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Ear infection in children


Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due August 2022

A middle ear infection is when your child’s ear becomes infected, swollen and painful because fluid is trapped in the part of their ear behind their eardrum. Middle ear infections are common in children, but adults can get them too. More than four out of five children will get a middle ear infection at least once before they’re two.

Your child may need painkillers, but they should get better in a few days. Antibiotics aren’t usually needed to treat a middle ear infection.

Image showing the outer, middle and inner ear

About middle ear infections

The middle ear is the space behind the eardrum. It’s normally filled with air but after a cold or sore throat it can become filled with fluid. This is because the tube which connects the middle ear to the back of the throat (the Eustachian tube) gets blocked. In middle ear infections (otitis media), the fluid becomes infected and the middle ear becomes inflamed and painful. For more information on this, see our section: Causes of middle ear infection.

Symptoms of middle ear infection

A middle ear infection can be triggered soon after your child gets a cough or a runny nose. Symptoms and signs of ear infection in children can include:

  • earache (young children may rub or tug at their ear)
  • a raised temperature
  • irritability, crying
  • not sleeping well
  • seeming generally unwell
  • not feeding or eating well
  • being sick
  • a cough or runny nose

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 the ear. Although a burst eardrum sounds nasty, your child will probably feel better after it happens because their pain eases.

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

Diagnosis of middle ear infection

Your GP will ask about your child’s symptoms and about other illnesses they may have had. If they think your child has a middle ear infection, they may then look at their eardrum using an instrument called an otoscope. This is a small, handheld device which has a magnifying glass and a light.

In most cases, your GP will be able to diagnose a middle ear infection without further tests. If your child is under three months old, they may advise that you take them to hospital for further assessment.

Your GP may also recommend further tests or referral to a specialist if your child doesn’t get better as expected. They might, for instance, suspect that your child has developed glue ear. This is when the middle ear remains blocked with fluid, which stops your child hearing properly.

Treatment of middle ear infection

It’s upsetting to see your child in pain with a middle ear infection. But you can be reassured that in most cases they’ll get better in a few days without any specific treatment. In the meantime, there are some things you can do to help.

Self-help

Often, the best treatment is just to relieve your child’s symptoms with painkillers until the inflammation has cleared up. You can buy paracetamol or ibuprofen in forms suitable for children at a pharmacy. These will also help to bring down any temperature and is probably all they’ll need. There’s no evidence that decongestants or antihistamines help. Don’t give aspirin to children under 16.

A flannel wrung out in warm water and held gently over the ear may also help to reduce pain.

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.

Antibiotics

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

Your GP may give you a ‘delayed prescription’. This means that they’ll give you a written prescription, but advise you only to use it if the symptoms continue for at least three days or become significantly worse at any point.

Your GP may prescribe antibiotics straight away if your child:

  • has already had symptoms for three days and is not 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)
  • has fluid or pus coming out of their ear

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

If your child does have antibiotics, it’s important to complete the course 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 about how your child should take it, ask your pharmacist.

Surgery

Most children with middle ear infections get better without specific treatment. There are some occasions, however, when your doctor may recommend surgery.

The most usual surgical procedure is called myringotomy. This is when your doctor makes a small cut in your child’s eardrum and puts 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.

Your doctor may recommend this treatment if your child keeps having middle ear infections.

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

Causes of middle ear infection

The middle ear is normally filled with air but can become filled with fluid if your child has a virus such as a cold. This happens because their Eustachian tube (the tube which connects the middle ear to the back of the throat) is swollen or blocked and the fluid can’t drain away. The fluid in the middle ear then becomes infected with bacteria, which travel up the Eustachian tube from the nose or throat. Pus builds up and causes pain.

Acute middle ear infections are very common in young children. Their Eustachian tubes are still quite short and horizontal, so fluid and mucus can build up in the middle ear more easily.

Other factors can increase the chance of your child getting an acute middle ear infection too. These include:

  • using a dummy (for more information, see our FAQ: Why do dummies increase the risk of ear infections? below)
  • formula feeding rather than breastfeeding, particularly if your child lies down when they feed (for more information, see our FAQ: Will breastfeeding protect my baby from infections? below)
  • secondhand smoke – if someone in the household smokes, your child is at higher risk

Boys tend to be affected more than girls and the condition is more common in winter than in summer. Your child has a higher chance of infection if they have a lot of contact with other children, for example, at a nursery or playgroup. Children who are born with a cleft lip or palate, or who have Down syndrome, are also more likely to get middle ear infections.

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. This is when fluid stays inside the middle ear after the infection clears up. It 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.

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 within weeks. However, sometimes the eardrum doesn’t heal and there is 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.

