Quiz: Ear infections

The most common kind of ear infection involves the middle ear — just behind the eardrum.

Middle ear infections fall into two general categories — acute otitis media and otitis media with effusion. In acute otitis media, fluid and mucus are temporarily trapped inside the middle ear. When effusion is present, fluid and mucus stay trapped in the ear after the infection clears up — which makes it easier to develop new ear infections.

Ear infections are most common in children younger than 3. In fact, three out of four children have at least one ear infection by age 3. Ear infections are less common in older kids, although infections are possible into adulthood.

Children certainly have smaller noses and ears than adults do. But that's not the problem. In babies and young children, the tubes that connect the middle ear to the inside of the nose — the eustachian tubes — are shorter and more horizontal. This makes it harder for fluid to drain out of the ear.

Children also tend to have larger adenoids, the infection-fighting structures in the back of the throat. If the adenoids become swollen, they can block the eustachian tubes — turning trapped air and fluids into a breeding ground for infection.

Ear infections aren't contagious — but the colds and other infections that often precede them are.

When your child has a cold, fluid and mucus may clog the tubes that connect the middle ear to the inside of the nose. If the openings to these tubes are blocked, air and fluid may get trapped inside the ear — creating a vacuum behind the eardrum in the middle ear. The body replaces this vacuum with fluid, which leads to an infection.

The infection-fighting adenoids also may become swollen when your child has a cold. In turn, swollen adenoids can block the eustachian tubes — once again trapping air and fluid in the middle ear.

Ear infections can be painful. If your child isn't old enough to tell you that his or her ear hurts, you may need to watch for other warning signs — such as crying or irritability, trouble sleeping and fever. Other signs may include vomiting, diarrhea and failure to respond to soft sounds.

Many parents consider tugging on the ear a telltale sign of an ear infection, but researchers don't necessarily agree. Children often tug on their ears whether they're infected or not.

Most ear infections safely clear up on their own without antibiotics, so a wait-and-see approach is often best. As long as your child feels up to it, he or she can still play or go to school or child care.

The American Academy of Pediatrics recommends antibiotics only for infections that last longer than two or three days. Widespread use of antibiotics — especially for common illnesses such as ear infections — contributes to the rise of antibiotic-resistant organisms.

Antibiotics don't relieve pain during the first 24 hours of an ear infection — when the pain is greatest. And they don't relieve fever any quicker or better than do over-the-counter medications. In most cases, the outcome is the same whether antibiotics are used or not. If your child is in pain, ask the doctor about numbing eardrops.

If your child's doctor prescribes antibiotics to treat an ear infection, give your child the full course of medication. Even if your child seems to feel better, finishing the medication will keep the infection from flaring up again.

Ear tubes aren't a first-line treatment for ear infections. They may be helpful if fluid remains trapped in the ear for several months, however. At this point, the trapped fluid may lead to hearing loss or delayed speech development.

Ear tubes are surgically implanted through a small opening made in each eardrum. By venting the ears, the tubes keep fluid from building up in the ear. Ear tubes typically fall out on their own within a few months.

Ear infections generally clear up without complications. Fluid lingering in the ear may cause temporary hearing loss, however, and recurrent infections are possible. In some cases, too much pressure in the middle ear may cause the eardrum to rupture. Most ruptures heal on their own within several months.

There are many ways to help prevent ear infections, including all of those listed above. Make hand washing a priority, and keep your child away from tobacco smoke and anyone who's sick. Make sure your child gets the recommended immunizations. If possible, choose a small-group setting for child care.

For infants, breast-feeding boosts immunity to colds and ear infections. Whether you're nursing or using a bottle, hold your baby slightly upright during each feeding to keep liquid from pooling in his or her eustachian tubes. Don't put your child to bed with a bottle.