I should call this: "The Eustachian Tube - Dictator of Ear Happiness." More later on that.

Few things I want to put out there first:

1) There are two kinds of ear infections: middle ear infections (otitis media - the type you get tubes for) and otitis externa (outer ear infection, no tubes for this)

2) "Water in the ear" from a bath or pool typically does NOT cause middle ear infections! It CAN cause something called "otitis externa," or, "swimmer's ear," which is an ear canal/skin infection that may require ear drops to improve. I'm not going to talk about that kind of ear infection today. From here on out when I say "ear infection," I mean the middle-ear kind.

3) Ear infections are incredibly common. Do NOT freak out if your child gets one. Five out of six kids will have at least one by their third birthday (and most will have more than one).

4) A "red ear" does not mean a child has an ear infection.

5) A "baby messing with an ear" does not necessarily mean they have an ear infection.

6) A fever with your child's cold does not necessarily mean an ear infection is happening. The only way to know if your child has an ear infection is to have the ear drum examined by a medical provider.

Why do ear infections happen? Well....snot. And inflammation. Snot and inflammation from colds. Snot and inflammation from allergies. Snot and inflammation from just walking into the door of daycare or that play date.

The inflammation blocks a vital little guy called a eustachian tube. Look at the picture to the left. Find the eustachian tubes. See how they're a little exit canal for the inner part of the ear? They drain the ear. An infant's eustachian tube is smaller than an adults', and more horizontal. That causes problems. It just doesn't drain well.

It swells up, gets blocked off, and the snot in the middle ear has nowhere to go. Once the cold or allergies are better, it de-swells, opens up, and voila!, ear infection is gone. All the junk drains out. The baby's eustachian tube is different than an older kid's, or adult's. This fact along with the fact that babies and toddlers are snot machines and always putting things in their mouths - that's why they get more ear infections. We hope they "outgrow" this eustachian tube problem (and hands in mouth problem) by age 2-3.

It can take 3 weeks to 3 months for the fluid to drain out of the ear. And your kiddo may have an ear infection and you'd never know about it, and that's ok - because they usually get better on their own! Most ear infections are VIRAL! That means the fluid just has a virus in it, and it will all go away on its own thanks to our great immune systems.

When I look into a child's ear, I examine the ear drum to know if they have an infection or not. When there is no infection, an ear drum is translucent, kind of like a shower door. When it is infected, it is red, bulging out, and full of what looks like pus. Sometimes this is just viral fluid. But sometimes, while that eustachian tube is all swollen and blocked off, the liquid stuck in the inner ear gets bacteria in it. We can tell the difference by looking in there. And that is why some children need an antibiotic for some ear infections. To kill the bacteria while we wait for the eustachian tubes to un-swell.

So...who needs "tubes?"

There are a few things that cause kids to get lots of ear infections:

1. Being in a child care setting (lots of kids...lots of snot).

2. Secondhand tobacco smoke exposure (as if you needed another reason to quit).

3. Taking a bottle to bed (when the child lays down and drinks, the milk actually puddles in the area where the eustachian tube meets the nose/throat and causes swelling and bacteria to hang out back there - this habit also causes cavities - no bottles in bed, folks!!)

Some kids have really tiny eustachian tubes that stay really swollen all the time. If they're around other kids a lot, like day care, they get tons of colds each year, and that's normal. However their little eustachian tubes mostly stay swollen shut, sometimes for months at a time. And we see them in our office 1-2 times a month for repeated ear infections.

I guess a "rule" I follow is that if a child gets 5-6 bacterial ear infections in a year, or more than 3 months of constant fluid in the ear, I will send them to the Ear-Nose-Throat doctor to get tympanostomy tubes (or just "tubes", as most people know them) put in. This brilliant procedure creates a little "canal" for the fluid to escape from the inside of the ear. They fall out in about a year, when we hope they've "outgrown" the problem.

