Otitis media in children

Overview

Otitis media is an infection or inflammation of the middle ear, the air-filled space behind the eardrum. It often happens when fluid builds up behind the eardrum and gets infected.

Yes, otitis media is very common in children and is one of the main reasons parents take their child to the doctor.

It mostly affects young children, especially those between 6 months and 2 years old. It can also occur in older children and adults, but it is less common.

Symptoms

Common symptoms

• Ear pain, especially when lying down
• Tugging or pulling at the ear
• Trouble sleeping
• Fever (temperature of 100.4°F / 38°C or higher)
• Fluid draining from the ear
• Trouble hearing or responding to sounds

Symptoms in children

• Irritability or crying more than usual
• Loss of appetite
• Difficulty sleeping
• Fever
• Tugging at the ear
• Fluid drainage from the ear

Symptoms in older adults

• Otitis media is less common in older adults, but symptoms can include ear pain, hearing loss, and a feeling of fullness in the ear.

Causes

Main causes

• Bacteria or viruses that cause colds, flu, or other respiratory infections can travel to the middle ear and cause an infection.
• Eustachian tubes (small tubes that connect the middle ear to the throat) can become blocked by swelling and fluid, especially during a cold.

Risk factors

• Age: children under 2 years old are at highest risk
• Bottle-feeding while lying down (instead of upright)
• Pacifier use after 6 months of age
• Exposure to secondhand tobacco smoke
• Attending daycare or group childcare
• Being born prematurely
• Having a family history of ear infections

When to see a doctor

See a doctor urgently if:

• See a doctor urgently if your child has severe ear pain, a high fever, or discharge from the ear.

Book a routine appointment if:

• If symptoms are mild and the child is otherwise well, you can often wait 2 to 3 days to see if they improve. If symptoms persist or get worse, schedule an appointment.

Diagnosis

A doctor will look inside your child's ear using a lighted instrument called an otoscope. They can see if the eardrum is red, bulging, or has fluid behind it.

Tests that may be done

• Pneumatic otoscopy: the doctor puffs a small amount of air into the ear to see if the eardrum moves normally.
• Tympanometry: a test that measures how well the eardrum and middle ear are working.

What to expect at your appointment

The ear exam is quick and usually not painful. The doctor may also check your child's temperature, look at the throat, and ask about symptoms. Your child may need to sit on your lap during the exam.

Treatment

Treatment depends on your child's age, symptoms, and whether the infection is likely viral or bacterial. Many cases get better on their own, but some may need medicines or other procedures.

Self-care at home

• Give your child plenty of rest and fluids like water or warm soup.
• Use a warm, damp cloth over the ear to help with pain.
• Give age-appropriate pain relief medicines as directed by your doctor or pharmacist.
• Elevate your child's head while sleeping to help drain fluid.

Medical treatments

If the doctor suspects a bacterial infection, they may prescribe a course of antibiotics. It is important to take the full course as prescribed, even if symptoms improve. For viral infections, antibiotics will not help. Sometimes the doctor will recommend a 'watch and wait' approach for a few days before prescribing anything.

When is surgery considered?

If your child has frequent ear infections (3 or more in 6 months) or persistent fluid in the ear that affects hearing, a doctor may recommend a procedure to place small tubes called grommets in the eardrum. These tubes help drain fluid and prevent infections. This decision is made with a specialist.

Living with this condition

Most children recover fully from ear infections with no lasting effects. While your child is ill, keep them comfortable, monitor symptoms, and follow the treatment plan. Once the infection clears, your child should return to normal activities.

Lifestyle tips

• Keep your child away from secondhand smoke.
• If you use a pacifier, try to phase it out after 6 months of age.
• Breastfeed your baby if possible, as this can reduce the risk of ear infections.
• Make sure your child's vaccinations are up to date.

Diet and exercise

No special diet is needed. A healthy, balanced diet helps the immune system. Offer plenty of fluids when sick. Return to usual physical activity as your child feels better.

Mental health and emotional wellbeing

Ear infections can be stressful for both children and parents. The pain and fevers can disrupt sleep and daily routines. It is normal to feel worried. Talk to your doctor if you have concerns, and remember that most children outgrow ear infections.

Prevention

Not all ear infections can be prevented, but you can lower your child's risk. Avoiding smoking around the child, breastfeeding, and keeping immunizations up to date are helpful. Also, avoid putting your baby to bed with a bottle and limit pacifier use after 6 months.

Vaccines

Yes, vaccines can help prevent some infections that lead to otitis media. The pneumococcal vaccine (PCV) and the flu vaccine are especially important. Ask your doctor about the recommended vaccination schedule for your child.

Screening programmes

There is no routine screening for otitis media. Doctors check the ears during regular well-child visits.

Complications

If left untreated

• Temporary hearing loss (usually resolves once the fluid clears)
• Spread of infection to nearby tissues (mastoiditis - infection of the bone behind the ear)
• Rupture (burst) of the eardrum (usually heals on its own)
• In rare cases, infection can spread to the brain or the covering of the brain (meningitis)

Long-term outlook

The outlook for children with otitis media is very good. Most ear infections get better on their own or with simple treatment. Even if there is fluid behind the eardrum for weeks, it usually goes away without causing permanent problems. For children with frequent infections, options like grommets can help prevent future problems. With proper care, the vast majority of children recover fully and have no long-term issues.

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