Signs of Infection
One of the widely believed myths in pediatrics is that if your child pulls his ears, then he must have an ear infection. Even though this can be true in some circumstances, this behavior is a red herring in many cases. There are many symptoms associated with ear infections, and pulling on the ears is one of the least reliable. This section describes the various ways you can recognize an ear infection in your child. The presence of any single one of these symptoms may not be very helpful in determining the likelihood of ear infection. They must be considered together to assemble the whole picture.
Things That May Indicate an Infection
There are many factors that increase a pediatrician's suspicion that ear infection may be present, including the following.
Runny Nose
A runny nose is one of the symptoms most likely to occur along with an ear infection. In fact, a middle ear infection is unlikely to occur without some increased nasal secretion. If your child has a stuffy or runny nose for a few days, then suddenly starts to develop other symptoms of ear infection, it is quite possible that he has come down with an infection in the ear.
Crankiness
Crankiness is a very generic response from an ill child. He may be cranky for a lot of reasons, but ear infection must be one of the considerations. Simply having a cold often makes a child irritable, but the degree of irritability may be higher from the intense pain that originates from an ear infection. Parents are astonishingly good at recognizing an increase in the level of distress in their children, and pediatricians must heed their instinct.
Fever
Not all ear infections trigger a fever, and not all fever indicates the presence of an ear infection. Fever is a very nonspecific finding, but it may be a helpful clue in determining the presence of an ear infection. Like all other symptoms described in this section, it must be considered as one of the pieces of the puzzle.
Drainage from the Ear
If liquid, either white or pus-like, drains out from the ear, it usually means your child has an ear infection. While this might indicate a middle ear infection serious enough that it has caused the eardrum to rupture, it could also suggest the presence of the infection known as swimmer's ear, which only involves the external ear. Whether your child has a middle or external ear infection can be determined only by a health professional.
Vomiting and Diarrhea
Ear infections can also cause some seemingly unrelated problems, such as nausea, cough, vomiting, or diarrhea. When the ears are inflamed, the infection may irritate the throat and trigger a cough reflex. In addition, the nerve that controls equilibrium traverses through the middle ear. An infection of the middle ear could aggravate this nerve and cause dizziness, upsetting the stomach.
Alert!
The external ear canals should never be cleaned with cotton swabs like Q-tips. Cotton swabs are designed for removing makeup and cleaning computer keyboards. They have no place inside your child's ears. Using cotton swabs to clean the ears risks perforating the eardrum and causing permanent damage to the ears.
Ear-Infection Mimics
When diagnosing ear infections, most pediatricians inquire about additional symptoms that make ear infection less likely. Many confounding factors can make a child appear to have ear pain when in fact she does not.
Of course, it is important to keep the age of the child in mind. Beyond a certain age, usually between three or four years, most children can reliably report ear pain when it is present. It may take quite a bit of guesswork to ascertain whether younger children are experiencing discomfort in their ears.
Teething
Teething causes an uncomfortable sensation in the gums. Infants cannot verbalize their discomfort and they cannot accurately localize the source of their pain. Frequently, when infants are teething, they bat on the side of their heads or ears because they sense the discomfort of teething. Parents commonly misinterpret this gesture as a sign of ear pain.
Exploration of the Body
Many infants less than a year old love to use their fingers to explore the various parts of their bodies. Having just mastered rudimentary control of their hands, they enjoy touching their toes, faces, and ears. The external ear is interestingly shaped, and its novel form is fascinating to many children. Having an ear on either side of their heads is almost like having two toys that are attached there. The ears are very convenient to play with because they will never drop to the ground.
This type of exploration is most common between the ages of nine and fifteen months. Beyond that age, children typically do not play with their ears without a reason.
Eustachian Tube Dysfunction
When the Eustachian tube is blocked by mucus, hearing can be partially impaired because the pressure difference between the air pocket in the middle ear and the outside environment increases. Older children often describe this as “muffled” hearing. Even though this condition is not the same as having an ear infection, it can be a precursor of an ear infection. If your child describes this type of sensation, have her checked by the doctor to confirm the presence or absence of infection in the ear.
Headache
Babies do get headaches. When they do, they have no way of expressing their annoyance. Many of them end up hitting the side of their head, which can make their parents believe that they are experiencing pain in the ears. This is just another situation in which ear poking or pulling does not necessarily indicate the presence of ear infection.
