Ear Infections in Children

The ear is made up of three distinct parts: the outer ear, the middle ear (behind the ear drum) and the inner ear (deep within the temporal bone). Ear infections are the most common illness to affect pre-school children with up to 90% of children experiencing one before their third birthday.

When an ear infection occurs, it is the middle ear which is affected. Some children just get the occasional ear infection, others get recurring ear infections and it’s generally these children we see at the clinic. They may also go on to develop glue ear as a result of fluid building up in the middle ear.

The middle ear is normally filled with air and is connected to the back of the nasal passages by a small tube called the Eustachian tube. This tube is short and narrow and horizontal in babies and therefore not so effective. As a child grows the tube becomes more oblique and this allows fluid to drain from the middle ear much more effectively. This explains why some parents are often told that their child will “grow out” of ear infections.

The Eustachian tube allows us to equalise the pressure on either side of the ear drum – like when your ears go pop in a plane. Babies do this by crying, swallowing and yawning. However, when a child is susceptible to coughs, colds and ear infections this tube often becomes inflamed and can be blocked with mucus.

Children are frequently brought to see us because they don’t sleep. On closer examination, we sometimes find that the child has had a few ear infections. In many cases like this, the child wakes at night because of the fluid in the middle ear. It may be uncomfortable, and the ears may need to pop. A little drink of water may help when they wake up, but the main aim of treatment is to move the fluid and mucus away from the middle ear, relieving the pressure behind the eardrum.

There are certain conditions that increase the risk of ear infections and glue ear.

Being under three years of age or being a boy.

Going to nursery. Children in day-care have more contact with other children and as a result are more likely to catch infections.

Bottle-fed babies. Breastmilk increases the baby’s immune system.

Being near second-hand smoke. Children with a parent who smokes are 50% more likely to get ear infections and 40% more likely to get glue ear.

Being in a large family or having a family history of glue ear.

Using a soother. Children diagnosed with an ear infection have almost double the risk of recurrent infections if they use a soother. Sucking on a soother increases the negative pressure in the Eustachian tube and this draws mucus into the tube.

Having recurrent coughs and colds and babies who are constantly chesty.

Research done in the Czech Republic and published in the International Journal of Pediatric Otorhinolaryngology in 2015 suggests that there may be a link between infant reflux and glue ear. In the study, they tested the fluid in the middle ear for the presence of pepsinogen (an enzyme only found in the stomach) during grommet insertion. They discovered that samples from 31.8% of children were positive for pepsinogen.

In babies the Eustachian tube is not fully developed; it’s shorter and more horizontal than in adults. As a result, refluxed acidic stomach contents may enter the Eustachian tube and reach the middle ear. This increases the risk of ear infections and glue ear in babies with severe reflux.

Signs and symptoms of an ear infection

Ear infections can be caused by a viral or bacterial infection and very often follow on from a sore throat, cough or cold. Signs and symptoms of an ear infection include high temperature, pain and irritability, nausea and vomiting, difficulty sleeping and the child will often pull at their ears.

In some cases, the ear infection does not clear up completely and this may lead to fluid developing in the middle ear. This in turn will progress on to another ear infection, which exacerbates the problem by increasing the inflammation in the Eustachian tube.

Small children may not be able to tell you they have pain or discomfort and may be seen tugging at their ears. Children with symptoms of an ear infection should always be seen by their doctor.

Types of ear infection

Acute Otitis Media – This is the most common type of ear infection. Fluid builds up behind the eardrum and causes pain. When a very severe infection is present, the eardrum may perforate due to the pressure of the fluid in the middle ear. If this happens, you should see your doctor.

Otitis Media with Effusion – This is more commonly known as glue ear. In this case, fluid remains behind the eardrum after the infection has cleared. This can affect the child’s hearing and poses a risk to another infection developing.

If you would like more information about ear infections, glue ear or hearing tests, listen to episode 4 of The Happy Baby Podcast below.

Treatment for Ear Infections

For many infections the main treatment is to manage the symptoms. Give your child an analgesic like paracetamol to relieve the pain and bring down their temperature. Always follow the manufacturer’s dosage guidelines and only give the medication when needed.

If the symptoms persist for longer than 48 hours, or if you are concerned about your child, see your doctor. An antibiotic may be needed to treat the infection. You should however always see you doctor if your child’s temperature is above 38 degrees Celsius, if they are very distressed or if you have any other concerns.

A cold compress on the affected ear will help reduce the pain.

Encourage your child to drink plenty of fluids, particularly if they have a high temperature.

For children who have a recurring ear infection, it may be worth asking your doctor about antibiotic drops instead of oral antibiotics.

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