Sometimes, I send a kid to ENT if I've put them on 3 or more rounds of antibiotics and they're still having fevers and still in pain and I just can't get that dang fluid to go away. Who wants a kid on antibiotics for that long!? Another reason to see the ENT is if the fluid is making it hard for a child to hear. When a small child can't hear, they can't learn to speak. I've seen kiddos get ear tubes and within 1 week they are talking up a storm! It's amazing.

However, surgeries and anesthesia comes with risks. If you're worried your child has had too many ear infections, talk to us. We will let you know if we think it's time to see the ENT.

Wow...this was long. I hope it helped you learn something about one of the most common ailments we see in the office!

I don’t mean a new shirt or an electric screwdriver. I mean the intangibles, the things I experience and learn. As a dad of children with special medical needs, I’ve learned not to be afraid of the next “new normal,” whatever that may be.

Our 7-year-old boys, William and John-Raven, are identical twins with a unique form of muscular dystrophy. As identical twins, they inherited the same genetic variations, so their neurological development has been almost the same as well. They are non-verbal, non-mobile and tube fed. To go into the boys’ full history would take much more than a blog entry, but suffice it to say, they’ve logged quite a few surgeries and hospital stays in their short lives. In the last nine months alone, we’ve spent almost 90 days inpatient at Cook Children’s. I’m writing this from William’s room right now, actually, having been here over a month. During this stay, William got a tracheostomy, so we’re getting thoroughly educated on the ins and outs (literally) of trach care.

From before the boys were born, we’ve had to learn to adapt to new developments that most parents don’t encounter. The kinds of things that mean you have to shuffle significant parts of your life (both emotional and physical) to make room for new day-to-day processes and situations. From the very first sonogram, when we found out we were having twins and that they might be monoamniotic (sharing the same amniotic sac, which is risky for the fetuses), we learned not to get too comfortable. As it turned out, they weren’t monoamniotic, but they did have hydrocephalus (excessive fluid buildup in the brain).

They received shunts shortly after being born to treat the fluid buildup in their brains. They were hospitalized with aspiration pneumonia and received feeding tubes a year later. In the coming years, more things would change. They had corrective eye surgeries. They had their tonsils and adenoids removed. They contracted RSV and went to the Cook Children’s PICU, where both boys had to be intubated, and John-Raven spent several days on life support. Eventually, we received the genetic results that informed us our boys have muscular dystrophy. We’ve had to make numerous 911 calls and taken quite a few ambulance rides. These experiences have taught us to keep ourselves always prepared for a “new normal.”

I take an active role in the care of my kids, and that applies equally to when they’re home and relatively healthy as it does to when they’re at the medical center. For that reason, I am a big fan of the family-centered care approach at Cook Children’s.

I appreciate the way the professionals here involve me in the decisions that are made about the plan of care for my children. I wouldn’t have it any other way. With all of our stays, Cook Children’s has basically been our home-away-from-home. Certainly, we wish our boys did not have to be hospitalized so frequently and for such prolonged periods, but if they have to be, Cook Children’s is our preference. Being in a familiar place with people we trust helps us deal with the challenges that occur so often for a family like ours.

I’m also a member of one of the Family Advisory Councils, and in that role, I get to be more directly involved and improve the connections between the medical center and the families served by it. I think of that as my opportunity to give back and participate in a different way as a parent-partner at the hospital.

I think of Father’s Day as a time to celebrate the joys and opportunities and adventures I’ve had as a father, even the things that are difficult. Thanks to the guidance of the professionals in the Transitional Care Unit, my wife and I have finished our tracheostomy training so that we’ll be better prepared to care for William and his recently acquired trach. It’s just a matter of time before we’re back home again and adapting to our new situation. It isn’t easy, but to me, being a father means celebrating the little wins and making sure I’m ready for the next new normal, regardless of what that is.

About the author

Matthew Plummer Cobb is the father of two identical twins, William and John-Raven, and a member of one of Cook Children's Family Advisory Councils.