Middle Ear Infections


Middle ear infections are very common in young children. These infections often come after a cold. Children with middle ear infections usually have some discomfort and pain in the ear. If you think your child has a middle ear infection, you should take your child to the General Practitioner (GP) or the paediatrician if the child is below 12 months of age.

Causes of middle ear infection or otitis media

A middle ear infection is caused by infection behind the eardrum in the middle ear. The infection can be caused by either a bacterium or a virus. Bacteria cause about two-thirds of acute ear infections.

The medical name for middle ear infections is otitis media.

The ear has three main parts – the outer ear (the ear canal and ear lobe), the middle ear (behind the eardrum, and linked to the throat via a small tube called the Eustachian tube), and the inner ear (which has the nerves that help to detect sound).

Symptoms of middle ear infection or otitis media

Sometimes ear infections are ‘silent’ and don’t cause any specific symptoms.

Other times, symptoms might be like those of a cold, with fever, runny nose, irritability or loss of appetite. Children usually complain of earache, or of a feeling of fullness or pressure in the ear. Your child might also feel off balance and have trouble hearing.

Babies might cry a lot and pull at the affected ear, especially at night when lying down. Some children might suffer severe and intense pain in their ear.

Occasionally the eardrum might rupture. This is called a ‘perforated eardrum’. There might be a thick and sometimes bloody discharge from your child’s ear. This helps to relieve the pressure that has built up in the ear from the infection, and eases the pain. The burst eardrum usually heals naturally.

Ear infections that keep coming back might lead to ‘glue ear’, which is a thick, glue-like ooze in the middle ear. Glue ear might be associated with varying degrees of hearing loss, which might lead to behavioural, linguistic and educational difficulties.

When to see a doctor about middle ear infection

You should take your child to see your GP if:

  • your child complains of an earache
  • there’s discharge from your child’s ear
  • your child is generally unwell, has a fever or is vomiting
  • you think your child is having trouble hearing
  • your child keeps getting ear infections.

Tests for middle ear infection or otitis media

The GP will look carefully at the inside of your child’s ear using an instrument called an otoscope.

The GP might also do a tympanometry. This test measures how much your child’s eardrum can move, and it can help the GP work out whether the ear is normal. It’s usually a painless test that takes just a couple of minutes.

If your child has had several ear infections, or if your doctor thinks there might be a chronic infection or glue ear, the doctor might organise a hearing test. Your child can have a formal hearing test at any age.

Treatment for middle ear infection or otitis media

Symptoms of middle ear infection usually improve by themselves within 24-48 hours, so antibiotics aren’t often needed.

If your child still has pain and is unwell after 48 hours, is particularly unwell or is less than 12 months old, your doctor might prescribe a short course of antibiotics.

Most children improve after a few days of antibiotic treatment, but always make sure your child finishes the whole course, even if she seems better. Stopping too soon could make the infection come back. Often, your doctor will want to see your child again when your child has completed the course of antibiotics , to make sure the infection has cleared up.

Decongestants, antihistamines and steroids haven’t been medically proven to make any difference in treating ear infections.

You can give your child paracetamol in recommended doses to help with pain. Your doctor might suggest some anaesthetic ear drops if your child has severe pain.

Glue ear generally improves within 3 months. Your doctor will need to monitor your child during this time to check that it’s getting better.

Putting cotton wool in your child’s ear or cleaning discharge with a cotton bud can damage the ear. It isn’t recommended.

Prevention of middle ear infection or otitis media

Some children with recurrent ear infections or glue ear might need a long course of antibiotics.

Many children who get recurrent ear infections have grommets put into their eardrums to prevent infection. Grommets are special ventilating tubes that stop fluid from building up behind the eardrum and help preserve hearing. If your child needs grommets, she’ll need to see an ear, nose and throat (ENT) specialist.

Avoid smoking. Children who are exposed to second-hand smoke are more likely to develop a range of illnesses, including middle ear infections.

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