Introduction
An ear infection is when germs and bacteria enter the ear, causing pain and swelling.
Ear infections are very common in children as their immune systems are not fully developed and cannot fight illness well. The eustachian tubes that connect the ears to the back of the throat are also narrower and sit horizontally. This makes it difficult for fluid to drain out of the ear, causing it to get trapped and build up.
There are two common types of ear infections.
Middle ear infections or otitis media – These infections happen in the middle ear, which sits behind the ear drum. Middle ear infections usually start with a cold or sickness that causes fluid containing bacteria and germs to build up and cause infection.
Outer ear infections or otitis externa – These infections happen in the outer ear canal, which sits between the outside of the ear and the eardrum. Outer ear infections happen when fluid containing bacteria enters the ear canal, becomes trapped and causes infection. This commonly happens when swimming, so outer ear infections are sometimes called swimmer’s ear.
Signs and symptoms
Signs and symptoms of ear infection will be slightly different depending on which part of the ear is infected.
For middle ear infections, your child may experience:
- ear pain
- tugging and rubbing of the ears
- hearing loss
- headaches
- irritability
- fever
- loss of balance.
If your child has any redness, swelling or pain in the area behind their ear, see your local doctor or go to the nearest emergency department immediately.
For outer ear infections, your child may have:
- tenderness and pain in the outer ear, especially when moving the jaw
- muffled hearing
- feeling of pressure or fullness in the ear
- redness and swelling
- clear or yellow fluid coming out of the ear
- a swishing or squelching sensation in the ear when moving.
Take your child to your local doctor when they show signs of an ear infection. Untreated ear infections can be severe and can lead to infection spreading in the body and hearing loss.
Diagnosis
Your child’s doctor can diagnose an ear infection by checking their symptoms and looking inside the ear with an otoscope. An otoscope is a magnifying tool that can see the ear drum.
Treatment
Treatment options depend on which type of ear infection your child has and how severe it is.
Middle ear infections
Middle ear infections will usually clear up in about a week. Your child’s doctor may recommend pain relief like paracetamol or ibuprofen, or they may prescribe numbing ear drops. Always speak to your doctor before using drops for middle ear infections.
Antibiotics are not usually given for middle ear infections unless your child is experiencing severe symptoms like fever and vomiting.
If your child has ear infections that keep coming back, they can be referred to an ear, nose, and throat (ENT) specialist for treatment.
Outer ear infections
Outer ear infections are usually treated with medicated ear drops prescribed by your child’s doctor. You will need to give your child the drops several times a day. Follow the instructions given by the doctor or pharmacist.
If your child has a severe outer ear infection, the doctor may place some gauze into the ear canal to help get the medicine inside. Your child should avoid swimming and touching the inside of their ear as the infection clears up.
Symptoms should improve around day 3 of treatment, and your child should feel much better by the end of the first week. Follow up with your child’s doctor if symptoms do not improve.
Management
Risk factors and prevention
Ear infections are very common in children, but some factors can mean your child is more likely to have severe and repeated infections. These can include:
- being born with a condition or syndrome that affects the structure of the ears, nose, and throat, like cleft palate or Down syndrome
- being Aboriginal or Torres Strait Islander
- living with people who smoke
- hay fever, allergies, and other breathing issues and illnesses.
Outer ear infections can be more common in children who swim often, especially in dirty water. This includes public pools, lakes, and rivers.
You can lower the risk of ear infections by:
- not smoking in places where children are, including in the home, backyard, and car
- having your child seen by their doctor as soon as possible to treat coughs, colds, and runny noses
- gently cleaning your child’s outer ear with a damp cloth instead of cotton buds.
For babies, you can:
- breastfeed for as long as possible if you can do so
- hold their head upright when bottle feeding to avoid fluid getting into the eustachian tubes
- avoid putting them to sleep in the cot or bassinet with a bottle.
Glue ear
Glue ear is a condition where the liquid made by the middle ear becomes thick and gluggy, like glue. When the liquid becomes too thick, it cannot drain through the eustachian tube properly and builds up in the middle ear. This can cause infection and hearing loss.
Glue ear can be caused by:
- previous and reoccurring ear infections
- colds and other upper respiratory infections
- exposure to cigarette smoke.
If your child has regular ear infections, make sure their doctor checks them for glue ear.
Glue ear does not always show the same signs as a middle ear infection, so it is important to watch your child for signs of hearing loss, including:
- rubbing or pulling ears
- not listening or paying attention
- changes or a delay in their speech
- needing the volume to be louder for TV and music
- trouble with balance.
Glue ear usually clears up on its own. If it has not gone away after three months, your doctor may suggest treatment with grommets. Grommets are small tubes that are inserted into the ear to help fluid drain out.
It is important not to leave the glue ear untreated, as it can cause hearing loss and issues with learning, communication, and development.
Ruptured ear drum
The eardrum is a sheet of tissue that separates the middle ear from the outer ear. When children have severe middle ear infections, pressure can build up from trapped fluid. When the pressure becomes too much, the eardrum can rupture or burst. When the eardrum ruptures, your child will feel immediate relief from pain, and yellow discharge may drain out of the ear.
The eardrum will usually heal by itself. Check in with your local doctor around six weeks after the rupture to make sure it has healed properly. Your child should avoid swimming and getting the ear wet during a bath or shower while they are recovering.