Middle ear infections

What is a middle ear infection?#

A middle ear infection (called otitis media) is an infection behind the eardrum. Ear infections are very common and are usually painful, but they do not usually cause long-term problems. By the age of six, most children have grown out of middle ear infections.

Symptoms#

A middle ear infection can cause:

• Earache – mild to severe pain in the ear or face. In a baby, you may notice pulling at the ear and irritability.
• Fever – a high temperature may be the only symptom in babies or young children.
• Mild deafness – caused by fluid building up behind the eardrum.
• Ear discharge – this happens when the eardrum bursts because of the pressure behind it.

Children usually recover from mild infections quite quickly, although your child may feel tired afterwards.

Diagnosis#

The doctor makes the diagnosis by examining the eardrum with an auriscope (also called an otoscope).

What causes them#

Middle ear infections are usually caused by a viral or bacterial infection, and they often happen during or after a child has a cold.

Treatment#

Mild infections can often be eased with paracetamol (also known as acetaminophen) to relieve pain and fever. Do not give regular paracetamol for more than 24 hours without seeking advice from your doctor. Raising the head of your child’s bed can also help.

Some middle ear infections lead to a condition known as glue ear, where thick fluid in the middle ear causes slight deafness. This is not permanent, but it may need treatment, which can include antibiotics and surgery to insert pressure-equalizing tubes in the eardrums. Children with glue ear usually recover within a few weeks after the fluid has drained away.

Whether antibiotics are needed depends on the child:

• Children six months of age or younger will generally need an antibiotic.
• In older children, antibiotics may not be needed in every case.
• If antibiotics are prescribed, it is important that your child finishes the whole course exactly as instructed (usually for five to seven days), even if they seem better after a day or two.

Your doctor may occasionally prescribe ear drops. Other medicines, such as decongestants, do not help middle ear infections.

When to see your doctor#

See your doctor if your child:

• is six months of age or younger
• has a high fever or bad earache
• has an ear discharge that lasts more than 24 hours
• still has a fever or bad earache two days (48 hours) after starting treatment
• still seems to have trouble hearing after six to eight weeks
• seems to be getting worse, or you are worried at any time

Seek urgent medical care if you are concerned about your child or symptoms are severe.

Key points#

• Ear infections are very common and usually painful, but they do not usually cause long-term problems.
• Most children grow out of middle ear infections by the age of six.
• Infections are caused by a virus or bacteria and often follow a cold.
• Some infections lead to glue ear, where fluid causes temporary slight deafness that may need treatment.
• If antibiotics are prescribed, it is important your child finishes the whole course.

Where to get help#