Helene Stoyanovski’s son and daughter have had their fair share of ear infections — daughter Victoria, 3, has suffered through several and her son, Peter, 2, recently had his third go with this common toddler ailment.

“I’ve tried to find out what I can do to avoid them and each time it was a different response, like don’t give them a bottle just before sleeping because it would leak into their ears, which is understandable, but I breastfed,” explains the Milton, Ont., mom. “I’ve also been told it is probably from teething or a sore throat or something. It’s very frustrating.” But the worst part is the pain, she says. “Now that they both can tell me what hurts, I get the ear grabbing and crying and “mommy it hurts’ and there’s no sleep for anyone until the pain is better.”

What is it?
An ear infection occurs when bacteria or a virus, usually caused by a cold, infects the middle ear, the space behind the eardrum. Symptoms may include ear pain, crying, ear tugging, fussiness, fluid draining from the ear and fever. In many cases the infection is caused by a blockage of the Eustachian tube which connects the middle ear to the back of the nose and throat. The blockage often occurs in the setting of congestion caused by a cold. This is more common in babies and toddlers because their tubes are shorter and more horizontal than in adults, making it harder for fluid to drain. When the infected fluid builds up, it causes pressure to increase in the enclosed middle part of the ear, causing pain. Recurrent infections may also be associated with enlarged tonsils or large adenoids, which decrease drainage.

Treating the infection
Gone are the days when every ear infection was treated with a round of antibiotics. These days a “watch and wait” attitude is reasonable for children over age two. “Many ear infections are viral. Viral infections do not require antibiotics,” says Dr. Gian Egger, a pediatrician and pediatric cardiologist at the Credit Valley Hospital in Mississauga, Ont., who recommends giving a child a pain reliever such as acetaminophen or ibuprofen as a first step. If the fever and pain do not subside, antibiotics are often prescribed. If the symptoms continue or worsen or your child is under two, he suggests calling your family doctor or pediatrician for an appointment to be accurately diagnosed. If left untreated, an infection can cause potential middle or inner ear damage, which can affect hearing.

If your child is prescribed antibiotics, it’s important he finishes the whole course of treatment even if he feels better. If not, there is a higher risk of a repeat infection.

Toddlers and tubes
If your little one is experiencing recurrent middle ear infections (three or four times over six months) that fail to respond to antibiotics, your doctor may recommend an appointment with an otolaryngologist (ear/nose/throat specialist) to be evaluated for the placement of tympanostomy tubes. These small, soft tubes are inserted in the eardrum to let fluid drain more easily from the ear. The surgery usually takes 5-10 minutes under general anesthesia. The tubes generally fall out on their own in about a year, but may have to be removed by a surgeon if they remain in the ear for longer than two years.

What about swimmer’s ear?
Unlike a middle ear infection, swimmer’s ear is an infection of the outer portion of the ear canal. It occurs when bacteria, often from water, remains in the ear, allowing bacteria to grow, leading to an infection. Your child may complain of an itchy eardrum, a “plugged” feeling or pain that is made worse by chewing. “If a child has pain, they should be seen by a doctor who will determine the source. If fever is present, it’s more urgent,” says Dr. Egger. Your doctor may prescribe antibiotic drops for your child and he should not get any water in his ear until it is completely healed.

CF senior editor Robin Stevenson is waiting patiently for her five-year-old daughter to grow into her enlarged tonsils, which are the cause of her recurring ear infections.

Risk factors for ear infections

• Exposure to second-hand smoke
• History of ear infections
• Drinking from a bottle while laying down
• Nasal allergy symptoms
• Daycare
• Prematurity or low birth weight