Ear Infections In Detail

Key points about ear infections

• ear infections are very common in young tamariki
• they can cause pain, and often fever
• if you think your child has an ear infection, see a health professional
• pain relief is important
• antibiotics are often not needed
• always take your child to a health professional for an ear check 4 to 6 weeks after an ear infection, to make sure the ear fluid has gone
• most tamariki outgrow ear infections and will have perfect, undamaged ears and normal hearing

What the inside of the ear looks like

The inside of the ear can be separated into three parts, the outer, middle and inner ear.

What is an ear infection?

Ear pain and concerns about hearing are one of the most common reasons parents take their young tamariki to a health professional. The medical name for an ear infection is 'otitis media'.

There are 2 common types of middle ear problems:

• an ear infection (acute otitis media) – discussed on this page
• glue ear (otitis media with effusion or secretory otitis media)

Glue Ear

How ear infections happen

Ear infections often happen either during or just after a cold, in the following way:

• bacteria or viruses from a cold travel up the eustachian tube which connects the space behind the ear drum (middle ear) to the back of the nose
• the infection causes swelling and inflammation of the eustachian tube, so it can get blocked
• the blocked eustachian tube means air cannot reach the middle ear
• fluid and pus collects in the middle ear
• the eardrum bulges out and becomes red and painful
• the rapid stretching of the ear drum causes your child pain, and the infective process can cause fever

The image below shows a healthy ear with no infection.

The image below shows an ear infection.

Who gets ear infections

Ear infections are very common in pēpi (babies) and young tamariki who are more likely to develop them than older tamariki and adults. This is because their eustachian tubes (connecting the middle ear to the back of the nose) don't function as well as in older tamariki and adults - the tubes are smaller, shorter and flatter (more horizontal).

As tamariki grow older, their eustachian tubes work better and they get fewer colds. As a result, they outgrow the tendency to have ear infections at around 7 years of age. But, some tamariki may have problems beyond this age.

Things that put your child at risk of getting ear infections

We know some important risk factors, but not all the reasons why some tamariki develop more ear infections than others. The most important risk factors include:

• a family history of ear infections
• living with someone who smokes
• going to early childcare - pēpi and tamariki are exposed to more colds and viruses
• having an older brother or sister in childcare or early primary school also increases the risk
• season of the year - ear infections are more common during the autumn and winter months

There is no clear evidence that allergy causes ear infections.

Signs and symptoms of an ear infection

The pain from an ear infection comes on rapidly and doesn't last long. It usually wears off within 24 hours.

Symptoms in older children

Older tamariki will complain of significant ear pain and may have a fever. They may also feel unwell and complain of reduced hearing in the affected ear. They may complain of problems with balance.

Symptoms in babies and younger children

In pēpi and younger tamariki, sometimes the only sign of an ear infection is a fever.

Younger tamariki may also:

• cry and become very upset, distressed, irritable and hard to settle
• have very disturbed sleep at the beginning of the infection
• become 'clingy' and 'grizzly'

Burst ear drum

Sometimes pus will burst through the eardrum. The pus looks like snot coming out of the ear. When the eardrum bursts, tamariki often feel better as the pressure causing the pain is suddenly released. The burst eardrum usually heals without treatment or future problems. 

See a health professional if this happens. Your doctor may give your child antibiotic ear drops.

The image below shows an ear infection that has led to a burst ear drum.

Can you catch middle ear infections?

Ear infections cannot be passed on from one person to another, but the cold or other infection which caused them can.

When to see a health professional for an ear infection

If you think your child may have an ear infection, see a health professional. They will talk with you about what you have noticed in your child and look into their ears with an otoscope. An otoscope is a small powerful light with a magnifying lens.

Holding your child while the health professional looks in their ears

Most pēpi nd tamariki do not like having their ears examined. To make it easier, your health professional will probably encourage you to:

• hold your child sitting sideways on your lap
• hug their arms firmly with one of your arms
• hold their head firmly against your chest with your other arm

Treatment for an ear infection

Pain relief

Regular pain relief is important to help your child feel more comfortable. Paracetamol and/or ibuprofen can help reduce pain, and also lower fever which can make your child feel better. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose. 

Safe Use Of Paracetamol

Antibiotics

Ear infections do not usually need treatment with antibiotics. After one week, at least 3 out of 4 tamariki will be better whether they take antibiotics or not. 

The decision about whether or not to use antibiotics may depend on some of the following:

• whether your child has a high fever or severe pain
• how old your child is - your doctor is more likely to give antibiotics if your child is under 3 years old
• if your child still has pain or discomfort after 48 hours of pain relief
• how often your child has had middle ear infections before
• whether your child has ever had complications from ear infections before
• whether your child has any other medical conditions
• your views on how to manage your child's ear problems

Caring for your child with an ear infection at home

• give your child the pain relief suggested by your doctor
• your child may need rest and lots of comforting and cuddles
• keep your child home from child care or school while they are unwell or have a fever

There is no evidence that decongestant medicines (including nose sprays) and antihistamines are of any benefit in the treatment of acute ear infections. Don't use them as they can have unwanted side-effects.

How long an ear infection lasts

The pain from an ear infection comes on rapidly and doesn't last long. It usually wears off within 24 hours.

After an ear infection, your child may have fluid behind their eardrum (effusion). This can last several weeks to months. It may cause your child to have a continuing feeling of discomfort in their ears. It is more a dull, abnormal feeling than a nasty, sharp pain. The fluid also causes a short-term decrease in hearing in that ear.

Glue Ear

When to go back to a health professional for an ear infection

Once an ear infection is diagnosed, your child should start to improve within 24 to 48 hours. Go back to a health professional if:

• an earache is not settling after 2 days
• fluid starts coming out of your child's ear
• your child seems more unwell

There are some very rare complications of ear infections. Go back to a health professional immediately if your child:

• has any swelling, redness or tenderness in or around the ear (this could be mastoiditis)
• is feeding poorly
• is floppy, sleepy or drowsy
• is becoming less responsive
• is not interested in surroundings (lethargic)
• complains of a stiff neck or light hurting their eyes (this could be meningitis)

Frequent ear infections

If your child gets frequent ear infections, they may need to see an ENT (ear, nose and throat) specialist to consider grommets.

Grommets

Possible long-term complications from ear infections

Most tamariki outgrow ear infections and will have perfect, undamaged ears and normal hearing.

The fluid that collects behind the eardrum (called an effusion) can last for weeks to months after the pain of an ear infection is over. Within 12 weeks, the fluid is usually gone in 8 out of 10 tamariki.

Hearing loss

Hearing loss is the main complication of ear infections. Make sure your child has the B4 School Check and has their hearing tested.

B4 School Check

Hearing & Communication

A hole in the eardrum that doesn't heal

If your child has had a hole in the eardrum (eardrum perforation), it can become long-lasting with fluid leaking from the ear. Sometimes an operation to repair the perforation may be necessary but usually not before the age of 8.

Preventing ear infections

It is not easy to prevent ear infections, but the following may help reduce the risk:

• making sure your child's environment is smoke-free. 
• breastfeeding your baby for at least 3 to 6 months is thought to be protective against the early development of ear infections - this may be because breastfeeding boosts the immune system
• keeping your child's room warm and dry
• making sure your child has all their vaccinations on time

Keeping Your Home Warm & Dry