Overview
Ear infections are one of the most common reasons children visit the doctor. Middle ear infections (otitis media) occur behind the eardrum, while outer ear infections (otitis externa or swimmer's ear) affect the ear canal. Most middle ear infections clear up on their own.
How common is it?
About 3 in 4 children will have at least one middle ear infection by age 3. Outer ear infection affects people of all ages, particularly swimmers.
Causes and risk factors
Middle ear infections usually follow a cold or upper respiratory infection when the Eustachian tube (connecting throat and ear) swells, trapping fluid where bacteria or viruses then multiply. Outer ear infections develop when moisture or injury to the ear canal allows bacterial or fungal growth.
Common risk factors
- Recent cold or upper respiratory infection
- Age under 5 (immature immune system and Eustachian tube anatomy)
- Bottle feeding lying flat
- Exposure to cigarette smoke
- Attending nursery or childcare
- Using cotton buds in the ear canal
- Swimming or moisture in the ear (outer ear)
Symptoms
- Ear pain
- Pulling or tugging at the ear in young children
- Fever
- Difficulty hearing
- Fluid draining from the ear
- Irritability and poor sleep in babies
- Feeling of pressure in the ear
When to see a doctor
See a doctor if ear pain is severe, there is discharge from the ear, hearing is significantly affected, symptoms persist beyond 3 to 4 days, or if a child under 2 is unwell. Seek urgent care for severe pain with facial swelling or weakness.
Diagnosis
Otoscopy (examination of the eardrum with an otoscope) confirms middle ear infection showing a red, bulging eardrum. Ear swabs guide antibiotic choice for outer ear infection.
Treatments
Pain relief and watchful waiting
Paracetamol or ibuprofen manages pain. Most middle ear infections in children over 2 resolve without antibiotics within 3 to 5 days.
Antibiotics
Amoxicillin is prescribed for children under 2, those with severe symptoms, or those who do not improve after 3 days of watchful waiting. Ear drops for outer ear infections.
Grommets (ventilation tubes)
Small tubes inserted into the eardrum under general anaesthetic to allow fluid drainage in children with chronic glue ear affecting hearing and development.
Self-care and lifestyle
- Keep water out of an infected ear canal while swimming or bathing
- Do not insert objects including cotton buds into the ear canal
- Pain can often be eased by a warm (not hot) cloth held over the ear
- Breastfeeding protects against ear infections in infants
Prevention
Breastfeeding, avoiding cigarette smoke exposure, flu vaccination, and pneumococcal vaccination reduce middle ear infection risk. Dry ears after swimming and avoid cotton buds to prevent outer ear infection.