Ask a Pediatrician: Are There Different Kinds of Ear Infections?

Dr. Jeremy Friedman, chief of pediatric medicine at The Hospital for Sick Children in Toronto, answers your most pressing questions about your child's health

From the print edition, October 2012

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Photography by Catherine Scott, via Flickr (CC)

Q: Does every ear infection that my three-year-old daughter suffers from need to be treated with antibiotics?

A: No. Firstly, one should distinguish between infection of the ear canal (otitis externa, known as swimmer’s ear), which tends to respond well to antibiotic eardrops, and the more common middle-ear infection (otitis media), which I think you are probably referring to. Middle-ear infections usually occur in the setting of a viral cold with congestion. Because of the congestion, the Eustachian tube that usually drains fluid from behind the eardrum to the back of the throat gets blocked and the pressure from the accumulation of fluid in a confined middle- ear space behind the eardrum causes an earache. At this stage it may still resolve on its own if the cold or congestion settles and the tube opens up to allow the fluid to drain.

In some cases, the fluid stuck behind the eardrum may get infected with bacterial germs over the course of a few days. It is difficult for the health-care provider to definitively distinguish whether the fluid is “superinfected” with bacteria (antibiotics are then usually required) based on the symptoms or sometimes even when looking directly at the eardrum. For this reason, many practitioners may opt to treat children with mild or moderate earache with something for the pain only (usually ibuprofen or acetaminophen) and observe for 48 hours to see if they get better on their own. This is especially true as children get older.

For more advice from Dr. Friedman, be sure to check out these questions:

What Can I Do to Relieve My Child’s Cough?
• When Does a Nosebleed Need a Doctor’s Visit?
• How Do I Prevent My Child from Getting Head Lice?
• What Are the Signs of Celiac Disease?
• Does My Child Need More Sleep?
• What’s the Best Age to Get My Kids Tested for Allergies?

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