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Illnesses & Symptoms

Ear pain and Infections

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What is an ear infection?

Not all perceived ear pain is an ear infection.

Middle ear infections are caused by a build up of pus from the sinuses into the ear behind the ear drum.  It is not from wind in the ears or water in the ears.

Some babies pull at ears or are fussy for a variety of reasons, such as teething, sore throats, or simply "finding the ears."

Ear infections are most common from 4 months until preschool age, but can happen even in adults. Ear-Pain-and-Infections.png


Swimmer's ear infections are an entirely different process. They are caused by inflammation of the skin lining the ear canal. This can happen from water in the ear, or trauma to the ear canal. For this reason, we do not recommend any cleaning of the ear canal with solid objects, such as cotton swabs. You can use a cloth to wipe the outside of the ear. For people who build up a lot of ear wax, you can use ear drops, such as peroxide ear wax removal drops, from your pharmacy.

How do I treat the pain?

  • Treat the pain with Acetaminophen (i.e. Tylenol) or Ibuprofen (if over 6 months).  Do not alternate Acetaminophen with Ibuprofen. Choose the one that works best for your child.
  • If the ear is not draining pus, you may try ear drops, often called "sweet oil" from the pharmacy or olive oil from your kitchen, 2-3 drops in affected ear(s). 
  • There are prescription pain relief ear drops, similar to the Novocain your dentist uses to numb your mouth. An appointment would be required to prescribe these. 
  • Antibiotics are not pain relievers, so pain control is still most important.

When are antibiotics needed?

About 80% of middle ear infections will go away on their own because they are caused by viruses.

We may choose to begin antibiotics if a child is severely ill, is a young infant, or if the infection lasts longer than 3 days.

Antibiotics are not pain relievers, so pain control is still most important. We do not send out antibiotics over the phone. If antibiotics are used, giving a probiotic can help to prevent antibiotic associated diarrhea. Give a probiotic at least 2 hours apart from an antibiotic, if both are used, so that the antibiotic doesn't kill all the good bacteria. For a searchable database on probiotic brands, see 
Clinical Guide to Probiotic Products

When is an ear infection an emergency?

Most ear infections require pain control and time, but occasionally they can develop into a more serious condition called mastoiditis. Symptoms include ear pain and fever, as well as redness and swelling behind the ear, causing it to appear to stick out from the head more than normal. 

What can I do to prevent ear infections?

  • Ear infections often follow the common cold, so prevention of illness with good handwashing will help prevent ear infections.
  • Never lay your baby down with a bottle, as this encourages milk or formula to enter into the middle ear, resulting in an ear infection.
  • Do not allow your child to be exposed to cigarette smoke. Remember that smoke particles remain in hair and clothing, and when you hold a child close to you after smoking, they inhale the smoke dust and are at risk even if you never smoke in the same room as the child!
  • There is new research that shows that using nasal saline with Xylitol can help prevent ear infections.  Xylitol is a sugar substitute from plants that is completely safe (also found in sugar free gum that can help prevent cavities).  It keeps the bacteria from multiplying, which decreases the likelihood of an infection.  You can purchase nasal saline with Xylitol at health food stores.
  • Research also supports the use of probiotics to prevent many illnesses.

When should we consider “tubes” and what are they, anyway?

Ear tubes put a hole in the ear drum, and keep that hole open to drain any pus that goes into the middle ear.  This helps relieve the pain associated with ear infections, but does not prevent future infections.

We consider tubes if the pus persists for over 3 months continually, if multiple courses of antibiotics fail to cure the infection, if speech is delayed, and many other factors. The time of year must also be taken into account. If your child has difficult to treat infections in the summer (a low risk season), we might consider tubes before winter, anticipating a "bad season." If however, the infections are through the winter and clear up in the spring, we can simply monitor for other infections.

There is pus draining out of my child’s ear… it stinks!  What is it?

If your child has tubes, the tubes are working and draining the pus of the ear infection. If there are not tubes, then the pus behind the ear built up enough pressure to pop a hole in the eardrum, and the pus is able to drain. While this sounds serious, it actually tends to relieve the pain of the infection and helps the body heal itself. The hole in the eardrum tends to heal quickly (sometimes too quickly, before the infection is completely drained, letting the pus build back up again).  This does not cause permanent hearing loss.

Do ear infections cause hearing loss?

When the pus is behind the ear drum, the drum cannot move back and forth like it should, and decreases hearing temporarily. Usually when the pus goes away, the hearing returns to normal. If pus continues or recurs often, tubes are placed to drain the pus (see above).

For more on ears:

Dr. Stuppy's All About Ears blog series:
  1. All About Ear Infections – What they are and why they happen
  2. All About Ear Infections – Treatments
  3. All About Ear Infections – Prevention
  4. Swimmer's Ear 

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Illnesses & Symptoms