It’s that time of year again – kids are back in school and we are all worried about getting infections. In my world, the big concern is kids’ ear infections. Ear infections are some of the most common infections in children and are usually treated with antibiotics. Occasionally though, children will need ear tubes if they have a lot of ear infections.

The ear has an outer ear, a middle ear and an inner ear, and the type of infection depends on where it occurs in the ear.

Outer ear infections

Outer ear infections are quite common, especially in the summer. When humidity or moisture accumulates in the ear canal, it changes the normal bacteriology of the ear canal and can cause an ear infection. An outer ear infection is commonly referred to as a swimmer’s ear because it occurs when children have been in the pool, lake or ocean. Sometimes a scratch, bite or other injury can also cause an outer ear infection.

Usually ear drops do the trick for outer ear infections, and the pain and discomfort slowly go away as the infection subsides. Occasionally a child will need oral antibiotics if the infection spreads to other parts of the ear.

Inner ear infections

An inner ear infection is quite rare and can present in very different ways than an outer or middle ear infection. The inner ear is responsible for hearing and balance – thus an inner ear infection can affect both of these areas. A child can have dizziness or even hearing loss with an inner ear infection. These infections are rare, but it’s important for your pediatrician and otolaryngologist (ENT surgeon) to work closely together in managing them.

Middle ear infections

That leaves us with the most common type of ear infections – a middle ear infection. We call this otitis media (middle ear infection). More than 80 percent of children have at least one episode of otitis media by the time they are 3 years old. These ear infections can be viral or bacterial (it’s often difficult to tease out which is which) and they occur when there is inflammation in the middle ear.

Middle ear infections are usually treated with either a watch and wait approach or antibiotics.

Some countries, especially those in Europe, use the “watch and wait” approach – they will see a patient in the office and give the family a prescription for an oral antibiotic, only to be used if necessary (the child is not improving, the fever is worse, etc.). It is not recommended to always give antibiotics for otitis media because if the infection is due to a virus, it will need to run its course.

If your child is having too many middle ear infections, then your pediatrician will usually send you to an otolaryngologist to help decide if ear tubes are necessary. There are approximate guidelines for the number of infections a child needs to have before getting ear tubes, such as three infections in six months, or four in a one year period. Your pediatrician and ENT surgeon will work together to determine if your child needs ear tubes.

Ear tubes, also called “pressure equalization tubes,” help equilibrate the middle ear pressure with the atmospheric pressure, reducing the amount of fluid – and hence ear infections –  in the middle ear. As a child grows, their Eustachian tube (a normal anatomical component that connects the middle ear to the back of the nose) changes its angle from almost parallel to 45 degrees, decreasing the chances of having fluid and infections in the middle ear.


Rahul Shah Rahul Shah, MD, MBA, serves as Vice President, Chief Quality and Safety Office at Children’s National as well as senior vice president for the Children’s National Hospital-Based Specialties Center. His clinical interests include the broad realm of pediatric otolaryngology.

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