bacteria to reproduce and grow, leading to infection.

Another factor in contributing to ear infections is a child's anatomy.  In children, the eustachian tube is horizontal.  In adults, it's angled more vertically.  If the tube is horizontal, it's harder for fluid to drain.  Often, the child will grow out of the ear infections as his or her anatomy changes.

Inflammation in the middle ear often begins with the same infections that cause sore throats, colds or other respiratory problems.  Common symptoms include pain, fever and typical cold symptoms.  A child with an ear infection often will tug or pull at one or both ears, indicating that he or she is experiencing discomfort.  Draining fluid from the ear, loss of balance and hearing difficulties also are good indicators that a child may have an ear infection.

It was long believed that antibiotics were necessary to treat all ear infections; however studies have shown that these infections can get better without the use of antibiotics.  Prescription antibiotics often aren’t recommended for 48 to 72 hours after diagnosis.  In the meantime, many physicians encourage watchful waiting.  Acetaminophen or ibuprofen can be used for pain and fever.  This theory isn't recommended for young children, those with recurrent ear infections or with certain other risk factors.

Serious complications don’t often occur from a single ear infection , yet there are instances when they can become serious.  It’s rare, but ear infections can spread beyond the ear space into the brain, causing meningitis.  In other cases, fluid can remain in the inner ear even after the infection clears.  This trapped fluid will restrict movement of the eardrum, affecting hearing.  In young children, this also can lead to speech delays.

When infections won't go away with antibiotics or when they impact a child’s hearing, doctors may recommend putting tubes in the child's ear drums.  These tiny tubes provide an opening from the middle ear to the outer ear canal, letting the trapped fluid drain.  Tubes don’t necessarily reduce the number of  infections, but they can reduce the severity of the infection and make them easier to treat.  Tubes also help reduce the amount of pain that comes with ear infections and improves hearing.  With tubes, ear infections can often be treated with ear drops instead of oral antibiotics.

Symptoms of ear infections usually come on rapidly, and because many young children can’t vocalize what’s bothering them, it’s important that parents be aware of the warning signs.  It’s equally important to get an accurate diagnosis and prompt treatment.