About middle ear infection or otitis media
A middle ear infection is an infection in the fluid behind the eardrum.
The infection can be caused by bacteria or a virus.
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.
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 has the nerves that help to detect sound).
Symptoms of middle ear infection
Most children with a middle ear infection have an earache or a feeling of fullness or pressure in the ear. They might feel off balance and have trouble hearing. Symptoms can also include fever, runny nose, irritability or loss of appetite.
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 ears.
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.
Sometimes ear infections don’t cause any specific symptoms.
Ear infections that keep coming back might lead to ‘glue ear’, which is a thick, glue-like ooze in the middle ear. This thick fluid can stop sound getting through to the inner ear, which leads to varying degrees of hearing loss. This might lead to behaviour, language and learning difficulties.
Medical help: when to get it for children with middle ear infection
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 behind the ear or the ear is pushed forward.
Tests for middle ear infection
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 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.
Treatment for middle ear infection
Most middle ear infections are caused by a virus. The symptoms of this type of middle ear infection usually improve by themselves within 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 some numbing ear drops if your child has severe pain.
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.
Most children’s symptoms improve after a few days of antibiotic treatment, but 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.
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.
Prevention of middle ear infection
When children are young, you might be able prevent middle ear infections by encouraging children to blow their noses when necessary. This helps to drain the tubes that connect the middle ear to the back of the throat. As children get older, these tubes become larger and drain more easily.
Some 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, 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.