Medical Matters: Middle ear infection in children

written by Scally McDaid Roarty September 21, 2018

Continuing his popular medical column, Medical Matters, Dr Ciarán Roarty of Scally McDaid Medical Practice discusses the common problem of an ear infection in children.

Any parent will tell you that an ear infection is very common in children, though it can actually occur at any age.

Most children will have at least two ear infections before their fifth birthday. Usually when we talk about ear infections we mean those which occur in the ear canal itself or those that occur in the middle ear which is behind the eardrum.

Today we will discuss infections in the inner ear (otitis media). This middle ear space is usually filled with air and is connected to the back of the throat by a very small channel. The middle ear space contains three tiny bones which facilitate hearing.

When a child has a cold this space may become filled with mucus which then becomes infected with either a virus or bacteria.

What are the symptoms of an ear infection?

Pain is by far the most common symptom though it may not always occur. The hearing may be reduced and a high temperature is quite common. The child is generally unwell and may feel nauseous and vomit.

Young babies may be irritable and run a temperature. Sometimes the eardrum perforates and the fluid behind it is released. The ear has a discharge and the pain goes away. Usually, this perforation is quite small and heals within a few weeks.

What is the treatment for an ear infection?

Most ear infections get better within a few days without any treatment. Paracetamol and ibuprofen help ease the pain and temperatures and help make the child feel better. It is important to try to ensure the child drinks plenty of fluids

Will my child need an antibiotic?

Most ear infections don’t require an antibiotic as the child’s immune system is capable of clearing the viruses and bacteria which cause ear infections within two to three days.

Antibiotics are unlikely to be helpful if your child is unwell for 2 days or less, is over 2 years of age with a temperature of less than 39.0 C and not severely distressed.

Antibiotics are likely helpful if your child is under two, has a severe infection, or an infection in both ears, has a discharge or is not settling within 2- 3 days.

If complications develop or there are other medical conditions present which might increase the risk of infection, your doctor may also prescribe an antibiotic. It is quite common now for your doctor to suggest waiting for 2-3 days, giving pain relief and encouraging fluids to see if the infection settles, before starting any antibiotic.

Antibiotics as we know, are not without their side effects such as diarrhoea, rashes and the elimination of good gut bacteria which upsets the digestive system for short time.


If your child is healthy the risk of serious complications is small.
Fluid remaining behind the eardrum for a short while after the infection has cleared may result in reduced hearing for a week or so.

If this mucus does not clear properly and becomes trapped a “glue ear” may develop and your child may be more prone to ear infections and have an ongoing reduced hearing.

Other rarer complications include an infection in the bone behind the ear or an infection in the brain.

If your child with a sore ear seems to become more ill, you should take them to the doctor.

If the temperature is above 39C ( or over 38C in a young baby) or things are not improving within 2-3 days or you are just not sure about their symptoms, you should also seek medical attention.

If infections are very frequent an ENT specialist may advise the use of a long course of antibiotics or even the insertion of a little tube or grommet into the eardrum to help drain fluid from the middle ear canal.

It is next to impossible to prevent ear infections in children though we do know that breastfed children and children who live in a smoke-free environment are less likely to develop them.

We also know that dummies can increase the risk of ear infections, but as research is showing that the use of dummies as babies are dropping off to sleep can reduce cot deaths, doctors now generally advise considering stopping the use of dummies at 6-12 months of age.

The above information is intended as advice only and should you have any concerns please contact your own Doctor.

Dr Ciarán Roarty MB, BCh BAO MICGP DRCOG Grad. Cert. Obst. Ultrasound is a full-time GP at Scally McDaid Medical Practice, Scally Place, Letterkenny, Tel 0749164111



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