Middle ear infections
The germs spread up the back of the throat, along the connecting tube (Eustachian tube) and into the middle ear space. The medical name for a middle ear infection is acute otitis media.
Ear infections can affect anyone, but are particularly common and distressing in children; eight out of ten will have had an ear infection by the time they are three years old. They tend to be very painful as the eardrum becomes swollen from the pressure of the infection in the middle ear, and can cause a fever and dulled hearing. Children with ear infections may feel sick or vomit.
If the infection causes the eardrum to burst (perforate), the outer ear canal may become itchy and weepy from the discharge of fluid, and the severe pain will stop. As long as you have had medical advice, you do not need to do anything except keep the ear dry, but you may wish to mop out only the part of the ear that you can see, gently with a tissue.
Sometimes, after the ear infection has cleared up, fluid remains in the middle ear because it is unable to drain away. It can cause hearing difficulties which, in children, can be serious enough to affect long-term behaviour and development. The condition is called glue ear and it is important to alert your doctor to the symptoms.
How are middle ear infections treated?
In the majority of cases, an ear infection will get better naturally. However, it is important to seek medical treatment promptly as, whilst rare, complications from ear infection can be serious. Seeing a doctor is especially important if symptoms include:
- A high fever (above 39°C)
- A new rash, extreme floppiness/drowsiness, or intolerance to bright light
- No improvement in symptoms in a child under two after 48 hours
- No improvement in symptoms in a child over two, or adult, by four days
On the first visit, the doctor may prescribe pain relief, but not antibiotics. This is because overuse is causing bacteria to become resistant to the main antibiotics.
However, antibiotics may be prescribed if there has been no improvement after several days or if the child or adult is very unwell, or has complications. If they are prescribed, it is important to take the entire course.
If you do not have pain relief on prescription, paracetamol or ibuprofen are effective and can be purchased from a pharmacy.
It can also help to sit with a warm towel pressed gently against the painful ear or to put several drops of room temperature olive oil into the ear. However, keep water out and put nothing in the ear if a discharge suggests there may be a hole in the eardrum.
A vaccine against pneumococcal disease is now offered as part of the UK national childhood immunisation programme and a vaccine against a bigger range of bacteria may become more widely available. Vaccination can help reduce the number of children getting middle ear infections.