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Ear Pulling Does Not An Ear Infection Make

Two different sets of parents came to the ED in the middle of the night not too long ago because their infant children were pulling at their ears and the parents were worried that the kids had ear infections.

One was pulling on his ears while he was asleep. Don’t even get me started on why parents are waking their kids from sleep at 2 AM to bring them to the ED.

Here’s some general medical information for you (I can’t call it medical advice because I don’t give medical advice out on this blog): Just because infants pull on their ears does not mean that you have a doctor’s visit in your future.

Ear pulling does not equal ear infection. In fact, ear infections are probably not related to ear pulling at all. If you don’t believe me, read this, then read this, then start reading this. I’m not paying to access the last one, but a summary is that of 100 kids with “ear pulling” as their complaints, not one of them in this study had an ear infection. Zero. Zilch. Nada.

But you may ask “WhiteCoat, what if my child does have an ear infection?” Glad you asked. Continue reading for more general information.

Even if your child does have otitis media, in most instances the recommendations are for “watchful waiting.” In other words, the “infection” goes away on its own most of the time anyway. The word “infection” is in quotes because I personally don’t believe that a large majority of the cases of otitis media are really bacterial infections anyway.

While all you naysayers are rattling off angry responses to me in the comment section, answer me this question first: How is it that a dental abscess or a skin abscess hardly ever causes a fever, yet a glorified zit behind a child’s eardrum supposedly causes fevers of 103 degrees? Give me the pathophysiology behind the “fever phenomenon” first, then bash me for being antiestablishment and an incompetent physician second. Gowannnn. I daaaare ya.

If you have some time to spare and want to read the American Academy of Pediatrics Policy on the Diagnosis and Management of Otitis Media, pull up a cozy chair and click here.
There is also another excellent article on the diagnosis and management of otitis media here.
Finally, there is a comprehensive patient handout on otitis media available on MD Consult. Normally you have to pay to access the site, but as an added bonus to the people who read my drivel every day, I printed out the entire handout in a .pdf format and have uploaded it to my blog here.

If you read all of these materials, you will know infinitely more than almost any physician about the diagnosis and treatment of otitis media – and you might save yourselves a few bucks in doctor visits to boot.

Picture credit here (isn’t this little guy adorable!?!)

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  1. I’ll have you know that whenever I have an ear infection, it goes away in a week if I get antibiotics, but takes a whole 7 DAYS if I don’t!

  2. Aw c’mon….your pulling my ear right?

  3. My little one pulls her ear daily – mostly when sleepy, before the eye rub and yawning. That’s my cue to get her to bed. Many if I went to the ER for every ear pull, I’d be broke.

  4. With no more “ear infection” patients to see, I guess I’ll have to sell one of my Mercedes.

    “I guess I’ll have to sell one of my Mercedes.” <– kickback from the Augmentin rep

  5. Merci, good médecin! Although older than the average bébé, my ears are as delicate and fine, so very sensitive — and sadly oversized due to my high strung, operatic compulsion to yank-yank, pull-pull. They resemble very much to the Playing Dough… Yes, you must make wary all the mères and the pères — the peril is not only the unnecessary médicaments, non! The antibiotics unnécessaires? They permit to the Super Bugs to faire l’amour, until there is très crazy sex in the ear!

    By the way, the picture credit for the charming waif? “Error 404. Not Found.” Thanks – fixed it.

  6. People just have nothing better to do with their time apparently…

    My baby is pulling his ears! Yes, he’s also pulling at his feet. Do you want him examined for a broken foot too? Oh, I just saw him touch his nose—what, are you beating the poor child?

    Look! My baby won’t stop crying, something must be wrong! Yes, you woke him up—I’d be crying too if someone drug me in here at 0330.

    What was the baby’s temp at home? Oh, it was high! What number? I don’t know. Do you have a thermometer? No.

    I think at least one set of these parents must have left our ED and driven straight to your ED.

  7. HEAR HEAR! ;)

    Great post.

    In the Arctic, Inuit babies have absolutely atrocious ear problems (so much so that it is referred to as ‘Baffin Ear’). Chronic draining ears, chronic OM/OE, perforations, even mastoiditis. There has been some speculation that it is due to the Inuit having shorter eustation tubes; but then there is also poverty, bottle propping, malnutrition, and high rates of second hand smoke exposure. The incidence of hearing loss is so high in this population that the newest clinical care guidelines in the eastern Arctic region are:

    treat all cases of OM/OE with amoxicillin, and cipro HC for the perfs/tubes. (!!!!!)

    Many parents know this so when I occasionally try and dissuade them to a watchful waiting period by keeping the draining ears dry (by wicking with tissue paper) and ibuprophen for pain, they say “but you are supposed to give antibiotics for this”. *sigh*

    Super bugs loom (don’t get me started on the lack of compliance to administration once you comply to treat it) and this is how we are dealing with it. It makes me see red (bulging TM’s all day long). It’s a very frustrating situation to which there are no immediate solutions and I fear a massive amount of amoxicillin resistance in the North is on the horizon. Thanks for arming me with a bit more ammo for my next battle regarding this!

