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Middle ear infections (Otitis Media)

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Middle ear infections are common in young children. They cause distress and pain, and affect the way children hear as well. 

Middle ear infections are different to infections that affect the outer ear (ear canal), known as Otitis Externa, which are can be a result of swimming or scratches to the ear canal. These are covered in the topic 'Infections in the ear canal (otitis externa or swimmer's ear)'.

Contents

Parts of the ear

The ear has three main sections:

  • Outer ear – The visible parts of the ear including the pinna and ear canal
  • Middle ear – Includes the ear drum and three small bones (ossicles)
  • Inner ear – Includes the cochlea and hearing nerve
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In a healthy ear, sound travels through the outer ear and middle ear which are each filled with air.  

Sound moves the ear drum and this movement is carried to the inner ear by the tiny bones in the middle ear. These bones can only move normally when the middle ear is filled with air. The inner ear is filled with fluid. Tiny 'hairs' in the inner ear (cochlea) pass the sound to the auditory nerve which carries the sound to the brain. Here it is processed and we can make sense of the sound.

A tube called the Eustachian tube leads from the middle ear to the back of the nose and throat and helps to make sure that air can reach the middle ear.

What is Otitis Media?

Bacteria and viruses that cause colds, tonsillitis and sinusitis are the most common cause of a middle ear infection.  If these bacteria or viruses enter the middle ear, they can cause ear pain and fever - an ear infection. If inflammation of the middle ear occurs as the result of an infection, fluid from surrounding tissue may enter the middle ear space causing increase in pressure in the middle ear (causing pain) and affecting how the tiny bones which carry sound to the inner ear move. 

Sometimes the ear drum will burst (rupture) because of the pressure of the fluid in the middle ear.

The fluid can stay in the middle ear space long after the ear infection itself is resolved.  The fluid may also begin to affect your child's hearing as it stops the ear drum and middle ear bones from moving as they should.  

In most cases, the fluid will be gone, by itself, within three months, but occasionally it can persist longer than this, meaning that medical management of your child's ear health may be needed.

Signs that a child may have an ear infection

These signs will often appear during or just after a child has had a cold, tonsillitis or sinusitis:

  • Younger children may pull at their ears
  • Older children may complain of an earache or headache
  • Your child may have difficulty sleeping or wake often during the night because of pain
  • They may have a fever
  • The outside of they ear may appear red and be sensitive to touch
  • They may have difficulty hearing and talk louder than usual, not be able to hear what you say to them (so they seem disobedient), or increase the TV volume
  • If the ear drum has ruptured, there may be fluid draining from the child's canal.

How can middle ear infections affect my child's hearing?

When the middle ear is filled with fluid instead of air, it is often unable to carry sounds to the inner ear as effectively as it normally would.  Fluid in the middle ear can affect your child's hearing in varying degrees, from not at all, to a moderate degree of hearing loss. 

Your child's hearing may change as the infection comes and goes – some days they may hear you better than others.

Hearing loss from middle ear infections is often temporary and will resolve once the fluid has drained and/or the ear drum has healed.  

However, fluid which persists in the middle ear space for a long time may cause long term damage to your child's middle ear and can affect their speech, language and learning if they are unable to hear speech and other sounds clearly.

There is more about hearing loss in the topic Hearing and hearing loss.

Other things to think about

Ear infections themselves are not contagious, but the original cold that caused them is, so keep them away (if possible) from other children and older adults while they are coughing or have a runny nose. Make sure that everyone washes their hand often as most colds spread when hands carry germs to the nose. 

Research has shown that passive smoking and being in crowded conditions with other children can increase the risk of your child having an ear infection. 

If your children are generally unwell, it is best to keep them home from childcare, kindergarten or school as they may need more comforting and rest than they can get there.  

Most children ‘grow out' of getting ear infections once they reach 6-8 years old, as the Eustachian tube is larger and begins to slope downwards and does not get blocked as easily.

Treatment

  • Most often antibiotics are not needed as middle ear infections are often caused by viruses which are not killed by antibiotics. Your child's immune system will be able to get rid of the infection. 
  • Since some infections are caused by bacteria your doctor may recommend antibiotics, but even bacerial infections will get better because your child's immune system can cope. Research has shown that middle ear infections do not get better more quickly when antibiotics are used, but sometimes the pain will decrease more quickly and a child will feel better more quickly if antibiotics are used. Doctors are being encouraged not to give antibiotics for middle ear infections.
  • Middle ear infections are very painful and your child may be much more comfortable if you give him some paracetamol or ibuprofen, especially before your child goes to bed. Have a look at the topic Using paracetamol or ibuprofen.
  • Sometimes a child may feel less pain if something warm such as a warm damp cloth is held against the ear. Make sure that the cloth is not so hot that it causes pain. Check by placing it against your own ear.
  • Usually the fluid in the middle ear space will drain by itself within a few weeks, so no treatment for this is needed.
  • Nose spray or decongestant medicines do not seem to make any difference in how quickly the infection gets better, and it is strongly recommended that decongestant medicines are not given to children because of their side effects (and because use of them does not help).
  • If the fluid does not drain by itself over several months and your child's hearing is significantly affected, then your G.P. may refer you to an Ear, Nose and Throat (ENT) specialist for further advice
  • Your ENT specialist may suggest grommets.  Grommets are small tubes that are surgically placed through the ear drum to allow air into the middle ear space in cases where the fluid has not been able to drain naturally. A child is given an anaesthetic and the operation takes only a few minutes.

What happens without treatment?

In most cases the fluid will go away by itself within several weeks, even if no treatment is used.  In some cases, the ear drum can ‘burst' because of the infection and this is when you may see fluid draining from your child's ear.  A burst ear drum will usually heal by itself, but your G.P. should be aware of the situation, so they are able to monitor your child's progress. 

Persistent middle ear fluid can also lead to re-current ear infections.  Your audiologist or G.P. will be able to tell you if you child has fluid in the middle ear space.

If your child's hearing is affected

  • Make sure that their hearing and middle ear health are checked regularly by your G.P.
  • Get their attention before you speak to them
  • Come closer to your child when speaking to them
  • Make sure that you are face to face when speaking with them, so that they can see your non-verbal 'speech'
  • Ensure that you speak slowly and clearly.

Flying and middle ear infections

Flying can be uncomfortable for a child who has a middle ear infection and the air pressure changes in the plane may cause a ‘burst' ear drum. It is best if a child (or adult) does not fly while they have a middle ear infection. 

Consult your G.P. at least a week before you go to check whether your child has a middle ear infection. Your G.P. or Ear, Nose and Throat specialist may also be able to discuss options with you to help manage your child's middle ear infection or fluid during the flight to keep your travel plans on track.

More to read


Information produced by:

Newborn and Children's Hearing Service
295 South Terrace
Adelaide 5000
Telephone: 8303 1530
www.sahealth.sa.gov.au

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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