Beat the Earache, Ear Pain and Ear Infection

Managing (Middle) Ear Infections

Middle ear infections are typically identified by a rapid onset of symptoms such as ear pain, discharge from the ear, hearing loss, and/or fever, along with visible changes in and behind the eardrum (which a doctor can check).

Key Points:

• Acute otitis media (middle ear infection) is usually self-limiting and most common in young children, particularly those under four years of age.
• The infection can be caused by both viruses and bacteria, often making it difficult to tell which is responsible (both may be present).
• Symptoms typically last about 3 days but may continue for up to a week.
• Most children recover within 3 days without needing antibiotics.
• Recurrent symptoms tend to improve as children get older, often by age 3-4 years.
• Serious complications, such as mastoiditis, are rare.

Risk Factors for Developing Middle ear infections:

• Young age
• Exposure to smoking, including passive smoke
• Regular contact with other children, such as in nurseries, or having siblings
• Formula feeding (breastfeeding can be protective)
• Facial abnormalities, like a cleft palate
• Dummy use
• Drinking from a bottle while lying down
• Family history of ear infections
• Lack of pneumococcal vaccination
• Tummy reflux
• Premature birth
• Frequent colds or coughs
• Weakened immune system

Symptoms of Middle Ear Infections:

Rapid  onset of symptoms:

• In older children and adults: ear pain/ earache.
• In younger children: signs like pulling, rubbing, or tugging at the ear, or non-specific symptoms such as fever, crying, poor feeding, restlessness, irritability, cough, or nasal discharge. These symptoms can also occur with common colds and aren’t specific to ear infections.

A doctor can confirm the infection by examining the eardrum for changes.

Serious Symptoms (“Red Flags”) Indicating Possible Complications:

Seek medical help immediately if you notice:

• Headache, blurred vision, nausea, or vomiting
• Heightened sensitivity to light, dizziness, vertigo, or fever
• Swelling, redness, or pain behind the ear
• Asymmetry of face
• In infants under 3 months with a temperature of 38°C or more, or 39°C in those aged 3-6 month

Managing a Middle Ear Infection at home

• Most infections improve within 3-7 days on their own.
• Pain relief with regular paracetamol or ibuprofen can be very effective. Give the correct dose based on the child’s age or weight, and use maximum doses for severe pain.
• Decongestants and antihistamines are not effective in treating middle ear infections.
• No special restrictions on daily activities are needed, though swimming should be avoided if there is a perforated eardrum. Air travel might also worsen ear pain.
• Children can return to school or daycare once they no longer have a fever and their      ear pain has resolved.

When to Seek Medical Advice:

• If  symptoms worsen quickly or significantly
• If  symptoms don’t improve within 3 days
• If your child or young person appears very unwell
• Your child has ear discharge
• Your child has symptoms in both ears and they are under 2 years of age.
• Your child has weakened immunity
• Your child has any of the 'red flag' signs mentioned above

Your doctor may prescribe pain-relieving ear drops if:

• Oral antibiotics are not being given straight away, and
• There is no perforation (tear) in the eardrum or any discharge from the ear.

Treatment Advice Regarding Antibiotics

Your doctor may decide not to prescribe antibiotics immediately because:

• Antibiotics often make little difference to symptom improvement in the first 24 hours      and only marginally improve symptoms after that.
• Antibiotics have minimal impact on the prevention of common complications, such as      eardrum perforation or recurrent infections.
• The risk of acute complications is low, whether or not antibiotics are used.
• Antibiotics can cause side effects like diarrhoea and nausea.

It may be that your doctor provides a “back-up” antibiotic prescription. In these cases, it’s important to follow these guidelines:

• Remember that an antibiotic is not needed immediately.
• Use the prescription if symptoms don’t improve within 3 days or if they suddenly      worsen.
• Seek medical help if symptoms rapidly worsen, or the child becomes unwell.

When Antibiotics May Be Necessary

Your doctor may prescribe antibiotics right away if:

• There is discharge from the ear.
• Both ears are infected in a child under 2 years.
• There are signs of a more serious infection, especially if the child seems very      unwell or has any “red flag” symptoms.
• The child’s condition worsens at any time or shows no improvement after 3      days.
• The child has a weakened immune system.

Ultimately, your doctor will carefully assess your child to decide if antibiotics are needed, as the symptoms may be due to another cause rather than a middle ear infection.

Hope that the above information takes some of the panic away when managing your child with common ear infections!