Middle Ear Inflammation In Babies: 13 Need-To-Knows

Ear inflammation is a very common part of childhood: many may remember having had quite a few earaches as kids, too! With around 75% of children having at least one ear infection by the age of three, and many children experiencing considerably more, it's practically part of growing up. But it isn't just painful, it can also be dangerous, and when one's own child is pre-verbal, they can't say where it hurts, so it's very important for parents to know what signs to look out for. Here's what parents need to know to keep their little one's ears healthy and safe.

So what is middle ear inflammation, anyway?

Generally, an inflamed middle ear is caused by infection: the inflammation may not be the only symptom, but it's generally a very painful one! Ear infections are split into two categories - middle ear and outer ear - and the middle ear infection is more common.

As we mentioned, it's a condition that will effect most young children by the age of three. About half of children under the age of 1 will experience it too, and they can't tell you, so vigilance is key. Despite not being able to verbalize what's happening, they'll still be doing their best to let you know about it.

As a adult, you probably haven't experienced earaches for a long time: for most of us, middle ear problems clear up over the years and fade into memory. Fortunately, it'll probably be the same for your little one, too!

13 Growing Pains, Quite Literally

Have you ever wondered why it is that young children seem to get so many more earaches than older children or adults? Well, it's pretty simple: there are these tubes in your ears (Eustachian tubes) which start off short and horizontal during infancy, and gradually grow to three times their original length as we reach adulthood; while they're short, it's much easier for infectious microorganisms to get into the middle ear. Babies and children also have less developed immune systems, so it's harder for their bodies to fight the microorganisms off, too.

These tubes also go from a horizontal position in childhood to a vertical position in adulthood, which means that it's much harder for fluid to drain from baby's ears.

12 It's More Common Than You Think

Even more common than you might've thought: ear infections, most of which involve middle ear inflammation, are actually the second-most commonly diagnosed childhood illness in the US, only being beaten out by the common cold.

Ear infections are also the most common childhood illness to be treated with an antibiotic prescription.

As we mentioned, 75% of children will experience at least one ear infection by three years old, so if your baby never has one, you've been lucky to beat the odds! Many children also experience recurrent, ongoing middle ear inflammation that flares up several times per year. It's a painful but normal part of growing up, and usually clears up without intervention - except when it doesn't, of course, which is why it's better to be safe than sorry. Keeping an eye out for the following signs and symptoms is important, since at some point in your baby's childhood you'll probably see them and need to recognize what they mean.

11 There Are Signs And Symptoms

Baby tugging at ears

A pre-verbal baby can't tell you that they've got sore ears, but they have other ways of letting you know: fussing is an obvious one, although it's hard to tell that an earache is what they're fussing about. They may also be experiencing ringing in their ears, nausea and headaches, or a feeling of fullness in the ear, but these may be hard for you to pick up on. Fortunately, there's other, more obvious, signs too: tugging on the inflammed ear(s), a fever, and loss of appetite.

If you're at all concerned that your baby may have middle ear inflammation, get in touch with a doctor. It's important to get medical advice, as this can be not only painful but a potentially dangerous condition. While most of the time ear inflammation will go away by itself, you certainly don't want your little one to be the exception to that rule! Remember: it's better to call a doctor and be told that your baby is okay, than not to call and find out that they're not.

10 It's Time For Baby's Check-Up!

While most ear infections do go away by themselves, some need to be treated with antibiotics - your doctor will discuss this with you to identify what treatment is best for your child. The decision to use antibiotics or not is one that is usually made in tandem with a parent or caregiver, but to broadly generalize the guidelines, severe cases are treated with antibiotics and non-severe cases are monitored by caregivers while your little one rests and recovers. However, there are some exceptions, and the decision isn't one to be made by Dr Google!