Very rarely, infection can spread from the middle ear to surrounding tissues. 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 into a vein (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 surgery to remove the infected cells from the bone behind the ear. This is known as a mastoidectomy.

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

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 the chance.

It’s important to make sure that all your child’s vaccinations are up to date, and make sure your child isn’t exposed to tobacco smoke. This includes not smoking in your house or car.

Breastfeeding reduces the chance of your baby getting middle ear infections. For more information, see our FAQ: Will breastfeeding protect my baby from infections? below.

When your child is feeding, keep their head up rather than letting them lie flat. Consider avoiding dummies. For more information, see our FAQ: Why do dummies increase the risk of ear infections? below.

It’s usually impractical to avoid your child mixing with other children with viral infections such as colds. But if they’re old enough, it’s really worth teaching your child about good basic hygiene and regular hand washing.

Test your knowledge and understanding with our ear infections in children quiz.

Frequently asked questions

  • Unfortunately, middle ear infections are very common. More than four out of five children will get at least one before their second birthday. And it’s thought that half of these children will have had more than three episodes before they’re three years old.

    Every child is different. But you can see that there’s quite a high chance that your young child will get more than one middle ear infection. Babies who have one shortly after birth are more likely to have further middle ear infections.

    It may help you to know that your child’s risk of getting a middle ear infection lessens as they get older. See our section on prevention above for ways that you can reduce the risk for your child.

  • Babies who use dummies are more likely to get middle ear infections, but doctors aren’t sure why. It may be that sucking on a dummy allows more fluids to get into the middle ear from your baby’s nose and throat. When they have a cold, this means the infection is more likely to spread to their middle ear. Or it may be that dummies affect the way your baby’s teeth develop. This in turn may affect the way their Eustachian tube works.

    It’s your decision whether or not your baby uses a dummy – many parents find them helpful in getting their baby off to sleep. If you can’t avoid using a dummy completely, using it only when your baby’s falling asleep may help to lower the risk of middle ear infections. If you stop your baby using a dummy after the age of about six months, this may also reduce the chance of a middle ear infection.

  • If you breastfeed your baby, they could still get middle ear infections, but the risk is lower. Breastfeeding helps to protect your baby from middle ear infections for the first two years of their life.

    There is some benefit even if you breastfeed your baby for just three months. But breastfeeding for six months or more means your baby has an even lower chance of getting an infection.

    There are two main ways in which breastfeeding is likely to reduce the risk of ear infections. Unlike formula milk, a mother’s breast milk contains many vital nutrients and antibodies, which help a baby to fight infection. Breastfeeding may also pass ‘friendly’ bacteria from you to your baby. These help to protect your baby against harmful bacteria.

    The way babies suck when breast or bottle feeding is different. This may mean that bacteria are less likely to get into the tube connecting the mouth to the middle ear (the Eustachian tube) when your baby is breastfed.

    Breastfeeding helps to reduce your baby’s chance of getting other infections and conditions, as well as middle ear infections and has many benefits for you too. Your midwife or health visitor will be able to talk to you about the benefits of breastfeeding and answer any questions you have.


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Related information

    • Tympanic membrane and middle ear. Encyclopaedia Britannica. britannica.com, accessed April 2019
    • Acute otitis media. BMJ Best Practice. bestpractice.bmj.com, last updated July 2018
    • Otitis media – acute. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last updated July 2018
    • Acute otitis media in children. PatientPlus. patient.info, last updated January 2016
    • Acute Otitis Media Clinical Presentation. Medscape. emedicine.medscape.com, last updated April 2018
    • Glue ear factsheet. Action on Hearing Loss. actiononhearingloss.org.uk, last updated June 2016
    • Otitis media with effusion. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last updated October 2016
    • Acute Otitis Media Treatment & Management. Medscape. emedicine.medscape.com, last updated April 2018
    • Mastoiditis. PatientPlus. patient.info, last updated August 2015
    • Acute Otitis Media. Medscape. emedicine.medscape.com, last updated April 2018
    • Rovers MM, Numans ME, Langenback E, et al. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract 2008; vol 25(issue 4): 233–36
    • Sexton S. and Natale R. Risks and Benefits of Pacifiers. Am Fam Physician 2009; vol 79(issue 8): 681–85
    • Bowatte G, Tham R, Allen KJ, et al. Breastfeeding and childhood acute otitis media: a review and meta-analysis. Acta Paediatr 2015; vol 104(issue S467): 85–95
    • Analgesia – mild-to-moderate pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2015
    • Personal communication, Mr Anil Banerjee, Ear, Nose and Throat Consultant, May 2019
  • Reviewed by Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, August 2019
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due August 2022



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