otitis media (earache)

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The middle ear is the small space behind the eardrum; this space is usually filled with . Otitis media is an infection of the middle ear that causes inflammation and a build-up of fluid. It is often extremely painful and be be associated with high fever.

Symptoms of otitis media:

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 the eardrum; this tends to heal up by itself.

Causes

Most cases of earache/otitis media in young children (under 5 years of age) are caused by viral infections; your child may also have a runny nose and cough. The Eustachian tube is a small tube that links the middle ear to the back of the throat. Its 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 and resulting in earache.

When should you worry?

If your child has any of the following:

Breathing very fast, too breathless to talk, eat or drink
Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
Breathing that stops or pauses
Is pale, blue, mottled or feels unusually cold to touch
Difficult to wake up, very sleepy or confused
Weak, high-pitched cry or can’t be settled
Has a fit (seizure)
Has a rash that does not go away with pressure (the ‘Glass Test’)
Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

Has pus coming out of their ear
Has pain, redness or swelling behind the ear
Severe headache persisting despite regular painkillers
Dizziness or is losing their balance
Breathing a bit faster than normal or working a bit harder to breathe
Dry skin, lips or tongue
Not had a wee or wet nappy in last 8 hours
Poor feeding in babies (less than half of their usual amount)
Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
Temperature less than 36°C in those over 3 months
Getting worse and I am still worried

You need to contact a doctor or nurse today.

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

Watch them closely for any change and look out for any red or amber symptoms
Additional advice is also available to young families for coping with crying of well babies – click here.
If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

Treatment

Most children with otitis media (earache) do no require treatment with antibiotics. Antibiotics rarely speed up recovery and often cause side effects such as rash and diarrhoea. They will also promote the development of antibiotic resistant bacteria in your child.

Antibiotics are usually only considered if your child:

Is under 6 months of age and has otitis media
Is between 6 months and 2 years of age with infection in both ears, or with associated symptoms such as altered sleep, fever and overwhelming misery
Has pus draining from their ear
Has a serious health condition that makes them more vulnerable to serious infection

In addition, if your child has any features of severe infection (amber or red features above), they will need to be urgently assessed by a healthcare professional

You can help relieve symptoms by: