Thursday, February 2, 2012

Ask A Nurse About: Ear Infections

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I
encounter numerous questions about health, medications, and random concerns such
as "What does it mean when my poop turns green?".  And so I begin a new feature here,
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy
and physiology of the human body.  Am I an expert?  Hardly.  But I am an
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw
from my experiences in my medical practice, my journey through motherhood, and
my endless collection of credible nursing textbooks and resources.  Remember: this is
just a blog.  Just as you should never base any serious decision on internet ramblings,
so should you not take anything you read here as concrete fact.  When in doubt, consult
your doctor/naturopathic/guru.
This week's topic: The Dreaded Ear Infection.
It's that time of year: cold, flu, sinus infection time.  With this lovely plethora of
illnesses usually comes the ear infection, one in each ear if you're really lucky.
Let's break it down, shall we?
What are ear infections and why do they occur?
Ear infections occur in the middle ear space, the area right behind the ear drum that
connects to the nose via the Eustachian Tube.  Because children often have Eustachian
tubes that are anatomically too short and angled, mucous from the nose and throat
can migrate into the middle ear, creating a breeding ground for bacteria.  As the mucous
gets stuck in the middle ear region, pus begins to form.  Before you know it, you have an
ear full of fluid, mucous, and pus: thrilling combination.  This yucky stuff puts pressure on
the eardrum, creating an awful lot of pain and discomfort.  It can also lead to
diminished hearing, the same type of feeling one might have with Swimmer's Ear.
Signs and Symptoms of an ear infection:
Rule of Thumb: If your child has a legitimate ear infection, they will most likely have
2 or more of the following:
Cold symptoms.  Ear infections are almost always the result of the common cold.
Remember: the mucous stewing inside the ear that is not draining properly is the
culprit of the infection.
Low grade fever (Not always present)
Complaining of ear pain or difficulty hearing
Increased fussiness
Disrupted sleep pattern and not wanting to lie down flat
Drainage from the ear, most notably blood and/or pus due to a ruptured eardrum 
(don't panic, eardrums heal up quite nicely)
Myth debunked: Ear pulling is very often associated with ear infections.  This is not
a credible sign of a possible infection as young children are not cognitively able to localize
pain.  If ear pulling takes place without any of the symptoms listed above, they are more
than likely pulling on their ears because ears are cool and fun and weird.  They could also
be teething and think that the pain from their gums is hiding deep inside their ears.
Poor little loves...
Some parents might chose to let the infection run its course, which it is completely capable
of pending any complications.  I try to use common sense when deciding what course
of treatment to take with my girls.  If they are running a fever, have a copious amount
of mucous and congestion present, and seem to be very uncomfortable, off to the
pediatrician we go for antibiotic therapy.  If they are simply complaining of ear pain that
is relieved by over the counter Motrin but otherwise seem comfortable, we hold off on a
visit to the doctor and use our favorite homeopathic treatments.
Why choose antibiotic therapy?
Myth debunked: Antibiotics, when used appropriately and conservatively, are
therapeutic and beneficial.  They speed the recovery process up and prevent infection
from spreading and/or getting worse.
Your doctor should first check the ears with an otoscope, examining the eardrums
and assessing whether or not they are red and bulging.  If an infection is confirmed, the
doctor should then ask you if your child is allergic to anything, most notably penicillin.
They should then prescribe the first line, most basic antibiotic first, in this case
Amoxicillin.  DO NOT be tempted to ask for something stronger simply because it will
involve a shorter, more convenient treatment schedule.  This can cause the body to
become resistant to the antibiotic, a common problem in today's medical society.
Remember: ALWAYS finish the ENTIRE antibiotic cycle, even if your child begins to
feel better.  This helps reduce antibiotic resistance as well.
Myth debunked: Teething DOES NOT cause ear infections.  Teething causes
excessive drool, not mucous production.  Don't excuse a bad cold and it's complications
on teething, that's not the correct culprit and will only deny your child the proper
The road to recovery:
As with any illness, you want to look at the big picture and treat all symptoms.  If
the infection warrants treatment, give the entire antibiotic cycle.  Use Motrin and/or
Tylenol for fever and ear pain.  You can also use warm compresses and analgesic ear
drops prescribed by your doc.  An expectorant, like Mucinex, works great to dry up all
the mean, nasty snot that started this whole nightmare in the first place.  Lots of fluids,
rest, Vitamin C, Echinacea, Saline Nose Drops, and Vick's Vapo Rub to soothe those
tired bones.  Breastfeeding has been scientifically proven (really, I'm not just saying that)
to lower the chance of ear infections and to decrease the severity of the infection when
it occurs.  Feed your baby upright as much as possible so that more fluid does not
accumulate in the ear.
To sum it all up:
Ear infections occur, typically, because of a basic anatomical inability to drain mucous.
They are NOT contagious.  They can be treated with antibiotics to stop the infection.
After antibiotic therapy, some fluid may remain in the ear.  Antibiotics are NOT meant
to drain the fluid from the ear, they are meant to kill the bacteria IN the fluid.  The fluid
could take anywhere from 3 days to 3 months to drain, sometimes requiring tiny tubes to
be placed by an ENT when fluid is chronic.  Also remember that antibiotics do NOT treat
the common cold, which is caused by a virus.  Cold medicines will be needed to address
those issues.  Treat the symptoms, get rest, and be patient.
These things usually heal up in no time.
Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future post.  
Or, email me at  

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Hilary@BabyMooHoo said...

oh, i know already i am going to *love* this new feature! :)

as you know, natalie has been the victim of chronic ear infections--we're now dealing with our first set of doubles since her tubes surgery several months ago, so i'm feeling pretty lucky that our winter has been (mostly) healthy. i heard from friends that chiropractors can also do some realignment stuff to help babies with ear infections--any truth to that?

deanna@delirious-rhapsody said...

i think i'm going to like this new little series. :)

i had horrible ear infections growing up. they kept me in the doctor's office more than anything else.

The Poole Family said...

Ahhhh, God is AMAZING!! This post is absolutely the Lord's timing! Andrew has been suffering from an ear infection for the last 2 weeks (he has had them on and off for the past 6 months! Yuck!} and we go back to the doctor tomorrow to see if he will need tubes! Since we don't have internet at the new house yet, I jumped on here at my sister's house and before I could google ear infections, I "accidentially" went to blogger first!! :) And here your post was!!!!! Yaayyyyyyy!!! You made it so easy to understand and it's so reassuring to know exactly what's going on!! Thank you!!! :}

Caitlin said...

I always had nasty ear infections and mouth sores as a mom took me to the doctor, who said that it was probably due to the fact that when I dropped my pacifier (which I parents called it my plug) my mom just popped it back into my mouth without boiling/cleaning it. Once she started doing that the sores went away! The ear infections were still there but were definitely less.

I don't have kids but I bet this will be a very helpful series!

Joanna said...

This is super helpful!! Thank you!

Lauren Knight said...

New to your blog- thanks for the interesting posts. I found this especially helpful since I have 3 boys under the age of 5, and all three currently have colds! I like that you offer a range of treatment suggestions as well. Keep up the good work!

She Said... said...

LOVE this new feature! In fact, Chloe was just diagnosed with a double ear infection! We are using the antibiotics now and it is so nice to understand a little more about them! Thank you for sharing your knowledge!

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