Common Questions About Ear Infections in Older Children

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Medically reviewed by Dr. Kathleen Billings and Dr. Laura Rosenthal

What are the common symptoms of ear infections in an older child?

Symptoms of an ear infection can include ear pain, fevers, irritability, sleep disruption, poor appetite and common cold symptoms. Symptoms can be hard to distinguish from general cold symptoms, so if an ear infection is suspected, the child should be examined by a clinician.

The symptoms can also vary depending upon the type of ear infection, but generally, a middle ear infection (also called otitis media), where infected fluid is stuck behind the ear drum, can cause pain, fever and temporary difficulty hearing.

Another type of ear infection, called otitis externa, or swimmer’s ear (although it is not necessarily from swimming), is when the ear canal skin becomes infected. Symptoms can vary but can include an itchy ear, pain, swelling and difficulty hearing. There can also be drainage of fluid or pus from the ear. 

What might it mean if an older child has recurrent ear infections? 

Younger children are more predisposed to ear infections because of issues with poor eustachian dysfunction (the tube that drains the ear to the back of the throat), and relatively reduced immune systems. Both issues mature over time as the child ages. Certain syndromes, like Down syndrome, and craniofacial issues, like a cleft palate, may predispose children to fluid in the middle ear space, called otitis media with effusion. Children who are immunocompromised may be at higher risk for infections, including ear infections.

What is the treatment for ear infections in older children? 

Treatment of an ear infection often starts with antibiotics geared toward the common organisms associated with ear infections. Some milder cases may not require an antibiotic, as the infection may resolve over several days. 

Pain management is appropriate given the discomfort associated with ear infections. If a child has multiple ear infections (three in six months, or four in one year as long as there was one in the past month), then they may be a candidate for ear tubes (tympanostomy tubes). A pediatric ear, nose and throat specialist can help families determine if this is right for a young patient.

When a child has otitis media with effusion (or fluid stuck behind the middle ear), it is often initially observed. If the fluid persists for over three months, and there are concerns for hearing or speech, then ear tubes may be suggested.

Are ear infections contagious?

Ear infections alone are not contagious. As the fluid is stuck behind the ear drum, it cannot be passed on to someone else. However, ear infections are frequently, but not always, the result of or accompanied by an upper respiratory infection. Additional symptoms such as coughing, nasal congestion, and drainage, may indicate a contagious upper respiratory infection.

How are ear infections treated?

Ear infections are often treated with antibiotics, sometimes with observation by a pediatric ear, nose and throat specialist and sometimes with ear tube surgery if the condition meets the criteria.

Pain relievers like ibuprofen and acetaminophen can help with managing the pain associated with ear infections. 

Learn more about ear tube surgery (myringotomy with tympanostomy tube placement) here.

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