Ear Infection (Otitis Media)

What is an ear infection (acute otitis media)?

An ear infection, sometimes known as acute otitis media, is a sudden infection that affects the middle ear. This is the air-filled space located between the inner ear and the eardrum, which contains the tiny bones that transmit sound vibrations from the eardrum to the inner ear, enabling hearing.

The eustachian tubes, which connect the back of the throat to the middle ear, help regulate air pressure and prevent fluid build-up in this space. When these tubes aren’t functioning properly, it becomes difficult for fluid to drain from the middle ear, leading to muffled hearing.

In addition, ear infections, often caused by bacteria or viruses, can lead to a build-up of infected fluid in the middle ear, typically causing pain as well as muffled hearing.

How common are ear infections?

Other than the common cold, middle ear infections are among the most prevalent childhood conditions. They are most common in children aged six months to two years, although they can continue to affect children up to the age of eight.

While older children and adults can also develop ear infections, they are far less common in these age groups.

Why are children more prone to ear infections than adults?

Children are more likely to develop ear infections than adults for several reasons:

• Their eustachian tubes don’t function as well as those of adults, allowing fluid to accumulate behind the eardrum.
• Their immune systems, which help fight off infections, are still developing.
• They are more exposed to infections from other children.

Symptoms

What are the signs and symptoms of ear infections?

Symptoms of an ear infection usually appear after a cold and may include:

• Ear pain
• Loss of appetite
• Difficulty sleeping
• Hearing problems in the affected ear
• A sensation of pressure or fullness in the ear
• Yellow, white, or brown discharge from the ear, which may indicate a perforated eardrum

If there is discharge from the ear, avoid inserting anything into the ear canal, as this could worsen damage to a perforated eardrum.

Infants and children

Infants and young children may not be able to express how they feel, so it's important for parents to recognise the signs of an ear infection. These may include:

• Pulling or tugging at the ears
• Excessive crying or irritability
• A fever between 100.5°F and 104°F (38°C and 40°C), which occurs in about half of children with ear infections
• Breathing through the mouth or increased snoring, which may indicate inflamed adenoids
• Refusing to eat, as swallowing can increase pressure in the middle ear, causing pain and reduced appetite

Causes

What causes ear infections?

Ear infections are usually caused by bacteria or viruses and often occur following a cold or other upper respiratory infection. Germs can enter the middle ear via the eustachian tube, causing swelling and a build-up of infected fluid.

Are ear infections contagious?

While ear infections themselves are not contagious, the bacteria and viruses that cause them are. Many of the same microorganisms responsible for colds and flu can lead to ear infections.

Risk factors

Some factors that increase the likelihood of developing an ear infection include:

• Age: Infants and children aged six months to two years are at higher risk.
• Family history: Ear infections can run in families.
• Colds: Being around other children, particularly in day care, increases the risk of contracting colds and other infections.
• Chronic conditions: Immune deficiencies or chronic respiratory illnesses like asthma and cystic fibrosis can raise the risk of ear infections.
• Ethnicity: Native American, Alaska Native, and Hispanic children are more likely to develop ear infections.
• Poor air quality: Exposure to polluted air or second-hand smoke can increase the risk of ear infections.

Complications

Most ear infections resolve without causing long-term problems. However, complications can arise, especially with recurrent or persistent infections. These include:

• Hearing loss: Temporary hearing loss is common, but recurrent or chronic infections can lead to more serious hearing problems.
• Speech and language delays: Hearing is essential for language development, so hearing loss can delay speech.
• Eardrum perforation: Around 5% to 10% of children with ear infections develop a small tear in the eardrum, which usually heals on its own but may require surgery in some cases.
• Infection spread: If untreated, ear infections can spread to nearby areas, including the mastoid bone or, in rare cases, the membranes surrounding the brain and spinal cord, causing meningitis.

Diagnosis and Tests

How are ear infections diagnosed?

Doctors usually diagnose ear infections based on symptoms and a physical examination. During an ear exam, an otoscope is used to check the eardrum for signs of infection, such as redness or swelling.

A pneumatic otoscope may also be used to assess fluid in the middle ear by checking how easily the eardrum moves.

