Ear infections: middle ear

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Ear infections are among the most common illnesses in babies and young children. Most ear infections are middle ear infections (otitis media). Young children are more prone to these type of infections, because the tubes (Eustachian tubes) which connect the throat to the middle ear are softer and shorter. This means that germs can reach the middle ear more easily than in older children, whose tubes are longer and more vertical. In younger children the tubes are prone to getting blocked, so that there is less ventilation into the middle ear space. Like colds and influenza, middle ear infections occur most frequently in the winter months. Although they may cause fever and pain in the short-term, they usually get better with treatment and there are no long-term consequences.

Some children do have recurrent ear infections, for reasons that are not clear, and these may lead to ‘glue ear’ and hearing loss. ‘Glue ear’ is the term used to describe the presence of thick, glue-like secretions in the middle ear. These are sometimes the consequence of repeated ear infections. Glue ear very often affects the child’s hearing, which in turn may have an impact on the child’s language development.

Ear infections in young children need to be seen promptly by a doctor and followed up to make sure that they don’t keep coming back.

When to see the doctor

Take your child to a doctor at the first sign of a possible ear infection. Often a doctor will ask to see your child again after the treatment is finished, to make sure that the infection has cleared up and that there is no evidence of glue ear. Also take your child to a doctor immediately if there is any discharge from the ear, as this may indicate a perforated eardrum.

What causes it?

Otitis media is caused by infection behind the eardrum, by either a germ (bacteria) or a virus. Bacteria are responsible for about two-thirds of acute ear infections.

What are the symptoms?

Depending on the age of the child, symptoms may include fever, irritability or drowsiness, loss of appetite, nausea or vomiting and sometimes diarrhoea, and headache. Younger children may tug their ear, or poke their finger inside. While sometimes ear infections are ‘silent’ and do not cause any specific symptoms, usually your child will complain of earache, or of a feeling of fullness or pressure in the ear. Babies may cry a lot and pull at the affected ear, especially at night when lying down. Some children may suffer severe and intense pain in their ear.

Ear infections can cause a temporary decrease in hearing, so that some children may have noticeable partial deafness during ear infections. Occasionally the eardrum may rupture (perforated eardrum), with a thick and sometimes bloody discharge. This creates some relief of the pressure that has built up in the ear as a result of the infection, and eases the pain. The burst eardrum usually heals naturally.

Is there a test?

Apart from careful inspection of the child’s ear, using an instrument called an otoscope, the doctor may perform a procedure called tympanometry. This measures how mobile the eardrum is, and may help diagnose whether the ear is normal. It is usually a painless procedure which takes a couple of minutes. If your child has had a number of ear infections, or if the doctor suspects there may be a chronic infection or a glue ear, then a hearing test may be organised. A formal hearing test can be done at any age if you suspect that your child has difficulty hearing.

How is it treated?

Antibiotics are usually only given to babies and children who are very unwell. Symptoms of a middle ear infection usually get better by themselves within 24 hours in most children. If a child older than 12 months is only mildly unwell, it may be worth waiting before commencing antibiotics. If the child still has pain and is unwell after 24 hours, or is initially distressed and unwell, your doctor may prescribe a short course of antibiotics. Various antibiotics can be effective, depending on the age of the child. Most children improve after a few days, but always make sure that the child finishes the whole course of treatment even if he seems better, as stopping too soon could make the infection come back.

Decongestants are somewhat controversial, for despite their common use in ear infections, they have not been demonstrated to be of benefit. Paracetamol, in appropriate doses, usually helps the fever and the pain. Nasal drops or spray may help relieve congestion and make your child more comfortable, as may blowing the nose. Saline drops are the safest to use in babies and toddlers.

Some children who have recurrent ear infections, or a chronic infection (glue ear), may require the insertion of ventilating tubes (grommets) into the eardrum. This prevents fluid from building up behind the drum, and helps to preserve hearing. This is a very common procedure in childhood, and usually your child can be a day patient (they do not have to stay overnight in hospital). The procedure is performed in the morning, under general anaesthetic, and the child is able to go home in the evening. While the tubes are in the ears, it is advisable not to go swimming, unless special ear plugs are used to prevent water entering the middle ear. A specialist will explain these precautions to you. Grommets usually fall out after 6-12 months, although sometimes special tubes are inserted which will stay in longer. In some children, grommets may need to be reinserted again if infections recur.

How can I prevent it?

There is no way to prevent ear infections. If your child has recurrent ear infections, or you suspect that their hearing may be reduced, then it is very important that your child be closely monitored to ensure that they do not have a significant and persistent hearing loss.

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