Key points to remember about ear infections
If you think your child has an ear infection, take them to see a health professional.
- ear infections are very common in young tamariki
- they can cause pain and fever
- if you think your child has an ear infection, take them to a health professional
- pain relief is important
- antibiotics are often not needed (if your child is over 2 years old)
- always take your child to a health professional for an ear check 4 to 6 weeks after an ear infection, to make sure the fluid behind the eardrum has cleared away
- most tamariki outgrow ear infections and will have normal, undamaged ears and normal hearing
What the inside of the ear looks like
The inside of the ear can be separated into three parts, the outer, middle and inner ear.
What is an ear infection?
Ear pain and concerns about hearing are some of the most common reasons parents take their young tamariki to a health professional. In tamariki, these things are often caused by problems in the middle ear.
There are 2 common types of middle ear problems.
An ear infection
Acute otitis media is the medical term for an ear infection. It is an infection behind the eardrum. The information on this page is about ear infections.
Glue Ear
Glue ear is also known as otitis media with effusion. Glue ear is when there is thick fluid behind the eardrum that doesn’t clear away - but there is no infection present.
See the page on glue ear to learn more.
Are there other types of ear infections?
Outer ear infections
Tamariki can also get ear pain caused by infection of the skin around the outer part of the ear.
Outer ear infections are usually caused by water going into the ear, often after lots of swimming. This kind of infection happens more easily if they have skin conditions like eczema, which causes dry or broken skin in the ear canal.
See the page on outer ear infections to learn more.
Outer Ear Infections In Children
How middle ear infections happen
Middle ear infections often happen either during or just after a cold, when there are bacteria or viruses present in the back of the nose. They can travel up the eustachian tube from the back of the nose to the space behind the eardrum (middle ear). This happens more easily in young tamariki when the eustachian tube is short.
The infection causes swelling and can block the eustachian tube, which means air cannot reach the middle ear. Fluid and pus collect in the middle ear,. The eardrum becomes red and inflamed and can bulge outwards. The inflammation and stretching of the eardrum is what causes ear pain. While there is fluid behind the eardrum, your child’s hearing can be reduced. Some tamariki with an ear infection can also have a fever.
The pressure that builds in the middle ear can sometimes cause the eardrum to burst.
Who gets ear infections
Ear infections are most common in pēpi (babies) and young tamariki. They are more likely to develop ear infections than older tamariki 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 tamariki and adults - the tubes are smaller, shorter and flatter (more horizontal).
As tamariki grow older, their eustachian tubes work better and they also tend to get fewer colds. As a result, they usually outgrow having ear infections at around 7 or 8 years of age. But, some tamariki may have problems beyond this age.
Things that put children at risk of getting ear infections
We know some important risk factors, but not all the reasons why some tamariki develop more ear infections than others. The most important risk factors include:
- a family history of ear infections
- living with someone who smokes
- going to early childcare - pēpi and tamariki are exposed to more colds and viruses
- having an older brother or sister in childcare or early primary school
- the season - ear infections are more common during the autumn and winter months
- having significant nasal allergies (allergic rhinitis or “hayfever”)
Can you catch middle ear infections?
Ear infections cannot be passed on from one person to another, but the cold or other infection which caused them can.
Signs and symptoms of an ear infection
The pain from an ear infection usually comes on quickly and doesn't last long. It usually wears off within 24 hours.
Symptoms in older children
Symptoms of an ear infection in older tamariki can include:
- significant ear pain
- fever
- feeling unwell
- complaints of reduced hearing in the affected ear
- problems with balance
Symptoms in babies and younger children
In pēpi and younger tamariki, sometimes the only sign of an ear infection is a fever.
Younger tamariki may also:
- cry a lot and become generally irritable
- be hard to settle and have very disturbed sleep, getting more upset when they lie down
- become 'clingy' and 'grizzly'
- not drink or eat as much as usual
Burst ear drum
Sometimes pus will burst through the eardrum. The pus can look like snot coming out of the ear. When the eardrum bursts, tamariki often feel better as the pressure causing the pain is suddenly released. The burst eardrum usually heals without treatment or future problems.
See a health professional if you think your child has a burst eardrum. The health professional may give your child antibiotic ear drops.
