Is it an ear infection or ear ache?

What exactly is an ear infection? Doctors are not always as precise in their language as they should be and this has lead to many different kinds of diseases being called “ear infections.” 

An outer ear canal infection occurs when water that is too alkaline gets into the outer ear and causes irritation and/or bacterial infection.  This often happens after swimming in a pool that did not have its acidity controlled well.  This condition can be painful and may have a peculiar sweet odor and is also called a “swimmer’s ear.” 

Outer ear infections are treated with antibiotic drops. They can be prevented with a combination of alcohol and vinegar drops in the ear after getting out of a pool. This is not the middle ear infection that pediatricians are usually looking for in their patients.    

Sometimes a virus gets into the inner ear and will cause severe pain, nausea and/or dizziness.  Inner ear infections are treated with oral steroids, but are only sometimes effective. The infection may get better by itself, with steroids, or it may never get better. These infections can cause ringing in the ears (tinnitus) and chronic loss of balance (vertigo). This inner ear infection is not the ear infections that young children get after having cold or the flu either.

A middle ear infection (also called otitis media) is bacteria and pus behind the ear drum in the space around the three small bones that conduct sound from the ear drum to the auditory nerve.  These infections often start from bacteria traveling up the Eustachian tube that connects the back of the mouth to the middle ear.  

Conditions that increase middle ear infections include:

  1. Smoking around the child
  2. Not breast feeding
  3. Drinking a bottle while lying on one’s back
  4. Having a bad cold (or other viral illnesses such as the influenza going around this winter)
  5. Having  parents who had middle ear infections as children

Ear pain can be caused by many things, not just active middle ear infections, including sore throat, grinding one’s teeth, seasonal allergies, none of which respond to antibiotics.  Ear pain drops work well for the discomfort and the doctor can prescribe them usually over the phone as long as one’s child does not have draining ears.

In children under two, we usually treat the ear infection with antibiotics especially if the child looks ill.  In children two and over and who are not very ill, we treat with ear pain drops and oral pain killers such as acetaminophen, and only treat if the pain does not go away in 72 hours.  About 70 percent of middle ear infections just get better if you wait three days.

So if your child has an ear ache, do not assume they need an antibiotic. They usually need pain medicine and time.