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Ear infection in children

Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant and Dr Elizabeth Rogers, Associate Clinical Director, Bupa Health Clinics
Next review due March 2025

A middle ear infection (otitis media) is when your child’s ear becomes infected, swollen and painful because fluid is trapped behind their eardrum. Middle ear infections are common in children. More than four out of five children will get a middle ear infection at least once before they’re two. Adults can also get middle ear infections. You don’t usually need to treat a middle ear infection with antibiotics.

A dad having a cuddle with his baby

About middle ear infections

The middle ear is the space behind the eardrum. It’s normally filled with air but after an infection like a cold or sore throat, it can get filled with fluid. This happens because the Eustachian tube (the tube which connects the middle ear to the back of the throat) gets swollen or blocked and the fluid can’t drain away. The fluid in the middle ear then becomes infected with bacteria or viruses, which travel up the Eustachian tube from the nose or throat. Pus builds up and causes pain.

Middle ear infections are very common in toddlers and babies, and they may get more than one. Their Eustachian tubes are still quite short and horizontal, so fluid and mucus can build up in the middle ear more easily than in adults.

Causes of middle ear infection

Most middle ear infections are caused by bacteria or viruses (or both) – for example, those that lead to a cold. Other things that can increase the chance of your child getting a middle ear infection include:

  • using a dummy (for more information, see our FAQ: Why do dummies increase the risk of ear infections?)
  • formula feeding rather than breastfeeding, particularly if your child lies down when they feed
  • passive smoking
  • lots of contact with other children; for example, if your child goes to nursery or playgroup or has older brothers or sisters
  • your child was born with a cleft lip or palate or with Down syndrome

Boys tend to be affected more than girls, and middle ear infections are more common in winter than in summer. Your child’s risk of getting a middle ear infection gets less as they get older.

Symptoms of middle ear infection

A middle ear infection can develop soon after your child gets a cough or a runny nose. Other symptoms and signs of ear infection in children can include:

  • earache (young children may rub or tug at their ear)
  • a fever
  • irritability and crying
  • restlessness
  • seeming generally unwell
  • not feeding or eating well
  • being sick

Older children may tell you that they can’t hear properly, and their ear feels blocked.

In some children, the eardrum bursts (perforates) because of the pressure. If this happens, you may see fluid or pus coming out of their ear. Although a burst eardrum sounds nasty, your child will probably feel better after it happens because their pain will ease.

The symptoms of a middle ear infection usually clear up on their own within three days. If you’re concerned about your child’s symptoms or they get worse, contact your GP.

Diagnosis of middle ear infection

Your GP will ask about your child’s symptoms and any other illnesses they’ve had. They may look at your child’s eardrum using an instrument called an otoscope. This is a small, handheld device that has a magnifying glass and a light.

Your GP will usually be able to diagnose a middle ear infection without any further tests. But if your child is under three months old, they may advise you take them to hospital for further checks.

Your GP may also recommend further tests or may refer your child to a specialist if they don’t get recover as expected. They may, for example, want to check if your child has developed glue ear. This is when the middle ear remains blocked with fluid, which stops your child hearing properly.

Self-help for middle ear infection

It’s upsetting to see your child in pain with a middle ear infection. But try not to worry because they’ll usually get better in a few days without any treatment. In the meantime, there are some things you can do to help.

Often, the best treatment is to just relieve your child’s symptoms with painkillers until the inflammation has cleared up. You can buy paracetamol or ibuprofen for children at a pharmacy. These will also help to bring down their temperature and is probably all they’ll need. Use these painkillers rather than aspirin because aspirin isn’t suitable for children under 16.

There’s no evidence that decongestants or antihistamines will help.

It may help to reduce pain if you soak a flannel in warm water, wring it out and hold it gently over your child’s ear.

Always read the patient information leaflet that comes with your child’s medicine. If you have any questions, ask your pharmacist. If your child’s condition doesn’t clear up after three days or it gets worse, see your child's GP.