When to get medical help for your child
If you think your child may have an ear infection, see a health professional. They will talk to you about your child’s symptoms and look into their ears with an otoscope. An otoscope is a small powerful light with a magnifying lens.
A video showing a health professional looking inside a young boy's ear canal with an otoscope.
Source: KidsHealth
Holding your child while the health professional looks in their ears
Most pēpi and tamariki do not like having their ears examined. To make it easier, your health professional will probably encourage you to:
- hold your child sitting sideways on your lap
- wrap one of your arms gently over their arm
- gently hold their head against your chest with your other hand
Photo showing how to comfort and hold your child during an ear exam.
Source: KidsHealth
Managing 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 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.
Antibiotics are often not needed
Ear infections do not usually need treatment with antibiotics, particularly if your child is over 2 years of age. After one week, at least 3 out of 4 tamariki will be better, whether they take antibiotics or not.
The decision about whether or not to use antibiotics may depend on some of the following:
- whether your child has a high fever or severe pain
- how old your child is - your health professional is more likely to give antibiotics if your child is under 2 years old
- if your child still has pain or discomfort after 48 hours of pain relief
- how often your child has had middle ear infections before
- whether your child has ever had complications from ear infections before, like a burst eardrum
- whether your child has any other medical conditions
- your views on how to best manage your child's ear problems
Caring for your child with an ear infection at home
Things you can do at home when your child has an ear infection include:
- giving your child regular pain relief, as recommended by your health professional
- giving your child lots of comfort and cuddles
- letting your child rest
- keeping 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. Don't use them as they can have unwanted side effects.
How long an ear infection can last
The pain from an ear infection comes on quickly, but usually doesn't last long. It usually improves within 24 to 48 hours.
After an ear infection, it is normal to have some fluid behind the eardrum (effusion). This can take a few weeks to drain away (down the eustachian tube). It may cause your child to have an ongoing feeling of discomfort or blockage 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, which goes back to normal as the fluid clears away. They may hear some crackling or popping noises, which is a good sign that the fluid is clearing.
When to go back to a health professional for an ear infection
Once an ear infection is diagnosed, your child should start to improve within 24 to 48 hours. Go back to a health professional if:
- an earache is not settling after 2 days
- fluid starts coming out of your child's ear
- your child seems more unwell
There are some very rare complications of ear infections. Go back to a health professional urgently if your child:
- has any swelling, redness or tenderness in or around the ear (this could be mastoiditis)
- is feeding poorly
- is floppy, sleepy or drowsy
- is becoming less responsive
- is not interested in surroundings (lethargic)
- complains of a stiff neck or light hurting their eyes (this could be meningitis)
Always take your child to a health professional for an ear check after any ear infection, to make sure the ear fluid has gone. Go to the health professional again 4 to 6 weeks after the ear infection.
Frequent ear infections
If your child gets frequent ear infections, they may need to see an ENT (ear, nose and throat) specialist to consider grommets.
Possible long-term complications from ear infections
Most tamariki outgrow ear infections and will have normal, undamaged ears and normal hearing.
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 clears up within 12 weeks for 80% of tamariki.
Hearing loss
Hearing loss is the main complication of ear infections. Make sure your child has the B4 School Check and has their hearing tested.
A hole in the eardrum that doesn't heal
If your child has had a hole in the eardrum (eardrum perforation) after an infection, it will usually heal on its own. If perforation happens more than once, or if the infection causes a larger hole, sometimes it doesn’t heal. Tamariki can sometimes need an operation to repair the hole, but usually this isn’t done until after the age of 8.
A hole in the eardrum can sometimes cause problems with frequent leaking from the ear. Your child may need earplugs or other measures to try to keep their ear healthy until they are old enough to have the hole repaired.
Preventing ear infections
It is not easy to prevent ear infections, but the following may help reduce the risk:
- making sure your child's environment is smoke-free
- breastfeeding your baby for ideally at least 6 months is thought to be protective against the early development of ear infections - this may be because breastfeeding boosts the immune system
- keeping your child's room warm and dry
- making sure your child has all their vaccinations on time
Acknowledgements
Illustrations by Dr Greta File. Property of KidsHealth.