According to MedicineNet, "observation is an appropriate option only when follow-up can be ensured and antibacterial agents can be started if symptoms persist or worsen within 2-3 days", so even if you're told that baby is fine now, you'll need to keep a close eye to make sure that they stay that way and the inflammation doesn't worsen. It's important to monitor the condition of baby's ears and general health to make sure that they are making a safe recovery, and your doctor can talk to you about what you'll need to do in order to handle this. If someone else is also looking after your baby, make sure that they understand these responsibilities as well.

9 It Can Become Severe

There are specific guidelines on this, which were devised in 2013 by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). To start with, ear infection is generally considered non-severe if the ear pain is mild, and the fever is below 39 C (102.2 F) over the past 24 hours. Severe illness is defined as moderate to severe ear pain, or any ear pain for at least 48 hours, or a fever of over 39C.

There are other aspects that doctors will also take into consideration, such as discharge from the ear, bulging eardrums and so on. However, most cases of middle ear inflammation are not severe in terms of either pain or physical consequences, and do heal without the need to take antibiotics; in milder cases of middle ear inflammation, doctors will weigh up whether the possible side-effects of antibiotics (vomiting, rash, diarrhea, antibiotic resistance, etc.) make it worthwhile to prescribe them or not.

8 It's Completely Treatable

Usually just with monitoring, but if antibiotics are prescribed, it will generally be with a ten-day course of amoxicillin. 10% of children do not respond to amoxicillin within the first 48-72 hours, and if this occurs your doctor will probably change the type of antibiotic therapy your baby is treated with. In some cases, your doctor may prescribe topical antibiotics (such as antibiotic ear-drops).

If your baby experiences recurrent ear infections, they may be referred to a otolaryngologist (ear, nose and throat specialist). Some children will have an ear tube placed so that fluid can drain from the middle ear - these tubes are commonly known as "grommets", and they do the work that the Eustachian tube is supposed to be doing so that the middle ear can recover properly.

If your baby has a bulging eardrum or severe pain, the doctor may recommend that their eardrum be lanced in order to release pus. It takes about a week for the eardrum to heal after this procedure.

Other than that, to lessen the pain, you can talk to your doctor about what pain relief options are safe and age-appropriate. Analgesics are often prescribed; you can also reduce pain by placing a warm washcloth by the ear.

7 Don't Necessarily Need Prescription Drugs

There isn't a scientific basis to indicate that natural remedies are effective in treating middle ear inflammation. While it's very important to use nature to keep us healthy in the first place (eat your greens, folks!), when it comes to nasty and potentially dangerous bacteria, medical science is where it's at to keep baby healthy and safe.

If you're using alternative medicine in conjunction with medical treatment, talk to your doctor to make sure that there's no contraindications or potential side effects involved. (Unless the alternative treatment you're using is something like the power of crystal healing, in which case, good news: you don't have to worry about it interacting with anything because it's actually just a pretty, sparkly object. The placebo effect isn't exactly known for its contraindications, so yay! Keep it up... or don't, since science suggests that it's not actually going to make a difference anyway).

6 Dangers Of Infection Being Left Untreated

Let's start this with doom and gloom: 2013 saw 2,400 deaths from untreated middle ear infections worldwide. So it can be very, very bad. Fortunately, if you're reading this, you probably have access to a standard of healthcare that is quite capable of preventing deaths that are, well, preventable. So now that we've got that figured out and out of the way, you can stop panicking.

Some less terrifying but still very serious results of middle ear inflammation include ruptured eardrums, hearing loss or scarring. The good news is, the sooner that a severe ear infection is treated, the more likely you are to be able to prevent serious damage. So when you first spot the symptoms of this condition that your little one is almost certain to get at some point, get in touch with your doctor!

5 Stop The Inflammation Before It Starts


While you probably can't entirely prevent baby from ever experiencing middle ear inflammation, there are steps that you can take to reduce the risk. It's believed that using a pacifier may increase ear infection risk (including middle ear inflammation) in babies and toddlers; one research study found that the risk was decreased by one-third in babies who didn't use pacifiers.