Treatment of middle ear infection

Antibiotics

Usually, middle ear infections clear up on their own within three days and your child won’t need antibiotics. Your GP will explain that antibiotics probably won’t cure to your child’s symptoms and may instead cause side-effects such as diarrhoea, vomiting or a rash.

Sometimes, your GP may give you a delayed or back-up prescription. This is a written prescription for use only if your child’s symptoms last longer than three days or get significantly worse at any point.

Your GP may prescribe antibiotics straight away if your child:

  • has a very severe infection
  • has already had symptoms for three days and isn’t showing signs of getting better
  • is under two and both their ears are infected
  • has a perforated eardrum (a hole or tear in their eardrum)

If your child is prescribed antibiotics, it’s important to complete the whole pack even if their symptoms get better. Read the patient information leaflet that comes with your child’s medicine carefully. If you have any questions about the medicine or how to take it, ask your pharmacist.

If your child is under three months and has a raised temperature, your GP may refer them to a hospital for further treatment.

Surgery

Most children with middle ear infections get better without any treatment. But if your child gets complications of middle ear infection (see our section on complications), your doctor may recommend surgery.

Surgery is usually one of two procedures.

  • In a myringotomy, your doctor will make a small cut in your child’s eardrum and put in small ventilation tubes called grommets, to help drain the fluid. The hole in the eardrum will heal naturally within a few days or weeks.
  • In a procedure called a tympanocentesis, your doctor will Insert a needle through your child’s ear to draw out the fluid from the middle ear. They’ll send this to a lab to see what has caused the infection.

If your doctor recommends surgery, they’ll explain exactly what will happen and what the benefits might be.

Complications of middle ear infection

Most children with middle ear infections get better without any lasting problems. But it’s not unusual for middle ear infections to lead to glue ear.

Glue ear

Glue ear is when fluid stays inside the middle ear after the infection clears up, which makes it difficult for your child to hear. This often doesn’t need any specific treatment and will usually go away on its own within about three months.

Burst eardrum

In some children, middle ear infections can cause the eardrum to burst (perforate) under the pressure of fluid building up. You may notice pus or fluid coming from your child’s ear. Fortunately, the eardrum usually heals quickly. But sometimes the eardrum doesn’t heal, which leads to a long-term infection of the ear. If your GP thinks your child may have a long-term infection, they may refer them to an ear, nose and throat (ENT) specialist for treatment.

Mastoiditis

Very rarely, the infection can spread from the middle ear to surrounding tissues. An infection in the bone behind the ear is called mastoiditis. You may notice a soft, red lump behind your child’s ear, which is painful to touch. If your child has mastoiditis, your doctor will refer them to hospital because they’ll need to have antibiotics through a drip (intravenously). They may also have grommets (small tubes) put in to drain any fluid or pus in the middle ear. Sometimes, they may need to have an operation called mastoidectomy to remove the infected cells from the bone behind the ear.

Prevention of middle ear infection

You probably won’t be able to prevent your child getting a middle ear infection at some point. But there are things you can do to lessen their chance.

It’s important to make sure that all your child’s vaccinations are up to date and that your child isn’t exposed to tobacco smoke.

Breastfeeding reduces the chance of your baby getting middle ear infections. Breast milk contains nutrients and antibodies that will help your baby to fight infection. The way babies suck when breast feeding is different from when they are bottle fed. Bacteria may be less likely to get into the tube connecting the mouth to the middle ear (the Eustachian tube) when your baby breastfeeds. It’s also a good idea to keep your baby’s head up when they feed, rather than let them lie flat.

Consider limiting or not using dummies. For more information, see our FAQ on dummies.

It’s usually impractical to stop your child mixing with other children who may have coughs and colds. But if they’re old enough, it’s really worth teaching your child about good basic hygiene and regular hand washing.

Frequently asked questions



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Related information

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, March 2022
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant and Dr Elizabeth Rogers, Associate Clinical Director, Bupa Health Clinics
    Next review due March 2025

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