Middle ear infection: babies, kids & teens

What is a middle ear infection?

A middle ear infection is an infection behind the eardrum.

Middle ear infections are very common in young children. More than 80% of children will have had one by the time they’re 3 years old.

The medical name for middle ear infection is otitis media.

What causes a middle ear infection?

A middle ear infection can be caused by a virus or bacteria.

The ear has 3 main parts – the outer ear (the ear canal and ear lobe), the middle ear (which is behind the eardrum and linked to the throat), and the inner ear (which includes the nerves that help to detect sound).

What are middle ear infection symptoms?

Symptoms in children

If your child has a middle ear infection, they might:

have an earache or a feeling of fullness or pressure in the ear
feel off balance
have trouble hearing
have a fever or runny nose
seem irritable
not feel like eating.

Some children might suffer severe and intense pain in their ears.

Symptoms in babies

Babies might cry a lot and pull at the affected ear, especially at night when they’re lying down.

Perforated or ruptured eardrum

Occasionally the eardrum might burst. This is called a perforated or ruptured 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 eardrum usually heals by itself.

Sometimes ear infections don’t cause any specific symptoms.

What is glue ear?

‘Glue ear’ is a thick, glue-like liquid in the middle ear. It can happen when middle ear infections keep coming back.

This thick fluid can stop sound getting through to the inner ear, which leads to varying degrees of hearing loss. Hearing loss might lead to behaviour, language and learning difficulties.

When should your child see a doctor?

You should take your child to see your GP if your child:

complains of an earache
has discharge from their ear
is generally unwell, has a fever or is vomiting
seems to be having trouble hearing
keeps getting ear infections
has swelling or redness behind the ear or their ear is pushed forward.

How are middle ear infections diagnosed?

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

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

If your child has had several ear infections or has an infection that won’t go away, or if your GP thinks there might be glue ear, they might organise for your child to see an audiologist for a hearing test. Your child can have a formal hearing test at any age.

How to get rid of a middle ear infection

Most middle ear infections start with a virus. The symptoms of this type of middle ear infection usually improve by themselves in 24-48 hours. In the meantime, you can give your child paracetamol or ibuprofen in recommended doses to help with pain. Your GP might suggest numbing ear drops if your child has severe pain.

Antibiotic treatment

Your GP might prescribe a short course of antibiotics if your child still has pain and is unwell after 48 hours, is particularly unwell or is less than 12 months old. This is in case there’s a bacterial infection in the ear, which might take longer to improve.

Most children’s symptoms improve after a few days of antibiotic treatment. Always make sure your child finishes the whole treatment, even if they seem better. Stopping too soon could make the infection come back. Often your GP will want to see your child again when your child has finished the treatment, to make sure the infection has cleared up.

What not to do

Putting cotton wool in your child’s ear or cleaning discharge with a cotton bud can damage the ear. It isn’t recommended. If you need to clean your child’s ear, gently use the twisted corner of a tissue.

Recurrent ear infections

Some children with recurrent ear infections or glue ear might need a long course of antibiotics. Glue ear generally improves within 3 months. Your GP will need to monitor your child during this time to check that it’s getting better.

You could also talk to your GP about other precautions you can take to avoid recurrent infections – for example, avoiding heated swimming pools.

How to prevent middle ear infections

Breastfeeding

Breastfeeding your baby for at least 6 months can help to prevent middle ear infections.

Nose blowing

When your child is young, you might be able prevent middle ear infections by encouraging them to blow their nose when necessary. This helps to open the tubes that connect the middle ear to the back of the throat. As your child gets older, these tubes become larger, work more efficiently and drain more easily.

Grommets

Some children who get recurrent ear infections have grommets put into their eardrums to prevent infection.

Grommets are special ventilating tubes that let air into the middle ear and equalize the pressure. This stops fluid from building up behind the eardrum and protects hearing.

If your child needs grommets, they’ll see an ear, nose and throat specialist.

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