RELATED STORIES • Quiz: Ear infections • Ear infection guide CHILDREN'S HEALTH Ear/Nose/Throat • Earwax blockage • Acute sinusitis • Hearing loss • Chronic sinusitis • Tonsillitis • Ear infection, middle ear • Tinnitus • Laryngitis • Airplane ear • Swimmer's ear • Nasal polyps • Ruptured eardrum • Sore throat • Epiglottitis • Benign paroxysmal positional vertigo (BPPV) • Meniere's disease • Nonallergic rhinitis

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Ear infections are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders.

The medical term for middle ear infections is otitis media. Otitis refers to inflammation of the ear, and media means middle.

Although ear infections worry parents and make children uncomfortable, take heart. Most ear infections clear up on their own within a few days, and most children stop having ear infections once they reach school age.

Ear infections can be hard to detect, especially if your child is too young to say, "My ear hurts." Knowing what to look for can help. Children with ear infections may:

• Tug or pull at their ears
• Cry more than usual
• Have trouble sleeping
• Fail to respond to sounds
• Be unusually irritable
• Develop a fever
• Develop fluid that drains from the ears
• Have headaches

Ear infections usually start with a viral infection, such as a cold. The middle ear becomes inflamed from the infection, and fluid builds up behind the eardrum.

Ear infections also can be associated with dysfunction or swelling within the eustachian tubes — the narrow passageways that connect the middle ear to the nose. Normally these tubes equalize pressure inside and outside the ear. But a child's eustachian tubes are narrower and shorter than those of an adult. This makes it easier for fluid to get trapped in the middle ear when the eustachian tubes dysfunction or become blocked during a cold.

Another factor in ear infections is swelling of the adenoids. These are tissues located in the upper throat near the eustachian tubes. Adenoids contain lymphocytes — cells that normally fight infection. But sometimes the adenoids themselves get infected or enlarged, blocking the eustachian tubes. Infection in the adenoids can also spread to the eustachian tubes.

In addition, children don't have fully developed immune systems. So it's easier for them to develop many illnesses, including colds and ear infections.

Major risk factors for ear infections include:

• Age. Children between ages 6 and 18 months are the most susceptible to ear infections, although ear infections are common from ages 4 months to 4 years.
• Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home.
• Reduced air quality. Children with exposure to tobacco smoke or higher levels of air pollution are at higher risk of ear infections.
• Family history. Your child's risk of ear infections increases if another member of the family has had such infections.
• Race. American Indians and Eskimos from Alaska or Canada tend to have more ear infections than do whites.
• Feeding position. Babies who drink from a bottle while lying down tend to have more ear infections than do babies who are held upright during feedings.
• Season. Ear infections are most common during the fall and winter.

Ear infections aren't usually an emergency — but they can make your child uncomfortable. If your child's signs and symptoms last longer than a day, call your child's doctor. In children younger than age 2, watch for sleeplessness and irritability after an upper respiratory infection, such as a cold.

Call your child's doctor if you see a discharge of blood or pus from the ear. This could indicate a ruptured eardrum.

If your child has been diagnosed with an ear infection, call the doctor if your child's signs and symptoms don't improve or they get worse.

There are two main types of ear infections:

• Acute otitis media (AOM). In AOM, parts of the ear are infected and swollen, and fluid and mucus are trapped inside the ear.
• Otitis media with effusion (OME). Effusion refers to fluid. In OME, fluid stays in the ear after the infection has cleared up. The presence of fluid increases the risk of a new infection.

Ear infections are diagnosed based on your child's medical history and a physical exam. During the exam, the doctor will look for inflammation in the middle ear with a lighted instrument known as an otoscope.

A related instrument is the pneumatic otoscope, which allows the doctor to gently puff air on the eardrum. Normally this causes the eardrum to move. Any fluid in the middle ear will prevent that movement.

Sometimes additional tests for ear infections are recommended — especially if your child has had fluid in the middle ear for some time:

• Tympanometry. This test also measures eardrum movement. A soft plug is inserted into the opening of the ear. The plug includes a device that changes air pressure inside the ear.
• Acoustic reflectometry. During this test, the doctor uses a hand-held instrument to project sounds of varying frequencies into the ear. How the sounds are reflected indicates differences between empty space and fluid.

