Ear Infection—Child Care and Schools

What is an ear infection?

There are 2 common types of ear infections: otitis media (middle ear infection) and otitis externa (swimmer's ear). Most ear infections in young children occur in the middle ear.

• Otitis media (middle ear infection): The middle ear is the space behind the eardrum where tiny bones attached to the eardrum transmit sound across the air space of the middle ear to the inner ear. Otitis media occurs when fluid collects in the middle ear space, usually during or shortly after a viral upper respiratory infection (ie, a cold). This fluid may be sterile, contain viruses, or become secondarily infected with bacteria, which produces pressure or outward bulging of the eardrum. Bacterial ear infections (acute otitis media) can be very painful. In older children, most ear infections resolve by themselves in a few days. However, if symptoms are severe or do not improve with pain and fever medications, antibiotics may be of benefit. In children younger than 24 months, bacterial ear infections (acute otitis media) can last longer, and they are likely to benefit from antibiotics started at the time of diagnosis. Sometimes, pressure from the infection breaks the eardrum, and pus drains from the ear, which almost always heals on its own within 1 week. Risk factors for middle ear infections include the following:

  • ? Young age: Young children have immature immune systems, frequent viral respiratory infections, and poor drainage of fluid and mucus from the middle ear due to a small, horizontal eustachian tube (which drains the middle ear to the back of the throat) that gets easily blocked by mucus in the nose and throat.

  • ? Educational settings: Increased exposure to and frequency of colds increases the odds of an ear infection.

  • ? Smoke exposure: Tobacco smoke exposure increases the risk of middle ear infections.

• Otitis externa (swimmer's ear): Infection in the lining of the ear canal caused by moisture and bacteria from bodies of water that produces painful swelling. Pus may collect in the ear canal.

What are the signs or symptoms?

• Pain inside the ear.

• Pain when moving the earlobe, mostly with otitis externa (infection of the ear canal).

• Fussing, irritability, crying, or poor feeding.

• Fever may be present.

• Ear drainage.

Cross section of the ear. Children have a smaller and more horizontal eustachian tube than adults have, which predisposes children to getting and keeping fluids in the middle ear.

A.D.A.M. INC.

Anatomical illustrations. Side-by-side infant and adult faces showing the cross section of the ear and comparing the shape and position of eustachian tubes in each. The left illustration shows the infant's eustachian tube extending horizontally from the nostril to the ear opening. The right illustration shows the adult's eustachian tube arcing upward midway between the nostril and ear opening. Below the images, the text "Eustachian tube" points to the reddish-pink tube in each image, illustrating the difference in arc.

What are the incubation and contagious periods?

• Incubation period: For middle ear infection, the incubation period is related to the type of virus or bacteria that is causing fluid buildup in the middle ear. For swimmer's ear, signs or symptoms usually appear within a day or so after swimming or getting water in the ear canal.

• Contagious period: Ear infections are not contagious.

a, Normal tympanic membrane (TM); b, TM with mild bulging; c, TM with moderate bulging; d, TM with severe bulging

ALEJANDRO HOBERMAN, MD

Four close-up otoscope views of circular, pinkish, fleshy eardrums or tympanic membranes labeled a, b, c, and d, ranging from normal to severe bulging. The normal tympanic membrane, labeled "a," appears gray in color, smooth, and translucent. The tympanic membrane with mild bulging, labeled "b," shows white/yellow fluid collections and is less translucent. The tympanic membrane with moderate bulging, labeled "c," is white/yellow, completely opaque, and swollen. The tympanic membrane with severe bulging, labeled "d," is white in color with blood vessels spreading across the swollen, completely opaque membrane.

How is it spread?

• Middle ear infections are a complication of a respiratory infection. The virus or bacteria that led to the middle ear infection may be contagious but no more worrisome than other germs that cause the common cold.

• Swimmer's ear is a bacterial infection of the skin in the ear canal.

• Drainage from ear infections (either middle ear infections or swimmers' ear) can contain bacteria and should be treated as wound drainage.

How do you control it?

• For a middle ear infection (otitis media)

  • ? Prevention

    • ? Promote breastfeeding, which reduces the number of ear infections.

    • ? Promote immunizations, which help reduce the number of ear infections caused by specific bacteria (eg, Streptococcus pneumoniae).

    • ? Avoid exposure to cigarette smoke.

  • ? Get treatment instructions from a pediatric health professional. Sometimes oral pain-reducing medication, such as acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil, Motrin), is all that is needed. Sometimes, the health professional will prescribe antibiotics.

• For ear canal infections (swimmer's ear)

  • ? Prevention

    • ? Rinse ear canals with warm, clean water or a solution of 1:1 vinegar and rubbing alcohol after swimming (only if the ear drum is intact and the child does not have ear tubes). For recurrent infections, a pediatric health professional may recommend a special ear wash after swimming.

    • ? Dry ears by allowing the water to drain out onto a towel.

    • ? Get treatment instructions from a pediatric health professional.

• For ear drainage

  • ? Have the child evaluated by a pediatric health professional. Drainage from the ear is a common occurrence if a child has ear tubes. Ear drainage does not require exclusion.

What are the roles of the educator and the family?

Encourage the family to seek medical advice if the child is very uncomfortable with signs of illness from the infection or if the child seems very ill.

Exclude from educational setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group