Key points to remember about ear infections

ear infections are very common in young children
they can cause pain, and often fever
antibiotics are not always needed
pain relief is important
there may be some fluid in the space behind the ear drum (middle ear) for several weeks or months after the infection. This is normal, and usually clears up on its own
most children outgrow ear infections and have perfect and undamaged ears and normal hearing
if you think your child has an ear infection, take them to your family doctor

For a shorter version of this fact sheet, more suitable for printing, see:

Ears: Ear infections – brief version (no photos or diagrams)

What does the inside of the ear look like?

Diagram of the inside of the ear.

What is an ear infection and how does it develop?

Ear pain and concerns about hearing are one of the most common reasons parents take their young children to the doctor. The medical name for an ear infection is “otitis media”.

There are two common types of middle ear problems:

an ear infection (acute otitis media) – discussed in this fact sheet
glue ear (otitis media with effusion or secretory otitis media) - see the detailed or brief glue ear fact sheet

Ear infections often happen either during or just after a cold, in the following way:

germs (bacteria and viruses) from a cold (or other upper respiratory infection) travel up the Eustachian tube which connects the space behind the ear drum (middle ear) to the back of the nose
the germs infect the space behind the ear drum
the swelling and inflammation of the Eustachian tube, as a result of the infection, can cause the tube to become blocked
as a result, air cannot reach the space behind the ear drum
fluid and pus collects in the space behind the ear drum (see diagram below left)
the ear drum bulges out and becomes red and painful (see diagram below right)
the rapid stretching of the ear drum causes your child pain, and the infective process can cause fever


Artwork copyright © Dr Peter Allen and printed with permission from the book “Understanding ear infections”. See Acknowledgements.

Who gets ear infections?

Ear infections are very common in babies and young children who are more likely to develop them than older children and adults. This is because their Eustachian tubes (connecting the middle ear to the back of the nose) don't function as well as in older children and adults. In a young child the tubes are smaller, shorter and flatter (more horizontal) than in adults. This makes it easier for them to become blocked during head colds, which are very common in small children.

As children grow older, their Eustachian tubes work better. They also get fewer colds, and so they often outgrow the tendency to have frequent ear infections. This tends to happen from around seven years of age, although there are some children who may have problems beyond this age.

What puts my child at risk of getting ear infections?

We know some important risk factors, but not all the reasons why some children develop more ear infections than others. The most important risk factors include:

a family history of ear infections
your child being exposed to cigarette smoke
early child care where young babies and children are exposed to more colds / flu viruses; having an older brother or sister in child care or early primary school also increases the risk
season of the year – ear infections are more common during the autumn and winter months

There is no clear evidence that allergy causes ear infections.

Can I do anything to prevent ear infections in my child?

It is not easy to prevent ear infections, but the following may help reduce the risk:

keeping your child smoke-free
breastfeeding your baby for three to six months is thought to be protective against the early development of ear infections. This may be because breast feeding boosts the immune system (the body's defence against potentially harmful germs)

What are the signs and symptoms of an ear infection?

Older children will complain of significant ear pain and may have a fever. They may also feel unwell and complain of reduced hearing in the affected ear.

In babies and younger children, sometimes the only sign of an ear infection is a fever.

Younger children may also:

cry and become very upset / distressed / irritable and hard to deal with
have very disturbed sleep at the beginning of the infection
be harder to settle to sleep
vomit, lose interest in eating, seem to have no energy
become “clingy” and “grizzly”
Sometimes pus will burst through the eardrum (see the diagram at right). The pus looks like snot coming out of the ear. When the ear drum bursts, children often feel better as the pressure causing the pain is suddenly released. The burst eardrum usually heals without treatment or future problems. See When should I seek help?

Sometimes pus will burst through the ear drum.

Pus bursting through the ear drum

Are middle ear infections catching (contagious)?

Ear infections can't be passed on from one person to another, but the cold or other infection which caused them can.

How are middle ear infections diagnosed?

Your family doctor will ask questions about your child's recent and past health and examine your child's ears. To do this they will use an instrument called an otoscope to look at your child's ear canal and ear drum. An otoscope contains both a small powerful light and a low power magnifying lens.

Most infants and children do not like having their ears examined. To make it easier, your doctor will probably encourage you to hold your child on your lap and hug their arms and body while your doctor looks inside your child's ear. This should not be painful. It is important to hold your child securely while having their ears examined. If your child moves during this examination it can be painful for them and make it more difficult to examine their ears both now and in the future.

How long does an ear infection last?

The pain from an ear infection comes on rapidly and doesn't last long. It usually wears off within 24 hours.

After an ear infection, your child may have fluid behind their ear drum (effusion) which can last several weeks to months. This may cause your child to have an ongoing feeling of discomfort in their ears. It is more a dull, abnormal feeling than a nasty, sharp pain. The fluid also causes a short-term decrease in hearing in that ear. See the fact sheet on glue ear (detailed version or brief version).

