Otitis media

Also called Middle ear infection, Ear infection

Very common in small children, usually viral, and usually better without antibiotics. The complications are rare and worth recognising.

What it is

Infection or inflammation of the middle ear, the space behind the eardrum. Most common between six months and two years, because children's eustachian tubes are shorter and more horizontal.

Most cases are viral, follow a cold, and settle within three days without antibiotics. Antibiotics shorten the illness by roughly a day and cause diarrhoea and rash in a fair proportion of children, which is why the standard approach is a delayed prescription rather than an immediate one.

Repeated infections or persistent fluid can cause glue ear, and glue ear during the years a child is learning to talk can hold back speech and language. That, rather than the infection itself, is the reason to keep an eye on the pattern.

Rare complications matter: infection spreading to the mastoid bone behind the ear, or, very rarely, further. The signs are specific and worth knowing.

Signs you might notice

Ear pain, and in a baby, pulling or rubbing at the ear, crying, being unsettled, and not feeding.

Fever, being off food, poor sleep.

Discharge from the ear, which often means the eardrum has perforated. That usually relieves the pain and usually heals.

Reduced hearing during and for some weeks after.

Same-day or 999: swelling, redness or tenderness of the bone behind the ear, the ear being pushed forwards, severe headache, neck stiffness, drowsiness, confusion, dizziness, or facial weakness.

How it can affect day-to-day life

The hearing loss after an infection can last weeks, and a child who seems to be ignoring instructions may simply not be hearing them. Teachers and parents commonly read it as behaviour.

Recurrent infections through a winter are exhausting for a family and are usually not a sign of anything more serious, but they are worth counting: the number in a year is what a specialist wants to know.

Adults get middle ear infections too, and a persistent one-sided ear problem in an adult, especially with hearing loss, needs proper assessment rather than repeated antibiotics.

For children with Down's syndrome or cleft lip and palate, middle ear problems are much more common and hearing should be watched closely.

Supporting someone well

Pain relief first: paracetamol or ibuprofen at the right dose for weight is the treatment that matters most in the first days.

Accept a delayed prescription and use it only if things are not improving after three days or are getting worse.

Do not put anything in the ear, including drops, unless a clinician has said so, and keep the ear dry if it is discharging.

Count the episodes over a year and take that number to the GP; it is what triggers referral.

Get hearing checked if speech is not developing as expected, or if a child is turning the television up, mishearing or becoming withdrawn.

Learn the mastoiditis signs above. It is rare and it is an emergency.

Where to get help

A pharmacist or GP practice for pain and assessment.

A GP for recurrent infections, persistent discharge, or hearing concerns, asking about referral to ear, nose and throat.

Audiology for hearing testing after repeated infections.

ENT UK publish patient information leaflets on ear infections and glue ear.