“We usually get referrals from pediatricians for children who have had recurring ear infections,” said Dr. Michael Kubala, an ENT surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery. “Most of the time that's in the wintertime and usually these are kids who are in daycare. Most of the patients we see have already been diagnosed with at least three or four ear infections. We provide that next step in treatment.”

As an ENT surgeon, Dr. Kubala treats a wide range of conditions affecting the ear, nose and throat, in children and adults, but the majority of his pediatric patients are contending with ear infections – in fact, ear infections are the most common reason parents bring their child to a doctor. 

What is an Ear Infection?

The ear has three major parts: the outer ear, the middle ear, and the inner ear. The outer ear is the part of the ear that’s visible on the outside as well as the ear canal. The canal leads to the eardrum, a membrane that separates the outer ear from the middle ear. The middle ear is the air space between the eardrum and the cochlea, which is also known as the inner ear. The cochlea is where the hearing nerve starts and travels to the brain.

An ear infection – acute otitis media (AOM) in scientific terms – occurs when a collection of fluid in the middle ear space becomes inflamed. Ear infections can affect anyone, but children get them more often than adults. In fact, five out of six children will have had at least one ear infection by their third birthday.

With an infection, bacteria infect the fluid of the middle ear space, leading to swelling, pressure, and pain in that area. Your child may complain of an earache and may have a fever. If your child is too young to talk, look for symptoms like fussiness and crying, tugging or pulling at the ear, trouble sleeping, clumsiness or problems with balance, trouble hearing or responding to quiet sounds. If the pressure behind the eardrum becomes too intense, the eardrum may rupture, causing the fluid to drain from the ear canal.

Fluid in the middle ear space may be persistent, even in the absence of an infection or after an infection has passed. This is called otitis media with effusion (OME). Once fluid has been present for at least three months, it becomes chronic otitis media with effusion (COME). Pediatricians and ENT’s become worried about COME because it can affect several aspects of a child’s development.  

Children are particularly prone to ear infections for a number of reasons. Their eustachian tubes are smaller, more floppy, and more level compared to those of adults. Even in normal conditions, this makes it more difficult for fluid to drain out of the ear. When a cold or allergies causes the nasal cavity and eustachian tubes to swell, or become blocked with mucus, fluid may not be able to drain. Also, because their immune systems are still developing, children tend to get sick more easily and more often.  

How are Ear Infections Diagnosed and Treated?

Many parents already know this routine. But if you take your child to the doctor for a suspected ear infection, here’s what happens. The doctor will first ask about your child’s health. Has your child had a sore throat or head cold recently? Is the child having trouble sleeping? Pulling at his or her ears? If an ear infection seems likely, the doctor will use a lighted instrument, called an otoscope, to look at the eardrum. If the eardrum is red and bulging, that indicates an infection. Usually, the otoscope confirms the diagnosis, but if not, the doctor may also use a pneumatic otoscope (which blows a puff of air into the ear canal) to check for fluid behind the eardrum, or tympanometry, which uses sound tones and air pressure to measure how flexible the eardrum is at different pressures.

Once an ear infection is diagnosed, a pediatrician will typically prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. It’s important to make sure your child takes the medication for the entire length of time it is prescribed, even after the symptoms clear up. To help with fever and pain, your doctor may also recommend over-the-counter pain relievers such as acetaminophen or ibuprofen. (Note: never give your child aspirin unless instructed by your doctor, due to the risk for Reye’s syndrome.)

Sometimes, a doctor may take a “wait and see” approach if it’s not clear that the child has an ear infection, and the child doesn’t have severe ear pain or a fever.  To avoid overuse of antibiotics, the American Academy of Pediatrics issued guidelines in 2013 encouraging doctors to closely follow children with ear infections that can’t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there’s no improvement within 48 to 72 hours after symptoms began, the guidelines recommend doctors start antibiotic therapy.  

Recurrent Ear Infections

When ear infections occur over and over, it’s time to turn to a specialist: an ear, nose and throat (ENT) physician. Ear tubes are generally recommended if a child has three or more separate instances of acute ear infections over a period of six months.  Ear tubes may also be recommended for chronic otitis media with effusion or other persistent symptoms related to middle ear effusions such as hearing loss, speech delay, balance problems, behavioral problems, or poor quality of life.

“When a child comes to our clinic, we usually provide ear tubes or other treatment, not just antibiotics for these children,” said Dr. Kubala. Ear tube placement is one of the procedures that Dr. Kubala performs most often with children.

Ear tubes are tiny, hollow cylinders that are surgically inserted into the eardrum. The tube’s opening enables drainage of the middle ear, allows air to flow into the middle ear, and prevents the buildup of fluids behind the eardrum. An ear tube is made of metal, silicone, or plastic. The tubes equalize air pressure in the middle ear, allow fresh air into the middle ear, and enable fluids to drain from the middle ear and into the throat. Most ear tubes fall out within four to 18 months, and the holes heal shut on their own.

Ear tube placement is a relatively safe procedure. The risk of serious complications is low but be sure to discuss possible complications with the surgeon before surgery. Following the pre-operative and post-operative instructions provided by the surgeon will help ensure the best possible outcome.

Can Ear Infections be Prevented?

In addition to ear tubes or other treatment to provide relief, Dr. Kubala says, is important to address the causes behind the ear infections.

“A lot of the issues that come from the ear infections actually start with nasal congestion, running nose, or allergies,” Dr. Kubala said. “We also help provide some management for those conditions as well, to get these kids healthy, so that they're not always going to the pediatrician's office two or three times a week. We want to get them back into daycare or back in school with their friends.”

Dr. Kubala also urges parents to follow preventive measures, even after ear tubes have been implanted. These measures include:

• Make sure your child gets the influenza, or flu, vaccine every year.

• Vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). (If your child already has begun PCV7 vaccination, ask your pediatrician about how to transition to PCV13.) The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age, especially if they are daycare. Studies indicate that vaccinated children get far fewer ear infections than children who aren’t vaccinated.

• Wash hands often to prevent the spread of germs.

• Avoid cigarette smoke. Babies who are around smokers are more prone to ear infections.

• Never put your baby down for a nap, or for the night, with a bottle. 

• Limit your child’s exposure to other children who are sick, and keep your child home if he or she is sick.

Swimmer’s Ear

Another common issue that Dr. Kubala sees in children: acute otitis externa, more commonly known as swimmer’s ear.

“We see this a lot, especially during the summertime, usually when the kids have been going to the pool, the lake or the beach,” he said. “The kids come back about two or three days later and they have very extreme ear pain. They may have actual drainage from the ear as well.”

Anyone can get swimmer’s ear, but it is most often seen in children.  Dr. Kubala typically cleans the ears out and prescribes antibiotic drops.

With swimmer’s ear, Dr. Kubala says, prevention is the best medicine.

“After the children get out of the pool or after they go to the beach, take a little washcloth and clean out the ears from the ear canal,” he advises. “Over the counter drops can also help prevent swimmer's ears. You can use a hair dryer, just for a couple of minutes after the child gets out of the pool, to keep that moisture from the ear canals.  The goal is to keep the ears as dry as possible.”

If you are concerned about an ENT condition for your child,  reach out to us to help get connected to an ENT surgeon on our medical staff.