Are there other tests?

Other diagnostic tests may include:

• Tympanometry: Uses air pressure to detect fluid in the middle ear.
• Acoustic reflectometry: Measures sound waves to identify fluid build-up.
• Tympanocentesis: Fluid is extracted from the middle ear for testing, typically if treatment isn’t effective.
• Hearing tests: An audiologist may assess hearing loss, which is common in children with long-term or recurrent infections.

Treatment

What are the treatment options?

Treatment depends on several factors, such as the child's age, the severity of the infection, and whether it’s a first-time, persistent, or recurrent infection. In many cases, ear infections clear up without treatment, though pain relief is often recommended.

• Antibiotics: Prescribed if bacteria are the cause. In some cases, doctors may wait a few days to see if the infection resolves on its own before prescribing antibiotics.
• Pain relievers: Over-the-counter medications such as ibuprofen or paracetamol can help relieve pain and reduce fever.
• Ear tubes: For recurrent infections or fluid build-up, ear tubes may be inserted to drain fluid and allow air into the middle ear.

Can ear infections resolve on their own?

Yes, many ear infections clear up without treatment. However, if symptoms persist or worsen, antibiotics or ear tubes may be necessary.

Prevention

To reduce the risk of ear infections:

• Prevent respiratory infections by encouraging handwashing and limiting exposure to large daycare settings.
• Avoid second-hand smoke exposure.
• Breastfeed for at least six to twelve months if possible, as breast milk contains protective antibodies.
• Keep up with immunisations, including the annual flu vaccine.

When to seek medical advice

Contact your doctor if:

• Your child has severe ear pain, a fever over 104°F (40°C), or symptoms such as neck stiffness, sluggishness, or facial weakness.
• Ear pain persists after three days of antibiotics, or a fever returns.

Outlook

Most ear infections resolve without causing long-term issues. However, recurrent infections or fluid build-up can lead to complications, so it’s important to follow your healthcare provider’s advice.

Can my child resume normal activities after an ear infection?

Yes, your child can return to school or daycare once their fever has subsided, and they feel well enough to participate in normal activities. Ear infections typically resolve within a few days, but if your child is still feeling unwell, it is best to consult with your healthcare provider before resuming normal routines.

Living with Ear Infections

When should I call my doctor about an ear infection?

It’s important to contact your healthcare provider promptly if you notice any of the following:

• Stiffness in your child’s neck
• Your child seems unusually drowsy, irritable, or unwell, and continues to cry despite your best efforts to comfort them
• Your child is unsteady when walking or displays poor balance
• Severe ear pain in you or your child
• A fever that exceeds 104°F (40°C)
• Signs of facial weakness, such as a crooked smile
• Pus-filled or bloody discharge from the ear

In addition, contact your doctor during regular office hours if:

• A fever returns or persists for more than 48 hours after starting antibiotics
• Ear pain does not improve after three days of antibiotic treatment
• Symptoms persist or worsen despite initial treatment

Additional Common Questions

Should I cover my child’s ears when going outside with an ear infection?

No, it is not necessary to cover your child’s ears when going outside, even if they have an ear infection. There is no evidence that exposure to cold or wind will worsen the infection or delay healing.

Can my child swim with an ear infection?

Yes, your child can swim, provided there is no perforation (tear) in the eardrum and no fluid draining from the ear. If there is a tear or discharge, swimming should be avoided to prevent further irritation or infection.

Is it safe to fly or be in high altitudes with an ear infection?

Yes, it is generally safe to travel by air or visit high-altitude locations, although some children may experience temporary discomfort when the airplane takes off or lands due to pressure changes. To relieve the pain, you can offer your child something to chew or drink during descent. For infants and toddlers, sucking on a pacifier may help. If your child has had recent ear surgery or has a severe ear infection, it is a good idea to consult your doctor before flying.

A Note from MD.co.uk

If your child shows signs of an ear infection and the symptoms do not improve within two to three days, it’s important to see a paediatrician. While most ear infections resolve without treatment, antibiotics may be required depending on the severity of the symptoms and the age of the child. Pain relievers may also be recommended to help manage discomfort while your child recovers from the infection.