Ear infections, which are known medically as otitis media, are very common in children. Many are caused by viruses. This page gives an overview of otitis media in children, including why pre-schoolers are so prone to get them, what to do when your toddler has one and how to prevent them.
You can click on the link for a specific question or just keep reading.
To read more about otitis media with effusion (OME) which is also known as glue ear, and ear tubes, click here
Very common. They are the second most common infection in young children after the common cold.
Between 30 and 50% of children will have had an infection of the ear (which is known as acute otitis media) by 3 years of age and it is estimated that 1 in 5 children less than 4 years of age are affected by acute otitis media at least once a year.
Otitis media is an upper respiratory tract infection and these are very common in children.
Acute otitis media is infection in the middle ear. When children get a cold they get a runny, snotty nose and they also get runny, snotty ears (middle ears to be exact). The middle ear is connected to the back of the nose via the Eustachian tube. Fluid in the middle ear is cleared through the Eustachian tube. If the fluid in the middle ear becomes infected, acute otitis media (or ear infection) is the result. The fluid is more likely to become infected if it stays in the middle ear longer – ie. doesn't get cleared by natural body processes.
Young children have narrow Eustachian tubes. When they get a cold and all their membranes become swollen, the Eustachian tube lining becomes swollen and so the tube becomes even narrower. As well as that, the Eustachion tube is relatively horizontal in young children so gravity cannot help in clearing the fluid. So, it is harder for young children to clear middle ear fluid because they have narrow, horizontal tubes. As they get older, the Eustachion tubes become wider and less horizontal and draining fluid from the middle ear is easier, so they are less prone to ear infections.
Acute otitis media causes pain in the ear, fever and transient hearing loss. There may be an associated cold and the symptoms that go with that, ie. runny nose, miserable, grizzly child. A doctor will see a red, bulging eardrum with an auroscope (otoscope).
Studies have suggested that up to 80%, acute otitis media will resolve by itself by 3 days. Some studies have suggested that up to 60% of children with otitis media will have improved within 24 hours with no antibiotic treatment. Ear infections (otitis media) that don't settle by themselves are usually responsive to antibiotics like Amoxicillin or Co-amoxiclav. With appropriate use of antibiotics, there are not usually any serious side effects.
However, occasionally there can be serious complications, including meningitis and mastoiditis, and if your child is not improving by 3 days or is very unwell at any time, you should see a doctor.
Not all children will need antibiotics. Many ear infections will get better without antibiotics. In studies, antibiotics have shown that symptoms improve more by 7 days with antibiotics compared to children who did not get antibiotics. However, antibiotics cause more diarrhea.
So often there is a toss up between benefit from antibiotics and the side effects of taking them. For that reason, if symptoms are not that severe and there are no serious signs when looking at the ear drum, doctors will not prescribe antibiotics initially. If the symptoms last for 3 days, then they will usually prescribe antibiotics at that point.
Therefore if your child is only moderately unwell and you can control the pain with pain relievers like Paracetamol, Acetaminophen or Ibuprofen, then you could wait 2 or 3 days to see if things settle without antibiotics.
Giving antibiotics to all children with an ear infection has some unwanted consequences – for the child, they can get side effects from the antibiotics like vomiting, diarrhea and skin rashes. From a public health point of view, giving antibiotics to all children with an ear infection results in bacteria developing resistance to commonly used antibiotics and this eventually leads to multi-resistant organisms that we are unable to fight – not a good situation to be in.
As many ear infections will get better by 3 days, we generally do not give antibiotics until symptoms have been present for at least 3 days. This limits antibiotic use. When antibiotics are needed, we usually use Amoxicillin or Co-amoxiclav (augmentin).
It is important if your child is given antibiotics that he finishes the whole course. If there is no sign of improvement after 48 hours of antibiotics, see your doctor again - your child might need a different antibiotic.
To read the Center for Disease Control (CDC) leaflet on why antibiotic use should be limited, click here
If the fluid behind the ear drum (in the middle ear) builds up to a high pressure, the ear drum can perforate. The fluid that has been building up in the middle ear is then released into the outer ear. The pain that occurs with fluid in the ear is relieved when the pressure is reduced by the fluid leaking into the outer ear, (so the burst drum means reduced pain). You may notice a discharge from the ear when the drum perforates.
There is no treatment needed for most cases of perforated ear drum. The drum will heal itself as long as it is kept clean and dry. Put a small piece of cotton wool in the ear to keep it dry and clean.
See your doctor if your child is unwell as he may need antibiotics for the ear infection.
If earache or other symptoms persist beyond 3 days, see your doctor as your child may need antibiotics.
See your doctor at any time you feel your child is seriously ill - read more.
Last reviewed 16 June 2011
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