Otitis Media

Advice intended for parents/carers taking their child home after seeing a hospital based healthcare professional

The middle ear is the small space behind the eardrum; this space is usually filled with air. Otitis media is an infection of the middle ear that causes inflammation and a build up of fluid, which can then become infected by bacteria or viruses. It is often extremely painful.

Symptoms

  • Earache
  • Fever may be present
  • Misery
  • Pulling, tugging or rubbing ear
  • Slight hearing loss

In most cases, the symptoms of a middle ear infection develop quickly and resolve in a few days. In some cases, pus may run out of the ear, this is the fluid that had built up behind the ear drum causing a small hole in eardrum, this tends to resolve with no intervention required.

Causes

The Eustachian tube is a small tube that links the middle ear to the back of the throat. It's main job is to regulate air pressure in the ear. Its other function is to drain any fluid or mucus that builds up. The common 'cold' can cause the Eustachian to become blocked, causing a build up of fluid or mucus.

Treatment

Most middle ear infections are caused by viral infections and resolve with 3-5 days without treatment. Paracetamol or Ibuprofen can help ease the pain caused by the build up of fluid.

Antibiotics are usually considered if your child:

  • Is less than 2 years old with an infection in both ears
  • Has pus draining from the ear and fever
  • Has a serious health condition that makes them more vulnerable to complications

Treatment with intravenous antibiotics (given into a vein) is occasionally considered for extremely severe cases.

Some children who need intravenous antibiotics are admitted to hospital initially whilst the majority can be looked after at home. These children would come into hospital once a day for someone to look at them and for their antibiotics to be given.

The decision on when to change from intravenous to oral antibiotics (tablets or liquid) will be made by the medical team caring for your child. This will depends on how quickly your child responds to treatment (improvement in fever, pain and sometimes their blood tests) and whether your child has other health conditions. Antibiotics are usually given for a total of 5 days. You can give regular pain relief (Paracetamol or Ibuprofen) until any discomfort his improved.

Complications

Most children recover without any complications. Complications of middle ear infections are rare, but can be serious if they do occur. Most complications are due to the infection spreading to another part of the ear or head, including:

  • Mastoiditis (infection of the bone behind the ear)
  • Labyrinthitis (infection affecting the inner ear)
  • Meningitis (inflammation of the lining of the brain)

If you are concerned that your child's condition is getting worse, you should contact your discharging ward.

Things to look out for include:

  • Fever
  • Fast heart beat
  • Fast breathing
  • Changes in behaviour, such as confusion or disorientation
  • Increase in pain
  • Swelling behind the ear, causing the ear to push forwards

Call 999 for ambulance if you have serious concerns for your child.

Prevention

It is not possible to prevent ear infections; however, you can do things that may reduce your child's chances of developing the condition.

  • Ensure your child is up-to-date with their immunisations
  • Avoid exposing your child to smoky environments (passive smoking)
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