Tale of the Tympanic Membrane (Ear Infections 101)

All parents have been there…your child started with a runny nose and cough that you thought would go away on it’s own but quickly turned into a fever, a screaming child who won’t lie down, let alone sleep, and an exhausted parent wondering “is it their ears?”.

Ear infections are extremely common in children. In fact, the NIH estimates that 5 out 6 children will have at least 1 ear infection by their 1st birthday1. They are more common in kids for a lot of different reasons including their anatomy, their increased number of colds per year and of course, daycare.

Why do children get ear infections?

First let’s take a quick look at some ear anatomy (stick with me, it will be brief). The part to highlight here is the Eustachian tube. This little tube connects from the back of the throat near the tonsils to the middle part of the ear. In an adult this tube has a steep angle so that any fluid that is in the middle ear space drains down into your throat and avoids becoming infected. In a small child this angle is closer to horizontal and does not drain very well so any fluid that gets in has significant trouble getting back out. Once fluid is in a warm, dark place for a significant amount of time there is the chance that small little bacterial invaders will make it their home and cause an infection.

What do they look like?

There are different types of ear infection, but the majority of the time when your child is diagnosed with an ear infection or “acute otitis media”, we are talking about an infection in that middle ear space. Since that middle ear space is behind the ear drum, or tympanic membrane, you can only see it by having special tools like that pointed flashlight we use in the office. When we look in your child’s ear this is what we see:



This is a beautiful ear drum with healthy- appearing tissues, no redness, no swelling. We can see all the little tiny bones. Compare that to this image of an ear infection or acute otitis media.







The entire ear drum is the color of a fire truck and you can even see some pus behind the ear drum, gross! No wonder your child isn’t sleeping!



When do you treat?

Current guidelines recommend treatment for children younger than 2 years of age with evidence of infection since it can affect their hearing and, in turn, affect their speech development. The majority of children with an ear infection can be treated with a round of oral antibiotics for 10 days that will resolve the ear infection.  For children older than 2 years of age, it gets into a gray zone of taking symptoms into account. Since they have developed the majority of their speech, it is up to the doctor and parent to decide whether antibiotics or monitoring for spontaneous resolution is appropriate.

How many is too many?

There are some patients that, because of anatomy and poor drainage of that tube into the back of their throat, will be predisposed to getting infections no matter what. In these cases, when you have more than 4 episodes of ear infection within 6 months, they are a candidate for ear tubes.

What is an ear tube?


An ear tube (or pressure-equalizing tube) is placed by a surgeon, specifically an Ear Nose and Throat (ENT) doctor, and is used as a bridge to help us avoid infections while your child grows and the risk of ear infections decreases. It helps to prevent the pressure from building in that middle ear space, provide a way for that fluid to drain from the ear, and gives us an opening to put drops directly into that space in the event there is an infection. This is what a tube looks like to us on exam.




What symptoms to watch for?

Symptoms of an ear infection:

  • Fever
  • Nasal congestion
  • Ear tugging
  • Refusing to eat
  • Refusing to sleep

As always, if you ever have any questions your doctor is always happy to hear from you and you should never hesitate to call the office!

And last but not least, don’t forget that flu season is coming; it is time to get your children in for their annual flu shot!


Special thanks to Dr. Tori Smith from Mercy Pediatric Clinic for sharing her wisdom on ear infections, just in time for Winter! We are so grateful for the partnership with the Mercy staff and their dedication to kids and families in our community. If you’re interested in learning more or making an appointment, please visit their Facebook page here or their website here.

{sources} https://www.nidcd.nih.gov/health/ear-infections-children

Iowa City Moms Blog
At Iowa City Moms Blog we’re a group of local moms who are passionate about connecting other moms to one another and to our community! Whether you’re an experienced mom, a newbie, expecting, or aspiring to be a mom someday, this blog is for you! Join us as we navigate this journey that is motherhood in the Iowa City area!


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