Ear Infections: Causes and Symptoms

One weekend, I was at work on my unit at Children’s Hospital Los Angeles when I started to feel as if the sounds of the entire hospital were thrumming and throbbing in my head.  High-pitched voices sounded sharp.  Middle sounds were muffled. 

I shared how I was feeling with my nurse practitioner colleague and she responded with two words:  "Ear Infection."

And with that, she pulled out an otoscope to peer into my ear. While she examined me, everyone on the unit began to swap stories about our children and their experiences getting ear infections.  With three out of four kids getting an ear infection between the ages of two and four, these types of stories are all too common. The reason children get ear infections more often than adults is because their inner ear anatomy is different than that of adults, but I'll explain more about that later in the post.

All the attention and discussion my ear infection caused on our unit made me think it would be a good idea to write a post for parents which covers:

  • Causes of Ear Infections
  • Signs and Symptoms

In a follow-up post, I discuss treatment options, which can sometimes include surgery. But first, here's some basic information about the anatomy of the human ear.

How the Ear Works

The ear is responsible for hearing and balance. Check out this video for a detailed explanation of exactly how our ears help us to hear.

Causes of Ear Infections

Role of the Eustachian Tubes
The internal workings of your ears use fluid to maintain same pressure as the outside world and this task falls to the Eustachian Tubes. Eustachian Tubes connect your ear to the back of your throat, letting air in to equalize pressure in your ears, and allowing mucous to drain into the back of the throat. You probably recognize this sensation because it's the "popping" feeling you often get while yawning, swallowing or riding on an airplane.

Kids and the Eustachian Tubes
In children, the Eustachian Tubes are shorter, narrower and more horizontal than in adults. Because of this, children more frequently experience clogging by congestion and fluid build-up in this tube, which can be caused by upper respiratory infections or colds. Germs can breed in the fluid, which is a prime cause of ear infection in kids.

Other Causes of Ear Infections

In addition to clogging of the Eustachian Tubes, there are several other possible causes of ear infections in children, including:

  • Exposure to cigarette smoke
  • Bottle feeding
  • Cold weather
  • Upper respiratory infections

Signs and Symptoms of Ear Infections

Your child may be suffering from an ear infection if he or she exhibits the following symptoms:  

  • Diarrhea
  • Eating less
  • Fever
  • Irritability
  • Nausea
  • Pain, tugging on ear, complaints of pain
  • Vomiting

Special Note for Infants
Some infants will not tug or pull at their ears, but may exhibit fevers or other symptoms. Special Note for School-Age Children In older children, behavior in school may change and be attributed to inattention, but may in fact be caused by their inability to hear.

Going to the Doctor

If you suspect your child has an ear infection, make an appointment with your pediatrician.  Like my nurse practitioner friend, your child's doctor may use an otoscope to examine your child's ear for signs of infection such as redness, swelling, fluid build-up or pus. The doctor may also conduct further studies if the infection seems persistent or more serious. This can include some or all of the following:

  • Lab tests The doctor will send a culture from the fluid in your child’s ear to see what types of bacteria are there to determine the cause and the best treatment for the infection.
  • Scans A skull X-ray may be ordered to see if the bones are infected.  A CT-scan may also be ordered.
  • Hearing tests

How I Recovered

My nurse practitioner colleague flushed my ears with water and ended up removing what she said looked like sand from my ear,  which was probably just wax compounded by the infection. All day long, the joke was that seashells and fish from my swims in the ocean were hanging out in my ears!

I also made an appointment with my doctor, who prescribed ear drops to help my ears heal from the infection. Fortunately for me, the treatment for my ear infection was relatively simple and non-invasive.

However, there are many children who suffer from chronic ear infections and they require more complex treatments. We see many of them at our hospital in the Division of Otolaryngology - Head & Neck Surgery.

In my next post, I'll discuss those treatment options, which can include antibiotics and even surgery.