  8. My son has been diagnosed with numerous ear infections, usually when we’re in for some other problem or a well visit. 95% of the time he’s given antibiotics from the pediatrician that has a “Why I don’t give out antibiotics like candy” mantra framed on the wall & posted on his website. One time I asked him why we always got antibiotics when he doesn’t like to prescribe them. His answer? “I follow the guidelines of the AAP.”

    Now you can print a copy of the guidelines out and leave an anonymous copy in his mailbox. Maybe he’ll get the hint.

  9. My son used to pull on his ears all the time and it was a constant battle with my friends and relatives to explain he didn’t have an ear infection, he just liked to tug on his ears.

  10. What if a child pulls your finger?

  11. Actually, there have beens studies (I can’t find the reference at the moment) that have shown some relationship between antibiotics in childhood (most unnecessary I am sure) and the development of food allergies. I tell demanding parents that one all the time – but then again I almost never diagnose OM for that very reason – for me to do it the kid must be febrile, and have pus-filled nearly bursting TM with erythema and dullness. Most kids with an earache have only a mildly dusky TM with no visible fluid and no fever, thus no ABx. They get Auralgan and Motrin.

  12. “What if a child pulls your finger?”


  13. My kids never pulled their ears. They just did nice things like refuse to nurse/eat/drink, scream, not fall asleep lying down (then, if you put them to bed, wake up screaming), develop 102 fevers. Boring stuff. Never took them to the ER though. The peds office knew me well. Eventually they did get prophylactic antibiotics for a year while they outgrew their short eustachian tubes (tubes would have been the next step, if they had 1 more infection, as the MD was concerned about hearing loss due to chronic fluid). We survived that year…barely…

    Eldest child ended up with a T&A at age 5 due to enlargement of the tonsils/adenoids. They obstructed the airway at night (you could hear the snoring across the room, through the closed bedroom door). No more ear infections after the surgery. Second child finished the year, cleared the ears, and has rarely had infections since.

  14. Carol Burnett must have had chronic ear infections.

    LOL. For those who are too young to remember the Carol Burnett show … she used to pull her ear at the end of a show to say “hello” to her grandmother who raised her.

  15. I’m gonna pull family members ears till they bleed now.

  16. LOL the comments are great, Dr. W!

    Question for you, though:

    My mom grew up during the War and had no access to medication of any kind. She claims that constant ear infections scarred her inner ear and that’s why, ever since, she’s had hearing loss.

    I’m thinking, wouldn’t the fact that the Russians were shelling her town had more of an impact on the hearing loss? And the scarring be caused by some other agent in the ear canal and not necessarily otitis media?

    Today, she still has ear problems and once every two months has to go to the doctor and get antibiotics as she does get an honest-to-god infection that, if not treated, spreads to her sinus cavities and salivary glands. Ever heard of anything like this? I mean, I don’t doubt she is in pain… but it is the oddest ailment I’ve ever witnessed.

    Are we sure that the otitis is causing the other problems or are the other problems causing the otitis? Strange. Only 10-20% of hearing losses are due to postnatal causes.
    Chronic otitis media can cause conductive and sensorineural hearing loss, but the amount of hearing loss doesn’t seem to be that severe. See here, here, and here.
    Maybe it was chronic otitis. It also might be something else that is causing mom’s hearing loss or it might be that mom’s hearing loss is just due to old age.
    I’m assuming she saw an ENT physician?

  17. “glorified zit behind a child’s eardrum”

    Cool description!

  18. All sensory organ fiddling is clearly diagnostic. Nose picking means meningitis. Eye rubbing means the kid is going to see something horrible and be struck blind, until a kindly psychiatrist with an Austrian accent (Arnold?) cures him years later. Thumb sucking is an early sign of esophageal varices and we must cut back on the amount of vodka junior is getting in his formula. Picking things up with the hands is obviously incipient Guillain-Barre Syndrome and we should hook him up to the vent now. This also protects against problems from badly prepared fugu. Think of the tragedy we invite by not acting aggressively NOW!

  19. Hey my baby is pinching his nose,

    maybe it BO…

    then I should visit a doctor instead.

  20. On the other hand (and to be a complete smartass, but what else would you expect?), we took a “watchful waiting” attitude with one of Carpet Shark’s infections…right up until he popped an eardrum.

    I’m still feeling the mommy guilt over that one. I KNEW something was seriously up, but the pediatrician convinced me to calm down and wait it out.

    That’s kind of a weird case. If the eardrum was *that* inflamed and bulging, then I would expect that antibiotics would have been prescribed – or at least the nasal saline flushes (they make them for kids, too) so that the ears could drain better.
    Don’t feel guilt – chances are that it will heal up fine.

  21. nice, you are right a single gesture can mean many things, but I guess if it consistent than there must be reason.

  22. As a parent of two and an alternative health practitioner, I can tell you that the three things that worked best for my children with earaches (I don’t recall more than two apiece) were Chiropractic, homeopathics and bovine colostrum dripped into the ears.

  23. Chronic ear infections since I was itty bitty. When I was a kid the pain was insane. I still get them all the time, however very rarly do anything about it – no time. Just wait it out and it is usually fine. Only go to the dr. when I can no longer hear. And for those that think chronic ear infections affect hearing – I can’t count how many I have had over the last 33 years and have perfect hearing, just some scarring on the ear drum. So chill with the ear infections people.

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