Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

How does the ear work?

The ear works by picking up sound waves and sending messages to the brain. The outer ear includes the part of the ear you can see and the ear canal. The sound waves go through the ear canal and hit the eardrum and cause it to vibrate.
The middle ear includes the space behind the eardrum. The eustachian tube connects the middle ear to the back of the throat. The movement of the eardrum causes three tiny bones (called the hammer, anvil and stirrup) to move. This movement sends the sound waves to the inner ear and here sound messages go to the brain.

What causes earaches?

Earaches commonly occur when the eustachian tube becomes blocked. Blockage of the eustachian tube prevents fluid from draining out of the middle ear. Fluid in the middle ear provides a good place for an infection to start. Blockage also increases pressure behind the eardrum, which in turn causes pain.

The eustachian tubes can become blocked because of swelling during a cold or other infection. Ear infections can be caused by bacteria or a virus. Sometimes allergies can cause the eustachian tubes to swell. In other cases, the adenoids become enlarged and block the eustachian tubes.
Acute ear infections mostly clear up within one or two weeks. But they may come back. Sometimes, ear infections become chronic. After an infection, fluid may stay in the middle ear for a few months. This may lead to repeat infections and hearing loss.

Why are earaches so common in children?

This may be because their Eustachian tubes are shorter and smaller than those of adults. More than three-fourths of children will have at least one ear infection by their third birthday. Nearly half of them will have had three or more infections before they are three years old.

What are the symptoms of ear infections?

The most common symptoms of an acute ear infection are ear pain (which may be sudden and severe) and fever. Your child may also be cranky, complain of a feeling of fullness in the ear, have trouble hearing, or not feel like eating. If your child is too young to tell you what hurts, he or she may cry and fuss. The ear pain may appear to be worse when your child lays his or her head down on the side of the affected ear. If the eardrum bursts, there may be pus or blood coming from the ear.

A child with fluid in the ear may not have these symptoms.

Will earaches hurt my child’s hearing?

Middle ear infections are the most common cause of short-term hearing loss in children. Children who have ongoing problems with hearing from other causes have been shown to have trouble with their speech and language skills. It's possible that hearing loss caused by earaches could have the same effect.

Things that may put children at higher risk of ear infections

	Being around second-hand smoke
	Having had ear infections before, mostly if these were before the child's first birthday
	History of ear infections
	Being bottle-fed instead of breastfed
	Day care
	Being premature or having had a low birth weight
	Being a boy (boys tend to have more middle ear infections than girls.)

What is the treatment for earaches?

The treatment for earaches may include any of the following:

	Pain relievers like acetaminophen (some examples are Panadol, Tempra, Tylenol) or ibuprofen (some examples are Children's Advil or Motrin) can help make your child feel better and reduce fever. Avoid giving children aspirin.
	A warm, not hot, compress held over the ear can also help relieve pain.
	If the eardrum has burst, your doctor may prescribe antibiotic drops
	Drink plenty of fluids.
	Antibiotics may be given. These medicines kill the bacteria that cause many of the infections. It's very important to follow the directions, and to finish all of the medicine. Older children often do not need to have their ear infections treated with antibiotics. Children under 2 years of age will get antibiotics.

If your child has symptoms, your doctor may want to see your child again after treatment to make sure the fluid seen after an ear infection has gone.

What can be done to prevent ear infections from returning?

Some children seem to get one ear infection after another. If your child has had three ear infections in six months or four in one year, your doctor may suggest that your child take a low dose of antibiotics every day, usually during the winter, when these infections are most common. It's also a good idea to keep your child away from cigarette smoke.

What about fluid that stays in the middle ear?

Your child's hearing may be affected if fluid stays in the middle ear after an infection. This may also lead to repeat infections. Usually the fluid goes away in two to three months, and hearing returns to normal. Your doctor may want to check your child again at this time to see if fluid is still present.

If the fluid stays for more than a few months, your doctor may want to check your child's hearing. Your doctor may recommend ear tubes (tympanostomy tubes) to drain the fluid if your child's hearing is decreased a lot. In such cases, ear tubes may also decrease the number of repeat infections that occur.

What are tympanostomy tubes?

These tiny plastic tubes help balance the pressure between the middle ear, and the ear canal, and allow fluid to drain. They're put into the eardrum (which is also called the tympanic membrane) during surgery. The tubes are usually left in place until they fall out on their own.

What are the risks of putting in tympanostomy tubes?

Placing tubes in the ears is an operation and has some risks. Your child will need a general anesthesia when the tube is inserted. Your child must keep from getting water in his or her ears while the tube is in place. And sometimes the tube can cause scarring or even leave a hole in the eardrum and affect hearing. However, these problems are rare and must be weighed against the risk of having repeated infections.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.