Ear pain – ouch! But did you know not all ear infections are created equal?

I was a kid who suffered from frequent ear infections. My mother would give me the pink bubblegum flavored amoxicillin (which I thought was delicious). The pain would go away. Years later, in high school, I found myself once again diagnosed with a painful ear infection. But this infection was different. I had smelly discharge coming out of my ear and was given ear drops instead of the oral antibiotics I had taken in the past. Why the different treatment? Aren’t all “ear infections” the same?

The answer is no. But it wasn’t until studying ear anatomy in medical school that I finally understood. The term “ear infection” can mean different things depending on what part of the ear is affected. Knowing the difference can help parents get proper treatment for their child’s ears.

Ear anatomy 101 – turns out, it’s complicated!

The human ear, after all, is quite a complex structure. It is made up of three parts: the outer ear, middle ear, and inner ear.

The outer ear (pinna and ear canal) is the part that sticks out from your head and includes the ear canal that leads up to your eardrum (tympanic membrane.)

The middle ear is an air-filled space between your eardrum and your skull. This space holds the tiny ear bones you need to hear sound. This part of the ear is connected to the eustachian tube, which opens to the back of your nose. That uncomfortable, stuffy feeling when your ears pop on an airplane? That is your eustachian tube opening to equalize the pressure in your middle ear.

Finally, the inner ear – which controls hearing and balance – is located within your skull bone.

What part of your child’s ear hurts?

Ear infections are a common childhood illness. The quickest, most effective treatment depends on what part of the ear is affected. Below I explain the difference between outer ear, middle ear, and inner ear infections – and how we can best help your child get better fast.

• Outer ear infections – An infection in the ear canal is often referred to as “swimmer’s ear.” The swelling and drainage are usually treated with topical ear drops. Severe cases of swelling can cause the ear canal to completely close off. This type of ear infection can be extremely painful. Your doctor may place an ear wick or small ear canal sponge to help the medicated ear drops reach the deepest part of the ear canal. Your child may also need oral antibiotics if there is significant swelling around the ear and face.
• Middle ear infections – Developing fluid in the middle ear is the most common type of ear infection in children because their eustachian tubes are shorter than adults. Symptoms include ear pain, fever, and decreased hearing and require oral antibiotics. We don’t generally see ear drainage unless the eardrum ruptures.
• Inner ear infections – Viral infections of the inner ear can present with sudden hearing loss and vertigo or dizziness. Inner ear infections affect adults but, thankfully, are rarely seen in children.

Does my child need tubes?

Ear tubes are small, plastic devices surgically placed into the child’s eardrum to help trapped fluid drain. Ear tubes are used to treat chronic or recurring middle ear infections. Your pediatrician may recommend your child be evaluated by a pediatric ear, nose, and throat specialist (ENT) if there are concerns about frequent infections (greater than 3 infections in 6 months or more than 4 infections in 1 year, chronic fluid in the middle ear for more than 3 months, or concerns for speech development).

Ear tubes can help decrease the frequency of ear infections, reduce oral antibiotic use, improve hearing, and help with speech delay.

Considering tubes or concerned about your child’s hearing?

Mary Bridge Children’s pediatric ENT specialists have advanced surgical training and experience in treating children with ear, nose, and throat problems. We’re here to help families, with convenient Mary Bridge Children’s outpatient centers in Gig Harbor, Federal Way and Tacoma. For more information on how to obtain an ENT referral to Mary Bridge Children’s, call 253-403-7777.

Learn more about the full range of pediatric ENT services offered.