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 the Eustachian tube) and the inner ear (containing nerves that help to detect sound).
Otitis mediais caused by infection behind the eardrum in the middle ear, by either a bacteria or a virus. Bacteria cause about two-thirds of acute ear infections.
Putting cotton wool in your child’s ear or cleaning away discharge with a cotton bud can damage the ear.
Depending on your child’s age, symptoms might include fever, irritability or drowsiness, loss of appetite, nausea or vomiting, headache and loss of balance. Younger children might tug their ears, or poke their fingers inside.
Sometimes ear infections are ‘silent’ and don’t cause any specific symptoms, but your child might usually complain of earache, or of a feeling of fullness or pressure in the ear. 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 (known as a ‘perforated eardrum’), with a thick and sometimes bloody discharge. This creates some relief of the pressure that’s built up in the ear from the infection, and eases the pain. The burst eardrum usually heals naturally.
Ear infections can cause a temporary decrease in hearing, so some children might have partial deafness while they have the ear infection.
Recurrent ear infections might lead to ‘glue ear’, which describes the presence of thick, glue-like ooze in the middle ear. Glue ear might be associated with varying degrees of hearing loss, which might lead to behaviour, language and educational difficulties.
When to see your doctor
You should take your child to the doctor at the first sign of a possible ear infection. It’s a good idea for your child to see your doctor again after the treatment has finished, to make sure the infection has cleared up and there’s no sign of glue ear.
Take your child to a doctor immediately if there’s any discharge from his ear, as this might mean he has a perforated eardrum.
Apart from careful inspection of your child’s ear using an instrument called an otoscope, your doctor might perform a procedure called tympanometry. This measures how mobile the eardrum is, and might help diagnose whether the ear is normal. It’s usually a painless procedure 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. A formal hearing test can be done at any age if you think your child has trouble hearing.
Symptoms usually improve by themselves within 24 hours, so antibiotics aren’t often needed.
If your child still has pain and is unwell after 24 hours, or is particularly unwell, your doctor might prescribe a short course of antibiotics. Most children improve after a few days, but always make sure your child finishes the whole course of treatment, even if she seems better – stopping too soon could make the infection come back. Often your doctor will want to see your child again once the treatment is complete, to make sure the infection has cleared up.
Decongestants and antihistamines haven’t been shown to do any good in treating ear infections.
Paracetamol in appropriate doses usually helps reduce fever and pain.
Some children with recurrent ear infections or glue ear might need a prolonged course of antibiotics or the insertion of grommets (special ventilating tubes) into the eardrum. A grommet prevents fluid from building up behind the drum, and helps preserve hearing. Having grommets put in is a very common procedure. The procedure is done under general anaesthetic in hospital, but your child can usually go home the same day.
While the grommets are in your child’s ears, she should avoid swimming, unless she uses special ear plugs to stop water getting into the middle ear. Grommets usually fall out after 6-12 months, but sometimes the specialist might put in special tubes that stay in longer. Occasionally grommets might need to be put in again if infections come back. A specialist will explain all this to you if your child needs grommets.
In some children with recurrent ear infections or glue ear, the specialist might consider removing the adenoids (part of the ring of tonsils at the top of the throat).
There’s no way to prevent ear infections. If your child has recurrent ear infections, or you think his hearing might be reduced, it’s very important to have him closely monitored to make sure there’s no significant and persistent hearing loss.
There are some factors that can make children more likely to get middle ear infections – for example, exposure to parental cigarette smoke, bottle-feeding rather than breastfeeding, and exposure to other children (such as spending time in a child care centre).
There’s a debate among researchers about whether dummy use is associated with a higher incidence of middle ear infections. As yet, the evidence isn’t strong enough to recommend that parents don’t use dummies for this reason alone. If you do decide to use a dummy, you might consider limiting its use to around sleep or settling times.