What is the treatment for an ear infection?

Pain relief
Regular pain relief is important to help your child feel more comfortable. Paracetamol and / or ibuprofen can help reduce pain, and also lower fever which can make your child feel better. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose. Your family doctor or pharmacist can advise you on the right dose of pain relief medicine for your child.

Antibiotics

Your doctor may either:

wait to see whether the infection will clear up by itself, or
recommend treatment with antibiotics, if your child is unwell and feverish

Your child's doctor will be happy to discuss your child's treatment with you so that you can be involved in the treatment decisions. The decision about whether or not to use antibiotics may depend on some of the following factors:

how severe the infection is
how old your child is
how often your child has had middle ear infections before
how long your child has had this infection
whether your child has ever had complications from ear infections before
whether your child has any other medical conditions
your views on how to manage your child's ear problems

How can I care for my child at home?

pain relief is important (see What is the treatment for an acute middle ear infection?)
propping your child's head up with an extra pillow in bed may help reduce the pain
your child may need rest and lots of comforting / cuddles
keep your child home from child care or school while they are unwell or have a fever

There is no evidence that decongestant medicines (including nose sprays) and antihistamines are of any benefit in the treatment of acute ear infections and they can have unwanted side-effects so they should not be used.

Are there any complications from ear infections?

Hearing loss is the main complication of ear infections. The fluid that collects behind the eardrum (called an effusion) can last for weeks to months after the pain of an ear infection is over. The fluid is usually gone in 80 percent of children within 12 weeks. See the fact sheet on glue ear (detailed version or brief version).

A hole in the ear drum (ear drum perforation) can result from the build-up of pus. In most cases this is a small hole that heals quickly (in hours to days). In a small number of children, the perforation can become long-lasting (chronic) with fluid leaking from the ear. Sometimes an operation to repair the perforation may be necessary but usually not before the age of eight.

There are some very rare complications which can occur. See When should I seek help?

When should I seek help?

The symptoms of ear infections also occur in other illnesses; for this reason, if you suspect your child has an ear infection, take them to your family doctor. Your doctor will examine your child to see if an ear infection (or another problem) is the cause of your child's symptoms.

Once an ear infection is diagnosed, your child should start to improve within 24 to 48 hours. If the symptoms are no better or are getting worse, or you are worried about your child, take them back to your family doctor.

You should always take your child to your family doctor to have their ears reviewed after any ear infection, to make sure the ear fluid has gone. This recheck usually happens around four to six weeks after the infection.

You should also take your child to your family doctor if:

your child's ear starts to discharge
your child has a fever which doesn't go away after 24 – 48 hours
you are worried about the continuing unwellness of your child

You need to take your child to a doctor immediately if your child:

has any swelling, redness or tenderness in or around the ear
is feeding poorly
has any change in consciousness
has a stiff neck
has sensitivity to light

If your child keeps getting frequent ear infections, they may need to see an ENT (ear, nose and throat) specialist to consider grommets (tympanostomy or ventilation tubes). See Grommets (tympanostomy or ventilation tubes), including the section When might my child need grommets?

Where to go for more information

On this website

Glue ear - detailed version

Grommets (tympanostomy or ventilation tubes)

Hearing and vision

What's involved in learning to talk? Introduction

Speech sound development

Language development: 0 - three years of age

Language development: four - five years of age

Encouraging language development

Using language socially - an important skill

NSU (National Screening Unit)

The NSU website provides information about the Universal Newborn Hearing Screening Programme, including a checklist Can your baby hear?

Website: http://www.nsu.govt.nz/

The National Foundation for the Deaf Inc

The National Foundation for the Deaf website makes the following resource available:

Your child's speech and hearing milestones

Website: http://www.nfd.org.nz/

Acknowledgements

Starship Foundation and the Paediatric Society of New Zealand acknowledge the co-operation of Procare Health Ltd in the development of this fact sheet. Procare Health Ltd provides GP (general practice) services in the greater Auckland area.

Diagrams / artwork:

Thank you to Dr Peter Allen for allowing reproduction of artwork from his book “Understanding ear infections”.

Please note: Permission to copy kidshealth fact sheets, with acknowledgement, does not extend to Dr Peter Allen's artwork on this page. Any requests to reproduce this artwork need to be made in writing to:

Dr Peter Allen
Central Family Health Care
7 Mansfield Terrace
Whangarei 0110

Your notes

Endorsement

This fact sheet was endorsed by PSNZ - 30/06/2011

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2012

The Paediatric Society of New Zealand
http://www.paediatrics.org.nz

Starship Foundation
http://www.starship.org.nz

The Paediatric Society of New Zealand
http://www.paediatrics.org.nz

Starship Foundation
http://www.starship.org.nz

This fact sheet was printed on: 17-May-2012 10:35pm

Ears: Ear infections - detailed version