My Doctor Online The Permanente Medical Group

Causes

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Infections of the nose or throat may spread through the Eustachian tube, which connects the back of the nose and throat to the middle ear.

If the Eustachian tube becomes blocked and bacteria or viruses are present, fluid can collect behind the eardrum. This fluid creates pressure and can cause an earache, swelling, and redness of the eardrum. The inflammation also affects the ability of the eardrum to vibrate properly and can interfere with hearing. Enlarged adenoids may also interfere with Eustachian tube function.

Young children are more likely to get ear infections than older children and adults. This is because the Eustachian tubes of children are small and can become blocked more easily. Some children are particularly prone to middle ear infections, even without a cold or another trigger.

Exposure to smoking, allergies or immune system deficiencies, and colds and flu can trigger middle ear infections.

Prevention for Children

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There are several things that you can do to help protect your child against ear infections:

• Breastfeed your baby. Babies who are breastfed for at least 6 months are at lower risk for ear infections.
• Do not insert anything into your child's ears. Pushing cotton swabs or any other objects into the ears can lead to impacted wax, infections, and punctured ear drums.
• Stay current with immunizations. Make sure children receive the following to help protect them against the most common causes of ear infections:
  • Hib (Haemophilus influenza type B) and pneumococcal vaccine - these 2 immunizations protect against the leading causes of ear infections, pneumonia, and meningitis in children.
  • Flu vaccine - all children 6 months and older need this vaccine annually.
• Don't smoke or allow anyone to smoke around your child or in your home or car. If you do smoke, consider smoking cessation programs.
• Limit pacifier use during your baby's first 6 months.
• Hold your baby upright during feedings and don’t put your baby to bed with a bottle.
• Daycare strategies. Try to choose daycare with the smallest number of children possible and one where good hygiene (hand washing or hand sanitizer) is routine.

If your child has frequent infections, he or she may be a candidate for placement of small pressure equalizing (PE) tubes in the eardrums to drain and ventilate the middle ear, or removal of the adenoids. We can discuss the options that are right for your child.

It can be frustrating to see your child experience repeated ear infections. You'll be glad to know that most children who have chronic ear infections simply outgrow them over time.

Symptoms

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Children with middle ear infections sometimes have different symptoms, depending on their ages. Look for the following signs:

In infants and toddlers

Young children who have hearing loss sometimes have difficulty with their speech and learning as a result. Fortunately, when the fluid drains, hearing is almost always restored to normal, but it can take several months. Symptoms can include:

• Pulling or scratching at ears
• Fussiness, especially during feedings and while lying down
• Muffled hearing or hearing loss
• Fever
• Clear or yellowish fluid draining from the ear

In older children and adults

Fluid behind the eardrum can cause temporary hearing loss. Fortunately, when the fluid drains, hearing is almost always restored to normal, but it can take several months. Signs of ear infection include:

• Earache, from mild to severe
• Feelings of fullness or pressure in the ears
• Hearing problems or ringing in the ears
• Nausea or vomiting
• Rarely, loss of balance or dizziness
• Ear drainage or fever

Diagnosis

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If you suspect an ear infection, contact my office to determine whether or not you need a telephone appointment or an exam. 

If an office appointment is needed, we will examine the ear using an otoscope, a small instrument that allows for visualization of the eardrum. Using a small rubber tube to gently blow air into the ear can be a quick test to see if there is fluid behind the eardrum.

Treatments

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Treatment of middle ear infections includes relief of pain and fever, along with observation (watchful waiting) or antibiotics. A combination of all of these treatments may also be recommended. 

We will decide together whether to treat the infection with antibiotics, depending upon the severity of symptoms, risk factors, medical history, and age. Be aware that once the infection clears up, temporary hearing loss may continue for weeks. This is normal and is not a cause for concern. 

Pain management

This is the most important part of caring for the infection.

• Ibuprofen or acetaminophen. You can use either of these over-the-counter pain medications. Ibuprofen has been shown to be more effective for ear pain and can be used if your child is 6 months or older. Make sure you follow the package dosing directions exactly. For children, download our pediatric dosage guide. Important note: Do not give aspirin to anyone under age 20.
• Eardrops. Do not use eardrops unless we recommend them.

