Hesperian Health Guides

Ear infection

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HealthWiki > Helping Children Who Are Deaf > Chapter 15: Why children lose their hearing and what we can do > Ear infection

Ear infections are one of the most common childhood illnesses and without treatment, they can cause permanent hearing loss. Ear infections often start with an infection of the nose and throat. The infection travels from the throat along the tube into the middle ear.

A woman and her little girl.

Children get these infections easily because the tube from the throat to the ear is shorter than in adults. When the ear is infected, the fluid and infection cannot drain out of the middle ear. And if a child has a cold, the tube from the throat that leads to the middle ear often gets blocked. As children grow older and stronger, they develop more resistance and get fewer colds and throat infections.

Sudden ear infections (acute)

Sudden middle-ear infection can occur at any age, and is common even in babies and infants. The child may cry, be irritable, and have a fever. Often the infection gets better in 1 or 2 days without any treatment. A mild pain reliever such as acetominophen may help the child feel better but will not cure the infection. Sometimes an antibiotic is needed to cure the infection. The ear drum may burst and pus leaks out through a small hole. This hole usually heals quickly.

Long-lasting ear infections (chronic)

When children do not get treatment for repeated sudden ear infections, the infection can become long-lasting. An ear infection is long-lasting if pus drains from the ear and there is discharge for 14 days or more. This can damage the ear drum. The ear drum may become pulled inward or have a hole that does not heal. Both of these problems lead to more infection with discharge.

A woman touching her son's ear.

Without proper and early medical care, children may lose their hearing, suffer from dizziness, weakness on one side of the face, or an abscess draining behind or below the ear. Rarely, an ear infection may also cause a serious complication like a brain abscess or meningitis.

More poor children lose their hearing because of ear infections than any other cause. Hearing loss due to ear infections can be prevented by improving general health and living conditions, and by access to medical care. Every community needs people trained to identify ear infections early, or clinics or hospitals that are affordable and easy to get to.

Glue ear

Sometimes after sudden ear infections, thick and sticky fluid collects in the middle ear (this is called glue ear). Glue ear does not usually hurt and drains away down the tube to the nose after a few weeks, but sometimes it lasts for years. Glue ear often affects both ears and it makes the child partially deaf as long as it lasts. Most cases of glue ear will heal without treatment. But if there is any pain, give an antibiotic by mouth as for acute infection.

A young unhappy boy pulling his ear.
Signs of ear infection:
  • Pain — a young child may cry, rub the side of his head, or pull on his ear
  • Fever between 37.7° and 40°C (100° and 104°F)
  • Runny nose, sore throat, cough
An ear with fluid draining from it.
  • Fluid may drain from the ear. It may be yellow, white, watery or sticky. The fluid may have some blood in it. A heavy flow of sticky, clear fluid is probably from a hole in the ear drum. This fluid may stop with medicines, but it can happen every time the child has a cold, or puts his ears under water or swims.

A slight fluid discharge that smells and may be yellow or green is probably from damage to the ear drum. An operation may be needed to repair the ear drum.

  • Hearing loss — temporary or permanent — in one or both ears
A girl with swelling behind her ear.
  • Sometimes nausea and vomiting
  • Sometimes infection spreads to the bone behind the ear (mastoiditis). This is very painful and antibiotics must be given.
    Go to a hospital!

Different signs may be present at different times — for example, the pain may stop when fluid starts flowing out of the ear.

Check the ear in 3 to 4 months after any ear infection, even if there is no pain and also check the child's hearing.

Treating ear infections

To treat sudden (acute) ear infections
For pain and fever:
  • give paracetamol (acetaminophen) by mouth 3 to 4 times a day as needed.
age 3 months to one year 60 to 120 mg
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age 1 to 5 years 120 to 250 mg
age 6 to 12 years 250 to 500 mg
  • give ibuprofen by mouth
age 1 to 2 years 50 mg, 3 to 4 times a day
age 3 to 7 years 100 mg, 3 to 4 times a day
age 8 to 12 years 200 mg, 3 to 4 times a day
Note: Do not give ibuprofen to children younger than 1 year old or who weigh less than 7 kg.
For the infection:
  • give amoxicillin by mouth, for 7 to 10 days.
Give 45 to 50 mg for every kilogram of body weight (per kg) each day, divided into 2 doses. If you cannot weigh the child, dose by age:
age less than 3 months 125 mg, 2 times a day
age 3 months to 3 years 250 mg, 2 times a day
age 4 to 7 years 375 mg, 2 times a day
age 8 to 12 years 500 mg, 2 times a day
age 12 years or more 500 to 875 mg, 2 times a day
Continue giving amoxicillin until 24 hours after all signs of infection are gone.
For severe infections you can double the dose, that is, give as much as 95 mg per kg, but divide it into 3 doses a day.

