Ear to the ground: what to look for in ear infections, especially in young children

Ear infections can sometimes fester within a child’s ear without anyone realizing.

Kimberly S. Traver, a clinical audiologist and chair of Bowling Green State University’s department of Communication Sciences and Disorders, says she often sees children who, according to parents and teachers, “aren’t paying attention in class.”

“It’s not that they’re not paying attention,” Ms. Traver said. “It’s that they’re not hearing well.”

Middle ear infections – most common in infants and young children – can cause temporary hearing loss. However, very young children might have trouble expressing their discomfort, meaning ear infections can be difficult for parents to detect. Such infections can also be very painful.

“Remember, the ear is a very sensory organ,” Dr. Charles Elmaraghy, Chief of ENT of Nationwide Children’s Hospital said. “It’s highly innervated, meaning there’s a lot of nerves.”

The most common type of ear infections occur in the middle ear and are most common during colder winter months. During the summer, a second type of ear infection often rises: an outer ear infection, more casually referred to as “swimmers ear.”

Though ear infections are often easily treatable, left untreated they can cause serious problems, preventing language acquisition, slowing childhood development, and even causing meningitis.

“If you’re concerned, or not really sure what might be going on, definitely call your pediatrician and have them evaluate the ear for you,” Dr. Essel, pediatrician at ProMedica Physicians Arrowhead Pediatrics said.

Middle ear infections

Middle ear infections are caused by bacteria or viruses in the middle ear, a cavity behind the eardrum. Such infections are often caused by respiratory tract infections in the throat or nose that then enter the ear.

Both anatomical and physiological factors predispose infants and young children to middle ear infections. The ear and throat are connected to a small tube called the Eustachian tube, and in infants that tube is shorter and flatter, said Dr. Elmaraghy.

“When a child or an infant has an upper respiratory tract infection, like a cold or a virus, it’s not a long distance from getting it from the back of the nose or throat into the ear,” said Dr. Elmaraghy.

Underdeveloped immune systems also put infants and young children at higher risk for upper respiratory tract infections in general, priming them for middle ear infections.

When very young infants develop a middle ear infection, however, it can sometimes be difficult for parents to detect. If a child does not have the language to describe their pain or has trouble locating pain in the body, it’s not unusual for a middle ear infection to develop without a parent’s knowledge.

Sometimes, a child may tug on their ear, indicating pain. Sometimes, the clearest indication of a middle ear infection may be loss of hearing. Such loss of hearing can impede a child’s development and language acquisition.

Ms. Traver expressed frustration with people who dismiss auditory problems as “just hearing loss.”

“[Hearing loss] is not life-threatening, but it can certainly be life-altering for anybody, especially developing children,” Ms. Traver said. “If they’re not hearing, how is speech and language going to develop normally?”

While little can be done at home to prevent the spread of upper-respiratory tract infection into the ear, if a child has recurrent ear infections parents can discuss with their doctor the possibility of ear tube surgery. The surgery places a small tube into the eardrum and allows fluid to drain more easily.

In very serious cases, ear infections can spread to the brain and cause meningitis – though this risk has been greatly reduced through antibiotics, said Dr. Elmaraghy.

“It’s not something that’s just a nuisance, and in a low percentage of patients it can develop into something more serious,” the physician said. “If you’re having a child who’s having recurrent ear infections, you should probably seek care.”

Outer ear infections

While middle ear infections peak alongside upper-respiratory tract infections in colder months, summer brings its own ear-related risk: outer ear infections, commonly known as swimmer’s ear.

An outer ear infection occurs in the ear canal, a tube that leads from the outer ear to the eardrums. The canal is a complex biological environment that maintains a slightly acidic pH, naturally maintained by earwax. When someone swims often in a chlorinated pool, the alkaline water can alter the pH of the ear canal.

Bacteria and fungi thrive in warm, moist, and slightly alkaline environments, making a swimmer’s ear canal an ideal space for growth.

“Your ear canal can swell – it can actually swell shut – and it can be very red, very scaly, and extremely painful,” Ms. Traver said.

Unlike a middle ear infection, an outer ear infection will make the ear painful to touch. Because the skin of the ear canal is immediately adjacent to the bone of your skull, the infection can also reach bone quickly.

“When bacteria starts breaching that skin barrier, it goes to bones fairly easily, and that can cause a really deep and intense pain,” said Dr. Elmaraghy.

To prevent outer ear infection, Dr. Essel suggests using earplugs when swimming, and treating the ear with a home remedy solution of half rubbing alcohol and half vinegar. An ear drop solution with vinegar can help restore some of the ear canal’s natural acidity which is usually maintained with earwax. Additionally, Dr. Essel said parents can use a hairdryer to dry excess water collected in the ear after swimming.

Dr. Essel warns against using a Q-Tip to try to clean the ear, which can cause more damage.

Contact Maggie Grether at mgrether@theblade.com