Infection of the middle ear (the space between the eardrum and the inner ear) is also called otitis media. Normally this space is filled with air, but sometimes it can become filled with fluid, which gets infected.
Middle ear infection is a very common childhood illness. About two thirds of children will have a least one middle ear infection by age three, and a third of these children will have at least three infections. Otitis media is more common in boys than in girls. Autumn and Winter are peak times for ear infections. Ear infections are not contagious.
Ear infections occur most commonly between the ages of six months and two years and become less frequent after the age of 5. The earlier a child has a first ear infection, the more susceptible he or she is to further infections.
Sometimes fluid (effusion) builds up in one or both middle ears. When this is chronic and severe the fluid is very sticky and is commonly called "glue ear".
What causes ear infections in children?
Anything that blocks the eustachian tube (the passage connecting the middle ear to the back of the throat and nose) can increase the risk of ear infection. Normally, the eustachian tube drains fluid from the middle ear into the nose.
However, during an infection of the upper airways, such as the common cold, the lining of the narrow eustachian tube becomes inflamed, swollen and, eventually, blocked. This prevents the normal drainage of fluid from the middle ear, causing a build-up of fluid. This fluid becomes a breeding ground for bacteria, leading to infection. Trapped fluid in the middle ear puts pressure on the eardrum causing it to bulge.
Eustachian tubes in children are shorter and smaller than in adults and become blocked more easily. The commonest causes of blockage are:
- Common cold
- Other upper respiratory infections
- Enlarged adenoids (glands near the ear)
Otitis media can also be caused by childhood illnesses such as measles (the child’s immune system is weakened).
Children who have glue ear are more likely to get acute episodes of otitis media
A perforated eardrum (hole in the eardrum) can lead to ear infection if water enters a child’s ear during bathing or swimming.
Some conditions make children more susceptible to ear infections:
- Day care/crèches
- Exposure to cigarette smoke
- Being bottle-fed
- Having siblings with recurrent ear infections
- Lower socio-economic groups
- Certain medical disorders, including Down's syndrome, cleft palate, Kartagener's syndrome, and immunosuppressive disorders such as HIV infection.
What are the symptoms of middle ear infection?
Some children with middle ear infection may have no symptoms. The following symptoms are common in acute otitis media:
- Severe earache, due to the pressure of fluid on the eardrum. The child may pull at his ears. Earache tends to be worse at night.
- Vomiting, poor feeding and lethargy
- Irritability, crying, poor sleeping.
- Slight deafness (temporary).
- Ear discharge – this happens if the eardrum perforates (a hole comes in the eardrum) allowing the infected mucus (pus) to escape from the ear. This sometimes helps to relieve pain by releasing the pressure on the eardrum, but can lead to re-infection.
- Following perforation of the eardrum, children may develop hearing loss, dizziness and tinnitus (ringing in the ear).
- Disturbance of balance (temporary).
Should I call a doctor?
Most ear infections clear up within three days without any treatment and 80% to 90% of children with uncomplicated ear infections recover within a week without antibiotics. Antibiotics do reduce symptoms more quickly, but only after a day, at which time the pain is less anyway. Overuse of antibiotics in adults and children can lead to drug resistance.
Do see your doctor, however, if you suspect your child has a perforated eardrum, a severe infection, or if the infection is getting worse after 2-3 days. While antibiotics may help with the short-term symptoms, there is no evidence that they make otitis media clear up faster or reduce the chance of complications. You should book a follow-up check so your doctor can make sure that the infection has fully cleared.
In the meantime, give your child paracetamol or ibuprofen to relieve pain and fever. A warm, not hot, heating pad held over the ear can also help relieve the earache.
Children with a perforated eardrum require careful follow-up to ensure that the perforation has healed.
My child gets recurrent ear infections. Should I be worried?
For children with recurrent, severe otitis media (more than four a year), surgery may be necessary. Tiny plastic tubes (known as grommets or tympanostomy tubes) are inserted through the eardrum. These allow air into the middle ear so that fluid can drain out the eustachian tube. Grommets usually stay in place for an average of six to nine months and fall out on their own. Children with grommets should use earplugs when swimming to help prevent infection. (Cotton balls coated with petroleum jelly are effective alternatives to ear plugs.)
Removal of the adenoids and tonsils may be advised if they are blocking the eustachian tube.
Can ear infections be prevented?
- Do not expose your child to cigarette smoke.
- Reduce your child's exposure to colds during the first year of life. Remember to wash your hands before eating and after going outside.
- Breastfeed your baby. Antibodies in breast milk reduce the rate of ear infections.
- If you bottle-feed, hold your baby at a 45° angle. Feeding in the horizontal position can cause formula to flow back into the eustachian tube. Allowing an infant to hold his own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between 9 and 12 months of age will help stop this problem.
- Control allergies. If your infant has continuous nasal secretions, consider allergy as a contributing factor to the ear infections, especially if your child has other allergies such as eczema.
- If your toddler constantly snores or breathes through his mouth, he may have large adenoids. Discuss this with your doctor.
Swimming can pose specific risks for children with an ear infection or previous surgery. Water pollutants or chemicals may exacerbate the infection, and underwater swimming causes pressure changes that can cause pain. The following precautions should be taken:
- Children with a perforated eardrum should not go swimming
- Children with an ear infection without rupture of the drum should not dive or swim underwater.