2 women speaking about a small boy.
When will he feel better?
The ibuprofen will help his pain right away while the antibiotic treats his infection over the next week.
Make sure you give all the antibiotic or the infection may come back.

Other treatments for sudden (acute) ear infections
If the child is allergic to penicillin medicines or the treatment is not working:
  • give cefuroxime by mouth, for 10 days.
age 3 months to 12 years 15 mg per kg of body weight, divided into 2 doses.
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If you cannot weigh the child, give 250 mg, 2 times a day.
Do not give more than 1000 mg in 1 day (24 hours).
  • give cefaclor by mouth, for 10 days.
age 1 month or more give 40 mg per kg of body weight each day, divided into 2 doses. If you cannot weigh the child, dose by age:
age 1 month to 1 year 125 mg, 2 times a day
age 1 to 5 years 250 mg, 2 times a day
age 5 years or more 500 mg, 2 times a day
Do not give more than 1000 mg in 1 day (24 hours)
  • give erythromycin by mouth, for 7 to 10 days, or until 24 hours after all signs of infection are gone.
Give 30 to 50 mg per kg, divided into 2 to 4 doses a day. If you cannot weigh the child, dose by age:
newborns 65 mg, 2 times a day.
age 2 years or less 125 mg, 3 times a day.
age 2 to 8 years 250 mg, 3 times a day.
age 8 years or more 250 to 500 mg, 4 times a day.

If there is fluid draining from the ear, wipe it away, but do not stick anything in the ear to clean it. Encourage the child to rest and drink a lot of liquids. The child can bathe, but should not put his ears under water or swim for at least 2 weeks after he is well.

If you think the child may have a complication, take him to a hospital. If you suspect meningitis, give medicine immediately.

To treat long-lasting or repeated (chronic) ear infections
(discharge for 2 weeks or more)
  • Give antibiotic ear drops for 1 week (2 to 3 drops, 3 times a day) such as ciprofloxacin, framycetin, gentamicin, gramicidin, neomycin, polymyxin B, or ofloxacin.
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Sometimes it helps to give an antibiotic by mouth at the same time as the ear drop. Use the same antibiotic as for sudden ear infection.

Antibiotic drops should not be used for longer than 10 days, or repeated frequently, as they can cause hearing loss themselves. But chronic ear infections are more likely to cause hearing loss than antibiotic drops.

If the discharge continues or returns, or if antibiotic ear drops are not available:
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for all ages 2 drops in the ear, 2 times a day for 2 weeks, then give
2 drops in the ear, 1 time a day (before going to sleep), for several weeks or months

Repeat the same treatment if infection and discharge occurs again. A health worker or doctor can teach parents to clean out the discharge with cotton wool before each dose of ear drops.

Keep all water out of the ear. Carefully dry the ear two times daily with cotton wool or gauze for several weeks (until it remains dry).

Sometimes an operation is needed to repair the ear drum. This is done by a specially-trained health worker in a hospital, usually when the child is at least 10 years old.

A woman breastfeeding her baby.

Preventing ear infections

To prevent ear infections, breastfeed babies — for up to 2 years if possible. Breast milk helps a baby fight infection. Breastfeeding also helps strengthen the muscles that keep the tubes between the throat and middle ear open.

Other ways to prevent ear infections

A woman using a cup to feed her baby.
  • If a baby has to be fed from a bottle or a cup, be sure to keep his head higher than his stomach as you feed him. If he lies down while feeding, the milk can flow from his throat into the tubes and into his middle ears, helping to cause infection.
  • Teach a child to wipe his nose instead of blowing it. If he does blow his nose, he should do it gently.
  • As much as possible, keep children away from smoke, including smoke from stoves and cooking fires. Smoke can make the tube between the throat and middle ear swell and close. Then fluid builds up in the middle ear and it can get infected.
  • When your child has a cold, find out if he also has ear pain. As much as possible, keep your child away from people with colds.