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Middle ear infection in children

Published by Bupa's health information team, February 2008.

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

Middle ear infections are most common in children. Adults can get middle ear infections, 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. Often there is no treatment and the infection gets better on its own, although your GP may prescribe antibiotics depending on the cause of the infection.

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

About 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 through your middle ear to your inner ear.

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

Illustration showing the outer, middle and inner ear
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 quite quickly. 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 the middle ear behind the ear drum.
Recurrent acute otitis media - this is when your child has three or more attacks of infection within six months.

Symptoms

It's quite likely that an acute middle ear infection will develop soon after your child gets a cough or runny nose. The symptoms come on quickly and can include:

earache
deafness
fever
blood and pus (if the eardrum bursts)
a general feeling of being unwell, including feeling sick and loss of appetite

You may also notice your child tugging at his or her ear - 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 very uncomfortable and as though the ear is blocked. Eventually, the eardrum may burst as a result of the pressure and it's likely to be less painful afterwards. Usually, a burst eardrum heals by itself.

Causes

Acute middle ear infections are caused either by bacteria or a virus. This may happen if there is a build-up of fluid or mucus in your child's middle ear which gets infected by viruses or bacteria which travel up his or her eustachian tube from the throat. The eustachian tube connects your middle ear to your throat (as shown on the earlier illustration). If this gets blocked, the pressure in the ear is reduced and this can cause earache.

Acute middle ear infections are very common in children. This is because the eustachian tube isn't fully developed in young children - it's quite short and horizontal so fluid and mucus build up there more easily. They are also more at risk because they are likely to come into close contact with other children, for example at nursery.

If your child has a cold, this can cause inflammation of the lining of the nose. This can block the eustachian tube and lead to viruses or bacteria multiplying in the middle ear.

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

using a dummy
feeding your child with him or her in a reclining position, rather than an upright one
smoking around your children

Diagnosis

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 an instrument called an otoscope. Your GP will look to see if there is inflammation of the middle ear and check the appearance of the ear drum. Usually this is pink, but if there is an infection it's likely to be red or yellow, and it may be perforated (have a hole in it). Your GP will also be able to see if there is any pus or discharge.

Treatment

Four out of five acute middle ear infections clear up within three days without any treatment. You may wish to give your child painkillers such as paracetamol (eg Calpol) or ibuprofen (eg Nurofen) to 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 infection hasn't improved after three days, your GP may prescribe your child a short course of antibiotics (usually a five-day course). He or she will only do this if the infection is caused by bacteria - viral infections can't be treated with antibiotics. Antibiotics may cause side-effects including sickness, diarrhoea and rashes. It's important that your child completes the course, even if his or her symptoms have gone.

It's not recommended that you give your child decongestants or antihistamines as 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 otologist (a doctor specialising in conditions affecting the ear).

Prevention

You can try to prevent acute middle ear infections by taking steps not to expose your child to the causes that can increase their risk, as mentioned earlier, such as not smoking around him or her. This includes not smoking in your house or car, even if the child isn't present at the time.

Further information

Deafness Research UK
0808 808 2222
www.deafnessresearch.org.uk