Try to keep baby away from people who have a cold; colds can lead to fluid trapped behind his ear, which can lead to ear infections. Also, breastfeeding is better than bottlefeeding in terms of baby's position, as it allows the Eustachian tube to function better. Of course, it's not always possible: if your baby does need to be bottle-fed, let her feed in your arms rather than lying down with the bottle.

Another important way of keeping baby healthy is by keeping tobacco smoke away from your baby. (Of course, I'm sure you were already doing that!) And lastly, according to the American Academy of Otolaryngology, the pneumococcal vaccine is effective in preventing ear infections, because it combats the infection-causing bacteria pneumococcus. Additionally, the National Institute on Deafness and Other Communication Disorders recommends that baby gets a flu shot.

4 Very Small Risk Of Long-Term Damage

For the most part, children with middle ear problems grow up to have perfectly fine, undamaged ears with normal hearing. If you ask around your circle of adult friends, you're bound to find people who went through a lot of earaches as a child but grew out of it over time. (You may have even experienced them yourself!) As long as you're careful about treatment and monitoring, you probably don't have to worry about much more than baby's understandable grumpiness during this painful period.

After an ear infection, there might be some fluid remaining in the middle ear for a few weeks or months: this is normal, and it usually clears up on its own, although reinfection can occur so as usual, be vigilant.

3 Don't Put Baby Under Unnecessary Pressure

You've probably heard that babies and young children struggle with the changes in air pressure associated with flying. Air pressure decreases when you go higher, and increases as you go lower, and when the pressure becomes unequalized, that higher air pressure pushes on the eardrum, causing pain. As we become older, it's easier for our ears to equalize, but it's certainly uncomfortable for little ones! You've probably noticed that babies are more likely to cry during the last few minutes of a flight, when the air pressure increases in the cabin.

The downside to this for a child with middle ear inflammation is that it can lead to an increase in what is already considerable pain, and can even lead to rupture of the eardrum. (If your child has had grommets inserted, then the artificial tubes will help here.) It's important to let your doctor know that you're planning to fly, so that they can let you know if it's medically advisable; they may recommend delaying your flight until any infection has healed.

2 There Isn't Just One Form Of Inflammation

Chronic middle ear inflammation refers to middle ear inflammation that is caused by a recurring infection, or an initial infection that just doesn't completely go away. Acute middle ear inflammation is short-term, and often occurs in the winter (and is usually preceded by a cold). Chronic inflammation can carry on throughout the year, on-and-off or persistently.

During baby's follow-up session with your family doctor, if baby is still experiencing middle ear inflammation/infection, the doctor will be able to establish whether the ear infection is a continuation of the original infection, or whether re-infection has occurred.

Chronic ear infection is less painful than acute, and it may take longer to be diagnosed. It is also much less common than acute. Because of the long-term nature of chronic ear infections, your baby may need to take medicine for several months so that the condition can completely clear up.

1 Once The Infection's Gone

Even if they seems all better, it's important to follow up with your doctor so that they can re-examine your baby. Your doctor will probably ask you to come back in a month to check on their recovery progress, and to establish whether there is still fluid remaining in the ears. Fluid in the ear can lead to reduced hearing, and accordingly impair speaking, so your doctor may recommend further treatment to drain the fluid. They will also check for persistence of the initial infection, or any repeat infection.

The steps for preventing an ear infection are just as important to prevent recurrence, so do your best to keep baby away from people with colds, smokers, etc. A lot of colds get picked up at childcare centres, so you could consider moving baby to a smaller centre: after all, less kids = less colds. Also, make sure that both you and baby are washing your hands regularly to avoid reinfection.

Ear infections are a normal part of childhood, but with love, care and appropriate treatment, they don't have to hurt as much, and the dangers can largely be avoided. By being prepared for middle ear inflammation if it happens (which it probably will at some point!), you can do the best for your baby.

Sources: American Academy of OtolaryngologyBetterHealth: Middle Ear InfectionsMedicineNet: Ear InfectionMedicineNet: Otitis MediamyDr: Middle Ear Infection And GrommetsNIH: Ear Infections in Children, Web MD: Ear Infections

More in Did You Know...