Observation, or "watchful waiting"

Antibiotics are not always needed to treat ear infections. In fact, 70 to 80 percent of ear infections go away with no treatment at all. In many cases, children who are over 2 years old who do not seem ill can often be safely observed for 48 to 72 hours without antibiotics.

Antibiotics

If antibiotics are prescribed, symptoms should be much better within a few days.  Amoxicillin is the most common antibiotic used for the treatment of ear infections. Sometimes, we might recommend an alternative antibiotic (for example, if you or your child has recently been on amoxicillin, or if there is a penicillin allergy).

Other medications

In some cases, we might recommend decongestants or antihistamines. Decongestants may relieve nasal congestion. If you or your child suffers from allergies, we might recommend antihistamines or other allergy medications.

Surgery

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If infections are recurrent, chronic, or complicated, we might consider referring you to an ear, nose, and throat specialist for a minor surgical procedure called myringotomy. This procedure is used to relieve pressure caused by the excessive buildup of fluid by creating a small incision or hole in the eardrum. Fluid that has accumulated behind the eardrum from the infection drains out through the incision. A small plastic or metal tube called a pressure equalizing (PE) tube is then inserted through the incision and left in place. The tube provides a ventilation hole in the eardrum, which allows the ear to heal.

Hearing usually improves immediately after the tube is inserted. Since fluid can no longer accumulate in the middle ear, new ear infections are less likely to occur.

What to expect

Surgery is done in the medical office or outpatient surgery clinic. For older children and adults, a local anesthetic to numb the area is used. Surgery for very young children is usually done under general anesthesia which is administered through a mask.

Recovery is usually quick; your child will go home on the same day. There is rarely pain after surgery, but any discomfort can be treated with acetaminophen. Generally, you can expect a full recovery by the next day.

After the surgery, your child should not be able to feel the PE tube at all, since it's so small. It is common to have drainage or bloody drainage for a few days after the surgery. Most PE tubes will slowly migrate from the eardrum to the ear canal, and then fall out of the ear on their own any time in the next several months. This is normal and not a cause for concern.

Surgery risks

The risks of surgery include drainage from the ear (indicating ear infection) and eardrum perforation (hole in the eardrum persisting after the PE tube falls out).

Complications from anesthesia are not common but can be very serious. You can discuss any questions with the anesthesia provider.

Learn more about PE tube surgery

If your child is a candidate for pressure equalizing tubes (PE tubes) in the ears, we recommend watching the video called Preparing for Your Procedure (Emmi) for myringotomy (see Related Health Tools).

Home care to prevent infections

It is important to prevent water from entering the ears after PE tubes are inserted. Water carries germs that may cause the ear to become infected again.

Bathing and swimming require some precautions:

• Keep soap, bubble bath, and shampoo out of the ear canal. Do not let a child lie down in the bathtub with his or her ears underwater. These products can cause itching and irritation.
• Keep the ears dry.
• After swimming or showering, have your child shake his or her head gently to remove water from the ear canal.
• Gently dry the ears with the corner of a tissue or towel, or use a blow dryer on its lowest setting. Hold the dryer several inches from the ear.

When to call us

If an infection does occur while a tube is still in place, you will notice pus or a small amount of blood draining from the ear. Please call us if you notice these signs.

Your Child's Care with Me

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If you are concerned about your child’s symptoms and suspect he or she has an ear infection, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

Depending on your child’s symptoms and medical history and your preferences, the advice nurse may recommend one of several treatment options:

• Home treatment, including pain management and “watchful waiting”
• A telephone appointment with me, or another pediatrician if I am unavailable
• An in-person appointment for an ear exam

We will discuss your child’s symptoms and medical history, along with any concerns or questions you may have. We can help you manage your child’s ear pain and understand what may be causing it.

If an office visit is needed, I will examine your child’s ears for signs of infection, using an otoscope, a small instrument that allows me to see the eardrum. I may also use a small rubber tube to gently blow air into the ear, as a quick test to see if there is fluid behind the eardrum.

Together we will create a treatment plan that is right for you and your child.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).