Pediatric ENT Symptoms & Conditions

What Is a Middle Ear Infection?

A middle ear infection, or otitis media, is one of the most common conditions affecting infants and young children. It occurs when fluid builds up behind the eardrum, often due to inflammation or blockage of the eustachian tube—a small passage that helps drain fluid from the middle ear and equalize air pressure. Most ear infections resolve within a few days without intervention. However, chronic or recurrent infections may require treatment with antibiotics or tympanostomy tubes (ear tubes) to improve drainage and prevent future infections.

Anatomically, the ear is divided into three areas: the outer, middle, and inner ear. Your ear not only enables you to hear, but it plays a role in balance as well. Your outer and middle ear are separated by your eardrum. The medical term for eardrum is tympanic membrane. Located just behind your eardrum is your middle ear. The eustachian tube in the middle ear drains fluid and equalizes air pressure. This allows the eardrum to vibrate and send nerve messages to the brain that are interpreted into sound.

What Is Tonsillitis?

Tonsillitis is an inflammation of the tonsils most common in children and adolescents. It is typically caused by a virus, although it can also be caused by a bacterial infection. Common symptoms include sore throat, difficulty swallowing and fever. Most cases of tonsillitis resolve on their own within 4 to 10 days. Treatment depends on whether tonsillitis is caused by a virus or bacteria, so it’s important to get an accurate diagnosis. Surgery is necessary only when tonsillitis recurs frequently, does not respond to treatment, or causes complications.

Tonsils are part of the body’s immune defense system. Located at the back of the throat, they help filter bacteria and viruses entering through the mouth and nose. However, when they become chronically infected, they may do more harm than good.

Causes and Symptoms

Middle Ear Infections

Middle ear infections occur when the eustachian tubes become irritated and plugged or from increased fluid that collects in the middle ear. Middle ear infections commonly occur after a cold, sinus infection, or allergy. Infants or children that are exposed to tobacco smoke have an increased risk of middle ear infections. Babies that are teething produce more saliva, which increases the risk of middle ear infections. Enlarged adenoids (glands in the throat) can contribute to middle ear infections as well. Symptoms include:

Earaches (infants may become irritable, cry, and have trouble sleeping)

Fever

Decreased hearing

Vomiting

Diarrhea

Tonsillitis

Tonsillitis is most often caused by a common cold virus, although it can also be caused by a bacterial infection such as group A streptococcus, the germ that causes strep throat. Like colds and strep throat, tonsillitis is spread when an infected child breathes, coughs, or sneezes and another child inhales the infected droplets in the air or comes into contact with them on the skin or an object that touches the eyes, nose or mouth. Symptoms of tonsillitis usually appear about 2 to 5 days after a child is exposed to the virus or bacteria. The most common symptoms include:

Sore throat

Difficulty swallowing

Fever

Ear pain

Headache

Stomach ache

Red, swollen tonsils

White or yellowish patches on the tonsils

girl getting hearing exam in doctor's office

Determining a Diagnosis

Your doctor will review your child’s medical history, ask you about your child’s symptoms, and complete an examination. Learn more about diagnosing specific conditions below.

Your doctor will review your child’s medical history, ask you about your child’s symptoms, and complete an examination. The inside of your child’s ear will be examined with an otoscope. An otoscope is a lighted device with a magnifying glass. If pus is present, a sample may be tested to determine what type of infection it is.

Tests may be conducted to check for fluid in the middle ear. A pneumatic otoscope delivers a puff of air inside the ear while the doctor checks if the eardrum moves or not. Fluid in the middle ear will prevent the eardrum from moving.

Tympanometry is another test to measure eardrum movement based on changes in air pressure. Acoustic reflectometry uses sound frequencies to provoke eardrum movement.

A doctor can diagnose tonsillitis by examining your child’s throat, ears and nose. The lymph nodes may be swollen and tender while the tonsils are red with white or yellow spots on them. The doctor may also swab your child’s throat to check for streptococcal bacteria. If the test is positive, then your child has a bacterial infection; if the test is negative, then your child’s tonsillitis is viral.

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