Kids Health Info

Ear infections and Otitis media

  • Ear infections are very common in small children. The two types of ear infections commonly seen in children are middle ear infection (otitis media) and outer ear infections (otitis externa).

    Most ear infections involve the middle ear. Babies and young children get more middle-ear infections than older children because the tubes (called the Eustachian tubes ) that connect the middle ear to the throat are smaller. This makes it easier for germs to reach the middle ear from the nose and throat during head colds, which are very common in small children.

    Infection of the outer ear (or auditory canal,) or Otitis Externa are bacterial infections usually due to excess moisture in the canal, eg.after swimming, or damage to the canal after use of cotton buds or scratching.

    Ear diagram KHI - RCH

    Signs and symptoms

    Babies and toddlers may have intense ear pain with both types of ear infections.

    • Because of the pain, toddlers can become extremely irritable, and hard to deal with.
    • They may pull at their ears or shove their finger inside their ear.
    • Children may also vomit, lose interest in eating, seem to have no energy and have trouble hearing.

    Middle ear infections

    • Sometimes pus will break through the eardrum so you see a thick yellow discharge from the ear. When this happens children often feel better as the painful pressure from the fluid inside the ear is gone. The burst eardrum usually heals without treatment.
    • Middle ear infections often happen with a cold (sometimes called an upper respiratory tract infection or URTI), with a runny nose and sore throat.
    • Usually they have a fever - sometimes a fever is the only symptom.

    Outer ear infections

    • There can be discharge from the ear, or the child might complain of a feeling of fullness in their ear.
    • The ear may be red and swollen.
    • The ear may be painful to touch and move.
    • If a fever develops, or the redness spreads beyond the ear, please see your doctor again.

    Care at home

    If your child is in pain give them a pain-reliever such as Paracetamol or Painstop.

    Middle ear infections

    • As with head colds, antibiotics do not usually help ear infections. Many middle ear infections in children clear up on their own, without antibiotics, over a few days.
    • Some children still do need a short course of antibiotics, especially if the child is very young or very unwell. So, if you think your child may have an ear infection see your doctor. If the doctor prescribes antibiotics, ask if they are really necessary. Antibiotics can cause side-effects.

    Outer ear infections

    • These infections always need treatment with antibiotic drops.
    • The doctor may insert an ear wick, this is the size of a matchstick, and helps keep the ear canal open so antibiotic drops can be inserted.
    • When applying ear drops to your child, have them lie down with the affected ear facing the ceiling. Put the drops in and keep your child in the same position for a few minutes, to allow the drops to be absorbed. Otherwise place a cotton wool ball in the ear to keep the drops in the canal.
    • Avoid swimming for one week to allow the infection to heal.

    After an ear infection, children may have some fluid in the middle ear for a few weeks. You may notice your child has some trouble hearing during this time. The fluid will usually clear up over a couple of months. If your child continues to be irritable or does not seem to be hearing well, see your doctor.

    Key points to remember

    • It can be very common for small children to have several ear infections in one year.
    • Antibiotics are not always needed for middle ear infections.
    • There may be some fluid in the middle ear for several weeks or months after the infection. This is normal, and usually clears up on its own.
    • Most children outgrow middle ear problems and have perfect and undamaged ears and normal hearing.
    • Outer ear infections are easily treated with antibiotic ear drops.

    Individual instructions

    Produced by RCH Department of General Paediatrics, ENT (Ear, Nose and Throat) and Emergency Department. Many thanks to the parents involved in the review of this factsheet.  First published March 2003, reviewed May 2010.

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This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.