Ear infection are rarely serious.

Most ear infections go away without any treatment

If your child is tugging on his ear but not cranky and not sick he can be observed for signs of ear infection which would be fever , irritability, and perhaps crying when he sucks on a bottle.

One study showed that of 100 consecutive kids tugging on their ears, only 18 had abnormal ear exams and not all required treatment.

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Ear infections result from eustachian tube dysfunction. The eustachian tube is a tube from the middle ear to the back of the nasopharynx (area between the nose and throat). The function of the eustachian tube is to protect the middle ear and equalize the pressure in the middle ear with the atmosphere around us. When you go up in a plane and your ears pop it is because your eustachian tube opened up and equalized the pressure in your middle ear.

Anything that interferes with eustachian tube dysfunction can predispose a child to ear infections. The most common precursor to ear infections are certain colds or upper respiratory infections with some infections being more likely than others to damage the lining of your nose and sinuses to cause eustachian tube dysfunction than others. If you have ever had a head cold and your ears popped or you couldn’t hear the cold was affecting your eustachian tube. Because of more frequent colds, small eustachian tubes that are easily plugged, and because a child’s eustachian tube is more along the horizontal plane than an adult, this happens much more often in children and hence ear infections are more common in children. A typical scenario would be that of a young child between about 6 months and three years with a cold who develops crankiness or ear pain several days into a cold. Although upper respiratory infections are the most common cause of ear infections, anything that can block the eustachian tube can cause ear infections. This would include allergies, irritants such as tobacco and wood smoke, and enlarged adenoids. Just as our eye color, shape of our face and nose is inherited, the shape our eustachian tubes, sensitivity to allergies and infections are also inherited so it is not uncommon to find ear infections running in families.

Serious consequences from ear infections are rare. If fact 90% of ear infections resolve without any treatment (However, antibiotics can make a child feel better sooner and prevent complications). Although some parents may worry about damage to a child’s hearing if an ear infection is not found and treated, this would be very rare and to occur would probably require a persisting uncontrolled infection where the ear drained and drained. The risk of a serious complication from an ear infection such as bacterial meningitis is estimated to be 1 in 10,000.

Although permanent hearing loss from ear infections would be very unlikely, many children with ear infections can have a temporary decrease in their hearing with both otitis media and/or serous otitis media ("fluid in the ears"). Following an ear infection this can persist for quite some time. In the past the medical literature was fairly evenly split over whether this decrease in hearing could adversely affect a child, particularly in the area of language development. The concern was that if a child did not hear clearly during the time he was learning to talk that this would have a long standing effect on his language. Although the pendulum of opinion on this swings back and forth, current thought is that there is not a significant adverse effect unless there are special conditions that already place a child at risk for language problems. There are probably individual exceptions to this.

Putting "tubes in their ears" is the most common surgical procedure performed on children. This is often done because of either recurrent attacks of ear infections or persistence of fluid in the ears beyond three months. It is an elective procedure meaning that it is an option in the management of ear problems in kids but rarely an absolute necessity. "Ear tubes" temporarily take the place of the eustachian tube and equalize the pressure in the ear and allow any fluid to drain. Tubes decrease the number of ear infections while they are in place and keep fluid from accumulating thereby restoring hearing. It is important to realize that they are a temporary and not a permanent cure with the benefit being while they are in place and functioning. It’s not like taking out tonsils. One tonsils are out they are out for good. Tubes help only while they are in place, decreasing the tendency towards infections as the child outgrows the period of time that ear infections are frequent. For example, if a child is destined to be susceptible to ear infections until he is three years old , whether tubes are placed at 6 months, one year or two years, if the tubes fall out before that child is three then he will be susceptible to ear infections until that time.