Many ear infections clear on their own with no complications. However, long-lasting or recurrent infections can lead to:

• Short-term hearing loss. Fluid buildup can temporarily affect your child's hearing. That's because it's harder for the eardrum and the tiny bones in the middle ear to send sound vibrations through fluid. The average hearing loss is 25 decibels — about the same as putting plugs in your child's ears.
• Long-term hearing loss. Usually the fluid disappears on its own in a few weeks. But sometimes it remains in the middle ear for months, which can damage the eardrum and bones in the middle ear. This may impair a child's hearing enough to affect speech development. In young children, even short-term hearing loss can delay speech development.
• Ruptured eardrum. During ear infections, fluid and pus may press against the eardrum. This can be painful. Rarely, the pressure ruptures the eardrum. If this happens, you may see a discharge of pus and blood from your child's ear. This can be alarming. But the rupture actually relieves your child's pain, and in most cases the eardrum heals on its own. If the eardrum ruptures repeatedly and doesn't heal, surgical repair may be needed.

Untreated ear infections also can lead to a type of sinusitis known as mastoiditis, which affects the mastoid bone of the skull. Rarely, infections can move from the ear to other parts of the head, including the brain.

Ear infections can be treated various ways. What's best for your child depends on many factors, including your child's age, medical history and the type of ear infection.

A wait-and-see approach
The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend a wait-and-see approach for the first 72 hours for children who:

• Are older than age 6 months
• Are otherwise healthy
• Have mild signs and symptoms or an uncertain diagnosis

Most ear infections clear on their own in just a few days — and antibiotics won't help an infection caused by a virus. In fact, about 80 percent of children with acute otitis media recover without antibiotics, according to the AAP and AAFP.

If your child is uncomfortable, the doctor may recommend an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). If your child doesn't have drainage from the ear or ear tubes, prescription eardrops containing a local anesthetic may be an option, too. The drops won't cure the infection, but they may relieve pain.

Warm the drops slightly by placing the bottle containing the drops in warm water. Then gently lay your child on a flat surface with his or her infected ear facing up. Don't insert the drops with your child in your arms or on your lap.

Antibiotic therapy
If your child is younger than age 6 months or has two or more ear infections within 30 days or chronic otitis media with effusion, the doctor may recommend an antibiotic. If the medication is effective, your child should start feeling better in a few days. Give your child the antibiotic for the full length of the prescription. Stopping medication too soon could allow the infection to come back.

Remember, antibiotics won't help an infection caused by a virus — and the overuse of antibiotics contributes to strains of the bacteria that resist these medications. Side effects — such as vomiting, diarrhea and allergic reactions — are possible as well.

Drainage tubes
If fluid in your child's ear is affecting his or her hearing or recurrent ear infections don't respond to antibiotics, your child's doctor may suggest surgery. The most common surgery for ear infections is a myringotomy. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through your child's eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear.

Your child's hearing should improve immediately. As your child grows, the tubes will come out on their own and the drainage holes will heal — often within a year. In the meantime, your child may need to wear special ear plugs in the pool and bathtub to keep water out of his or her ears.

Some children continue to have ear infections after surgery. Sometimes this leads to another set of tubes. If the ear infections continue after age 4, the surgeon may recommend removing your child's adenoids.

You can reduce your child's risk of ear infections with a few simple steps.

• Keep your child away from sick children. If you can, limit the time your child spends in group child care. A child care setting with fewer children may help.
• Protect your child from secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.
• Breast-feed your baby for at least six months. Breast milk contains antibodies that offer protection from ear infections.
• If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby's mouth while he or she is lying down.
• Ask your child's doctor about the pneumococcal vaccine (Prevnar). Prevnar is intended to prevent serious, life-threatening infections, such as pneumonia and meningitis. Studies indicate that it slightly reduces the risk of ear infections as well.

If your child is uncomfortable, ask the doctor about using an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Use the correct dose for your child's age and weight. Don't give aspirin to children younger than age 16, due to the risk of Reye's syndrome — a rare but serious condition.

It also may help to place a warm, moist cloth over the affected ear.

When caring for your child, plan some low-key activities. These can be simple things such as reading books aloud or playing board games. And don't underestimate the benefits of some extra cuddling.