Ear Infection? But I Clean His Ears Every Day (PedPathForParents)

19 Jan

The dreaded ear infection…it’s the black box of going to the doctor.

I think my baby is pulling at their ears, I go in and there’s nothing there.

I go in for a check-up with seemingly nothing wrong, and my baby has an ear infection.  What the heck?

How Common Are Ear Infections?

They are the most common reason for visits to the pediatrician’s office and the most common reason antibiotics are prescribed.

Around 70% of children have at least one episode of AOM by one year of age, and 80 to 90% by two to three years.

So, What Causes Ear Infections?  

Is it having them out in the wind?  Is it getting water in their ears when they take a shower?  Is it not cleaning out their ears properly?

No, No and Don’t stick anything in your ear smaller than your elbow.

One way to look at the cause of infections is to look at risk factors:

  • Age (6-18 months)
  • Family history (likely due to changes in anatomy, but just because you had tubes doesn’t mean your child will need them)
  • Day care
  • Smokers in the house

Here’s the story of how an ear infection develops:

Screen Shot 2013-01-18 at 10.45.25 PM

Here’s the way I describe the process to my families…

  1. The inner ear constantly drain fluid into the throat through a little tube that drains down (see Eustachian tube above)
  2. Viral infections or allergies cause swelling and drainage that block the bottom of the tube.
  3. Due to swelling and drainage, the fluid cannot escape.
  4. Fluid builds up behind the ear drum which is a nice warm bubble bath for bacteria-very romantic.
  5. Bacteria get into this fluid and start reproducing.
  6. Surprise…Ear Infection.

The pressure caused by the buildup of fluid on the ear drum is what causes pain from the infection.

Young children are more likely to get infections because their Eustachian tubes are more flat and not angled down as much as adults.

 Screen Shot 2013-01-18 at 10.43.49 PM

There are multiple bacteria and viruses that can cause ear infections.  Some of these infections will resolve on their own, some will require antibiotics.

So, What Does All This Mean?

There’s not much you can do to prevent infections…ear muffs, ear plugs, q-tips and ear candling are not the solution to preventing ear infections.  I asked Dr Tidmore (ENT) about ear candling once and I loved his response, “I generally don’t recommend people putting things that are on fire in their ear.”  Plus, ear wax is made for a reason and aside from me needing to see the ear drum to see if there is an infection, the wax should just stay where it is.

One of the most common stories I see is a child who has an upper respiratory virus with runny nose, cough and/or fever that last a couple of days and seems to be getting better then develops a second wave of illness with fever, fussiness, runny nose and cough which is the ear infection.

The problem with this is that if the parent brought the child during the first few days, then they are hesitant to come back in because, “Nothing was wrong last time.”  This is one of the reasons why we often ask our families to wait a day or two with runny nose, cough and congestion who continues to eat and drink well because the majority of those illnesses are viral infections.

Hopefully, this post sheds some light on a subject that many are confused about.

Any questions?  What wives tales have you heard about what might cause ear infections?


6 Responses to “Ear Infection? But I Clean His Ears Every Day (PedPathForParents)”

  1. Kelley January 19, 2013 at 7:15 pm #

    I know this probably depends on how bad the ear is infected but, what do you typically recommend in regards to taking antibiotics for ear infections? Do you always give them? Do you suggest giving it time to clear on it’s own?

    • jrsmith120880 January 19, 2013 at 8:17 pm #

      There are some options for older kids as many of the bacterial infections will resolve on their own and some of the cases of ear infections are caused by viruses. The guidelines from the AAP can be found at:

      If you pay attention, it also recommends using amoxcillin first.

      I try to remember to offer patients the option to not treat their older kiddos who are feeling ok but I have found the adoption of the “watch and wait” method is pretty low.

  2. Karen Howell January 19, 2013 at 7:18 pm #

    Hi Dr. Smith one thing my daughters pedi suggests is using garlic ear drops. It’s a natural antibiotic (garlic). I start using it at the first sign of a running nose or congestion. It works pretty well.

  3. Kelly January 19, 2013 at 8:18 pm #

    I have learned from our pediatrician that 95% of ear infections are due to a food intolerance. We tested and removed the offending foods and lo’ and behold the ear infections have ceased in our house. No surgery needed. When we do get any congestion now, we limit the most reactive foods that we are now eating and use the garlic oil that Karen suggested. I am so glad to be empowered with this knowledge and avoid the antibiotic route as much as possible. Keep in mind on the testing, the lab used matters! If a lab has a 40% variance in the results, I don’t want to waste my energy. The lab we used was Immuno Laboratories in FL. LabCorp drew the sample and rush delivered it…..their variance at the time we did this was less than 1%. I also used this lab when I had digestive issues, all were resolved through removing buckwheat (seriously)! Of course, this was after going to a GI doc for testing to rule out everything else it could have been. My pedi did tell me this is NOT taught in medical school, so no need to feel bad if doctors don’t know this…..they really do care about our kids and are doing their best with what they do know.

    • jrsmith120880 January 19, 2013 at 8:45 pm #

      I agree that food allergies (and other environmental allergies) can be the inciting cause of ear infections. If you go back to the description I gave of how an ear infection happens it fits right in with swelling and inflammation of the Eustachian tube as a primary cause.

      I have seen studies (the best one is here…http://www.webmd.com/allergies/news/20040622/food-allergies-may-be-linked-to-ear-infection) that show as high as 45% but I have never seen higher so I would be interested in seeing where the 95% figure comes from (unless you were trying to say generally a big percentage). I’m glad you had a great experience eliminating foods and having resolution of your infections, that does happen with some kids. I’ve had other families eliminate and still end up with recurrent infections. Just saying, I’ve seen it go both ways but is a great next step for those wanting to avoid tubes.

      The ginger drops have been shown to reduce pain in patients with ear infections and many infections will resolve on their own so this is a great option for those wanting to delay antibiotic usage.

  4. Leah March 13, 2013 at 9:12 pm #

    Another great article! We will be talking tubes with you soon! It’s surgery, but it works! And with most kiddos like my son, it took antibiotics out of the picture as far as for ear infections!

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