Otitis Media (Middle Ear Infection)

The symptoms of a middle ear infection usually start quickly and include:

• pain inside the ear
• a high temperature
• being sick
• a lack of energy
• difficulty hearing
• discharge running out of the ear
• a feeling of pressure or fullness inside the ear

Young children and babies with an ear infection may also:

• rub or pull their ear
• not react to some sounds
• be irritable or restless
• be off their food
• keep losing their balance

The middle ear space normally contains air and is connected to the back of the throat by the eustachian tube. When it’s working properly the eustachian tube allows drainage from the middle ear cavity and allows regulation of the air pressure between the throat, middle ear cavity and ear canal (outer ear). This is important to allow the ear drum to function properly during changes in outside pressure (e.g. underwater or at high altitudes).

If the eustachian tube becomes blocked or congested, such as during a cold, then the middle ear cavity may become filled with fluid. This mucus may then become infected by germs (bacteria or viruses) which leads to otitis media.

Young children (<5yrs) are particularly prone to this for a number of reasons:

• The eustachian tube is particularly narrow and small in younger children.
• The tonsils and adenoids (lumps of tissue sited around where the eustachian tube enters the throat) can be particularly large due to their role in the developing immune system of a child and can pinch or block the eustachian tube.
• Due to their immature immune system young children tend to be more prone to the common viruses and germs that cause upper respiratory tract infections.

Repeated ear infections can lead to glue ear where some fluid or mucus gets trapped behind the eardrum and causes dulled hearing.

There is some evidence to suggest that ear infections are less likely to develop:

• In breastfed children.
• In children who live in a smoke-free home. (Passive smoking of babies and children can increase the risk of developing ear infections.
• In babies and young children who do not use dummies.

However, research studies have shown that the use of a dummy in young babies when getting off to sleep can reduce the risk of cot death. So you could consider using a dummy in babies up to 6-12 months old at the start of each episode of sleep. (If you breastfeed, do not start to use a dummy until you are well established with breastfeeding. This is normally when the baby is about one month old.)

But note:

• Do not force a dummy on a baby who does not want one. If the dummy falls out when a baby is asleep, just leave it out.
• Never coat a dummy with anything such as sugar.
• Clean and replace dummies regularly.
• It is best to use a dummy only to help a baby get to sleep.
• Consider stopping dummy use at around 6-12 months old.

The immune system can usually clear germs (bacteria or viruses) that cause ear infections and most ear infections get better without any treatment. Recovery usually takes place within three days but can take up to a week.

There are several things you can do to help with the symptoms of an ear infection:

• drink lots of fluid and eat as normally as you can
• use painkillers such as paracetamol or ibuprofen (children under 16 should not take aspirin)
• place a warm or cold flannel on the ear
• remove any discharge by wiping the ear with cotton wool
• do not put anything inside your ear to remove earwax, such as cotton buds or your finger
• do not let water or shampoo get in your ear
• do not use decongestants or antihistamines – there’s no evidence they help with ear infections

Contact your GP if you or your child have:

• a very high temperature (over 38 degrees C if your child is under 3 months old) or above 39 degrees C if over 3 months) or feeling hot and shivery or very unwell
• earache that does not start to get better after 3 days
• swelling around the ear
• fluid coming from the ear
• hearing loss or a change in hearing
• other symptoms, like being sick, a severe sore throat or dizziness
• regular ear infections
• a long-term medical condition – such as diabetes or a heart, lung, kidney or neurological disease
• a weakened immune system – because of chemotherapy, for example

When an ear infection first develops it is common for a doctor to advise a ‘wait and see’ approach for three days. This means just using painkillers to ease the pain and to see if the infection clears. In most cases, the infection does clear. However, if it doesn’t clear, then following a review by a doctor, an antibiotic may be advised. Sometimes, it may be difficult to see a doctor again in three days if things do not improve – for example, over a weekend. In this situation a doctor may give you a prescription for an antibiotic with the advice to use it to obtain the antibiotic only if the condition does not improve within three days (a “delayed prescription”).

Antibiotics are not advised in most cases of otitis media. This is because the infection usually clears within three days on its own and antibiotics make little or no difference to the speed of this. There are many good reasons not to take antibiotics. Antibiotics may cause side-effects such as runny stools (diarrhoea) or rash. They also eradicate ‘friendly bacteria’ from the gut, which can temporarily upset the digestive balance. Many children feel less well whilst taking antibiotics. Overuse of antibiotics encourages resistant bugs to breed, causing problems for all of us later.

Antibiotics are unlikely to be helpful or justified if:

• Your child is 2 years old or more with a temperature of 39°C or less.
• Your child is not severely distressed.
• You child has been unwell for three days or less.

Despite all this there are occasions when antibiotics are needed. Antibiotics are more likely to be prescribed if:

• The child is under 2 years old and has an infection in both ears (as the risk of complications is greater in babies).
• A child or young adult has a discharge coming from the ear.
• The infection is severe.
• The infection is not settling within three days.
• Complications develop.
• Your child has another medical condition (for example, diabetes) which might increase the risk of infection.

Occasionally, some children have recurring bouts of ear infections close together. If this occurs, a specialist may advise a long course of antibiotics to prevent further bouts from occurring.

If infections are very frequent, a specialist may advise the insertion of a grommet into the eardrum. This is the same treatment that is used to treat some cases of glue ear. A grommet is like a tiny drainage pipe that helps to let fluid escape from the middle ear, and that lets air in. Some research suggests that this may reduce the number of ear infections that occur.

Useful information about Otitis media:

• Otitus Media (earache) – Healthier Together
• Ear infection – otitis media (Patient.info)
• Ear Infections (NHS UK)

Videos about Otitis media

What are ear infections? | Patient
Patient.info | 19 Feb 2018

Earaches | Healthier Together
NHS Wessex | 30 Mar 2021

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