Ear infections affect older children, too. What would that look like?

Ear infections are extremely common in children because of their smaller and more level eustachian tubes, which make it difficult for fluid to drain out of the ear, as well as their underdeveloped immune system. In fact, according to National Institutes of Health, five out of six children will have at least one ear infection by their third birthday.

Ear infections are one of the most common reasons for a doctor’s visit. Even after early childhood, kids may experience ear infections. Luckily, much of the guidance Dr. Kathleen Billings and Dr. Laura Rosenthal from Lurie Children’s Division of Otolaryngology share on what to look for — and how to respond if you suspect an ear infection — in younger children is also applicable to older ones.

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

Billings said the type of ear infection may also dictate its corresponding symptoms, 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. This will be true across all ages of children, but older children will ideally be able to vocalize their discomfort in a direct way.

Otitis externa, commonly referred to as “swimmer’s ear” (though swimming is not always the cause), is another type of infection where 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.

In understanding why an older child might recurringly experience ear infections, Rosenthal points out that it might be related to a specific predisposition they have. For instance, 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 also be at higher risk for infections, including ear infections.

Meanwhile, the poor eustachian dysfunction and reduced immune systems that make young children vulnerable to ear infections are expected to mature over time as they age.

Ear infection treatment will depend on the severity and the child. Some milder cases of ear infections may resolve on their own over several days, while others might require an antibiotic prescribed by the child’s doctor.

“Pain management is often appropriate given the discomfort associated with ear infections,” Rosenthal said. “If a child has recurring ear infections, then they may be a candidate for ear tubes, which allows ventilation into the middle ear. Seeing a specialist can help families determine what is best for a young patient.”

Rosenthal defines recurring infections as three in six months, or four in one year, as long as there was one in the past month.

When a child has otitis media with effusion (or fluid stuck behind the middle ear), typically the recommendation will be to observe it first. If the fluid persists for more than three months, and there are concerns for hearing or speech, then ear tubes may be suggested.

A common misconception about ear infections is that they are contagious. “The fluid is stuck behind the ear drum, meaning it cannot be passed on to someone else,” said Billings. “However, ear infections are frequently, but not always, the result of or accompanied by an upper respiratory infection. Additional symptoms, such as coughing and nasal congestion and drainage, may indicate a contagious upper respiratory infection.

While it may be inevitable that kids experience an ear infection at some point in their childhood, the best approach is for families to seek the advice of a pediatric specialist who can determine the most effective next steps in pain relief for them.

• Children’s health is a continuing series. To learn more about ear, nose and throat conditions and how to treat them, visit the Division of Otolaryngology at Lurie Children’s: www.luriechildrens.org/en/specialties-conditions/pediatric-ent-otolaryngology.