Ear Infections

Ear infections are surprisingly common in younger children and can cause considerable anxiety and distress to both parents and children

What is an ear infection?

There are 2 types of ear infection, one that affects the middle ear (the space behind the ear drum)  also known as acute otitis media and one that affects the outer ear (the ear canal) , otitis externa.

It is the middle ear infections (acute otitis media ) that affects younger children and often occur in association with a viral upper respiratory tract infection.

How do middle ear infections occur?

The infections are believed to happen because of a blockage of the eustachian tube causing a build up of fluid in the middle ear that then becomes infected by bacteria. Pus forms in the middle ear resulting in distension of the tympanic membrane, which can be very painful and sometimes the ear drum bursts with associated discharge from the ear.

What are the symptoms?


Pain – some children will pull at their ears or bang the side of their head

Being unsettled especially at night

Poor feeding and vomiting

Discharge from the ear


Why do some children get repeated infections?

Infants who start developing infections at an early age around 6-8 months when their maternal immunity wears off are more likely to develop recurrent infections. It is unclear why this happens but is thought to be due to bacteria colonising the back of the nose or middle ear

What factors increase the risk of ear infections?

The most significant factor is other children, and those children in nursery/daycareare more likely to develop recurrent infections

Can ear infections be serious?

Yes ear infections can potentially be very serious. If one imagines how close the middle ear is to the brain, there is a risk of infection spreading and causing serious complications such as mastoiditis or brain abscesses, but these are extremely rare. However you should always take your child to your GP, Paediatrician or ENT surgeon to be checked.

Are antibiotics always necessary?

No but because there is higher rate of complications in younger children there is a lower threshold for using antibiotics. However the ear infections can often be managed with Calpol and Nurofen reserving antibiotics for those children who are particularly ill or with a high fever that fails to settle

Signs of complications

Acute mastoiditis – the ear sticks forwards and there may be redness and swelling behind the ear

If a child is listless, drowsy, in severe painand not themselves they should see a doctor urgently

What happens if the eardrum perforates?

In fact this is actually quite a good thing as often the pain is eased when this happens. The perforation is usually a tiny hole that heals within a few days. It is best to keep the ear dry if this happens. Sometimes antibiotic ear drops are used to treat the discharge if this is persistent

What about grommets?

Grommets can be very helpful in managing ear infections.

They are particularly helpful when pain is a siginificant factor. The downside of grommets is that the infections may still occur with discharge through the grommet.

Do children grow out of ear infections?

Yes most children grow out of their ear infections when they are around 3 years of age