Ear infections (otitis media) in children
Ear infections, also called otitis media, are a common problem in children. About 50 percent of infants have at least one ear infection by their first birthday. Ear infections can cause pain in the ear, fever, and temporary hearing loss and general signs such as loss of appetite and irritability. Some children get better without specific antibiotic treatment but most young infants benefit from use of an antimicrobial agent.
What is an ear infection?
Ear infection, technically called otitis media, is an infection of the middle part of the ear. Ear infections often occur in children after they get a cold. Fluid can build up in the middle part of the ear behind the eardrum. This fluid can become infected and press on the eardrum, causing it to bulge
Does my child have the risk factors?
The risk factors in our population include:
- Age less than 5 years
- Frequent colds
- Day care attendance
- Smoker in the house
- Enlargement of adenoids
- Other conditions like Down’s syndrome and Cleft Palate
What are ear infection symptoms?
Children may present with specific symptoms such as:
- Ear ache or pain
- Ear tugging or pulling
- Discharge from the ear
- Temporary hearing impairment
Other non-specific symptoms include:
- Irritability or fussiness
- Vomiting and diarrhea
- Lack of appetite
- Decreased activity
How is an ear infection diagnosed?
Although the exam is not painful, most infants and children do not like having their ears examined. To make the process easier, hold your child in your lap and hug your child’s arms and body while the doctor uses an instrument (otoscope) to look inside the child’s ear.
It can be hard to tell for sure if a child has an ear infection. When the clinician is able to see clearly inside the ear and sees all of the typical features of ear infection, the diagnosis is certain. When all of the typical features are not present, the diagnosis is less certain. In this case, the doctor will work with you to decide what treatment is best. Often cerumen (ear wax) will need to be removed so your doctor can get a good view of the ear drum.
What are the treatment options?
Treatment of an ear infection may include:
- Medicines to treat pain and fever
- A combination of the above
The “best” treatment depends on the child’s age, history of previous infections, and any underlying medical problems.
Antibiotics-they are utilised when the diagnosis is certain, when the child has severe symptoms (high fever and/or disease in both ears), or when the child is less than 2 years. Children above 2 years, infection in one ear, uncertain diagnosis or non-severe symptoms may be observed initially and most heal without antibiotics. Studies both locally and internationally have demonstrated that older children improve without antibiotics. Antibiotics can have side effects such as diarrhea and rash, and overusing antibiotics can lead to more difficult to treat (resistant) bacteria. Resistance means that a particular antibiotic no longer works or that higher doses are needed next time.
Pain and fever management-medicines such as paracetamol, ibuprofen and diclofenac act to relieve pain and fever and aim to reduce the discomfort.
Observation-In some cases, your child’s doctor will recommend that you watch your child at home before starting antibiotics; this is called observation. Observation can help to determine whether antibiotics are needed.
Observation may be recommended in these situations:
- If it is not clear whether the child has an ear infection, based upon the exam
- If the child is older than 24 months
- If ear pain and fever are not severe
- If the child is otherwise healthy
You can give pain-relieving medicines during observation to ease pain.
If your child is being observed rather than treated with antibiotics, you will need to call or go back to the doctor’s office after 48 hours for follow-up. If your child’s pain or fever continues or worsens, antibiotics are usually recommended; observation may continue if the child is improving.
Follow-up- Your child’s symptoms should improve within 24 to 48 hours whether or not antibiotics were prescribed. If your child does not improve after 48 hours or gets worse, call your doctor for advice. Although fever and discomfort may continue even after starting antibiotics, the child should get a little better every day. If your child appears more ill than when seen by his or her health care provider, contact the provider as soon as possible.
Children who are younger than two years and those who have language or learning problems should have a follow-up ear exam two to three months after being treated for an ear infection. These children are at risk for delays in learning to speak. This follow-up helps to ensure that the fluid collection (which can affect hearing) has resolved
What are the complications of ear infection?
Ear drum rupture — One of the common complications of an ear infection is rupture of the ear drum, also known as the tympanic membrane. The tympanic membrane can rupture when fluid presses on the membrane, reducing blood flow and causing the tissue to weaken. It does not hurt when the membrane ruptures, and many people actually feel better because pressure is released. Fortunately, the tympanic membrane usually heals quickly after rupturing, within hours to days. Rupture of the ear drum is an indication for antibiotic treatment of an ear infection.
Hearing loss — The fluid that collects behind the eardrum (called an effusion) can persist for weeks to months after the pain of an ear infection resolves. An effusion causes trouble hearing, which is usually temporary. If the fluid persists, however, it can interfere with the process of learning to speak.
Effusions usually resolve without any treatment. However, if the effusion persists, the child may need treatment. The decision to treat is based upon how much the effusion affects the child’s hearing and the child’s risk of speech problems.
Children who are not treated for an effusion should be monitored over time. This includes an ear exam and hearing testing every three to six months until the effusion goes away.
Treatment — The best treatment for an effusion that does not resolve is a surgical procedure. During the procedure, fluid is drained from the middle ear by making a small opening in the tympanic membrane (called myringotomy) and placing a tube to maintain the opening (called a tympanostomy tube or grommet). This procedure usually is performed by an ear, nose, and throat surgeon in a hospital while the child is under general anesthesia.
The benefit of surgery is improved hearing. The risks of surgery include a small chance of damage to the tympanic membrane
How do I prevent ear infection?
Some children develop ear infections frequently. Recurrent ear infections are defined as three or more infections in six months, or four or more infections within 12 months. Several treatments can help reduce the risk of recurrent infections, including continuous low dose antibiotics and/or surgical placement of tubes in the ears. Up to date immunization is crucial.
- Scott-Brown’s Otorhinolaryngology Head and Neck Surgery. 7th UK: Hodder-Arnold; 2008, vol 1, page 880.
- Kiama AM. Prevalence of Otitis Media with effusion in children with obstructive adenoid disease compared with normal controls in Kenyatta National Hospital. (Unpublished data). 2014.
- Mugweneza A. Risk factors for otitis media with effusion in children at Kenyatta National Hospital. (Unpublished data). 2015.
- Kalu, Stella U., et al. “Clinical spectrum of acute otitis media complicating upper respiratory tract viral infection.” The Pediatric infectious disease journal2 (2011): 95.
- Coco, Andrew, et al. “Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.” Pediatrics2 (2010): 214-220.
- Hoberman, Alejandro, et al. “Treatment of acute otitis media in children under 2 years of age.” New England Journal of Medicine2 (2011): 105-115
- Schilder, Anne GM, et al. “Panel 7: Otitis Media: Treatment and Complications.” Otolaryngology–Head and Neck Surgery4_suppl (2017): S88-S105
- Acute otitis media. 2013.
The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.