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Acute middle ear infection in children

Published by Bupa's health information team, January 2010.

This factsheet is for parents of children with an acute middle ear infection, or who would like information about it.

Middle ear infections are most common in children. Adults are affected too, but three-quarters of all cases occur in children under the age of 10 years old. The medical term for a middle ear infection is otitis media. This means inflammation of the middle ear, which causes earache. Often the best treatment is to relieve the symptoms with painkillers while the inflammation clears up.

• About acute middle ear infection
• Symptoms of acute middle ear infection
• Causes of acute middle ear infection
• Diagnosis of acute middle ear infection
• Treatment of acute middle ear infection
• Prevention of acute middle ear infection
• Questions and answers
• Related topics
• Further information
• Sources

About acute middle ear infection

The middle ear

The middle ear is behind your eardrum. It contains three tiny bones that move when sounds reach them. These transmit sound waves from the eardrum to your inner ear.

Your middle ear is usually filled with air but sometimes fluid or mucus can build up and become infected.

The outer, middle and inner ear

Types of middle ear infection

A middle ear infection can affect one or both of your child's ears. The main types of infection are listed below.

• Acute otitis media - this comes on suddenly and is typically over in about four days. The term acute refers to time, not to how serious a condition is.
• Otitis media with effusion - this is also known as glue ear and occurs when fluid builds up in your middle ear behind the ear drum.
• Recurrent acute otitis media - this is when you have three or more attacks of infection within six months.
• Chronic otitis media - this is when it lasts for a long time or keeps coming back. The term chronic refers to time, not how serious a condition is.

Symptoms of acute middle ear infection

An acute middle ear infection can be triggered soon after your child gets a cough or runny nose. The symptoms come on quickly and can include:

• earache
• deafness
• a high temperature
• a general feeling of being unwell, including feeling sick and loss of appetite
• blood and pus coming out of the ear (if the eardrum bursts)

You may also notice your child tugging at his or her ear if he or she is too young to tell you that they have an earache. This can be a common symptom of a middle ear infection.

As mucus and pus build up in your child's middle ear it can feel as though the ear is blocked and it's very uncomfortable. Eventually, the eardrum may burst as a result of the pressure and after this it's likely to be less painful. A burst eardrum usually heals by itself.

Causes of acute middle ear infection

Acute middle ear infections occur if fluid builds up in your middle ear, and becomes infected. The middle ear is normally filled with air, but can become filled with fluid during infection with a virus, such as a cold. This is because the tube that connects your middle ear to your throat (the eustachian tube) can become swollen or blocked during this infection, and the fluid can't drain away.

The fluid in the middle ear can then become infected with bacteria, which travel up the eustachian tube from the nose or throat. White blood cells that come to fight the infection can build up in the middle ear as pus. This build up of pus can cause the ear pain and hearing problems that happen in middle ear infection.

Acute middle ear infections are very common in children and one in three children under three years are taken to their GP with a middle ear infection each year. This is partly because their immune systems are still developing and they are less well equipped to deal with infections than older children and adults. It's also because the eustachian tube isn't fully developed in young children - it's quite short and horizontal and so fluid and mucus build up in the middle ear more easily. Children also have larger adenoids (lumps of tissue at the back of the throat, that help fight infection) than adults, which can sometimes interfere with the opening of the eustachian tube. Younger children are also more at risk because they are likely to come into close contact with other children, for example at nursery.

There are a number of other reasons why your child may be more susceptible to middle ear infections. These include:

• using a dummy after the age of six months
• formula feeding rather than breast milk, particularly with the child lying down while feeding
• smoking around your child

Diagnosis of acute middle ear infection

Your GP will ask about your child's symptoms and may ask about their medical history. In addition, he or she will look into the ears using a specialist torch called an otoscope. Your GP will look to see if there is inflammation of the middle ear by checking the appearance of the eardrum. It may also be perforated (have a hole in it). Your GP will also be able to see if there is any pus or discharge.

Treatment of acute middle ear infection

After examining your child, your GP will probably recommend measures to relieve the symptoms - including painkillers - and then suggest one of three options.

The first option is to not take any antibiotics. This is because four out of five acute middle ear infections clear up within three days without any treatment. Antibiotics may cause side-effects including sickness, diarrhoea and rashes. This is the most common scenario in children who are otherwise fit and well and have only one ear affected. Painkillers such as paracetamol (eg Calpol) or ibuprofen (eg Nurofen For Children) will help to relieve pain and fever. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. If the condition fails to clear up promptly, or gets worse, you should go back to your child's doctor.

The second option is a 'wait and see' approach, where you give your child painkillers to relieve symptoms. Your child's doctor will give him or her a prescription for antibiotics but you shouldn't use the prescription unless the symptoms don't clear up within three days or so.

The third option is give antibiotics straight away. This is appropriate for children under two with both ears affected, if the eardrum is perforated, or when the child is very poorly (eg a very high temperature). For children under three months, your GP is also more likely to prescribe antibiotics, or advise that you go to hospital for further assessment and treatment. If your child does have antibiotics, it's important to complete the course - which is usually five days - even if his or her symptoms have gone.

Decongestant or antihistamine medicines aren't recommended. They are unlikely to help and may lead to an increased risk of side-effects.

If your child gets several acute middle ear infections in a six month period, or if a burst eardrum takes longer than one month to heal, your GP may decide to refer him or her to an ear, nose and throat specialist.

Prevention of acute middle ear infection

You can try to prevent acute middle ear infections by taking steps not to expose your child to tobacco smoke. This includes not smoking in your house or car, even if your child isn't present at the time.

Related topics

• Glue ear

Further information

Deafness Research UK
020 7833 1733
website

Organisation
Telephone
www.deafnessresearch.org.uk

Sources

• Otitis media - acute. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 16 August 2009
• Otitis media in children (acute). Clinical Evidence. www.clinicalevidence.com, accessed 16 August 2009
• Tan T, Little P, Stokes T. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ 2008;337:a437
• Otitis media with effusion. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 16 August 2009
• Beers MH, Fletcher AJ, Jones TV, et al. The Merck Manual of Medical Information. 2nd ed. New York: Pocket Books, 2003:1258-59
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2 ed. Oxford: Oxford University Press, 2006: 922
• Infections of the ear. British Association of Otorhinolaryngologists, Head and Neck Surgeons. www.entuk.org, accessed 29 August 2009
• Otitis Media. National Institute on Deafness and Other Communication Disorders. www.nidcd.nih.gov, accessed 16 August 2009
• Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009;79(8):681-85
• Diagnosis and management of childhood otitis media in primary care. Section 3: Medical treatment. Scottish Intercollegiate Guidelines Network (SIGN). www.sign.ac.uk, accessed 16 August 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: January 2010