Ear infection (middle ear) | Pokenga taringa

Middle ear infections often happen either during or just after a cold, when there are bacteria or viruses present in the back of the nose. They can travel up your eustachian tube from the back of the nose to the space behind your eardrum (middle ear). This happens more easily in young tamariki when the eustachian tube is short. 

The infection causes swelling and can block the eustachian tube, which means air can't reach the middle ear. Fluid and pus collect in the middle ear. The eardrum becomes red and inflamed and can bulge outwards. The inflammation and stretching of the eardrum is what causes ear pain. While there's fluid behind the eardrum, your child’s hearing can be reduced. Some tamariki with an ear infection can also have a fever.

The pressure that builds in the middle ear can sometimes cause the eardrum to burst. 

The image below shows the anatomy of the ear, including the eardrum, middle ear and eustachian tube.

Image credit: Depositphotos

Ear infections are most common in pēpi (babies) and young tamariki. They're more likely to develop ear infections than older tamariki and adults. This is because their eustachian tubes (connecting the middle ear to the back of the nose) don't function as well as in older tamariki and adults – the tubes are smaller, shorter and flatter (more horizontal).

As tamariki grow older, their eustachian tubes work better and they also tend to get fewer colds. As a result, they usually outgrow having ear infections at about 7 or 8 years of age. However, some tamariki may have problems beyond this age.

Things that put children at risk of getting ear infections

We know some important risk factors, but not all the reasons why some tamariki develop more ear infections than others. The most important risk factors include:

• a family history of ear infections
• living with someone who smokes
• going to early childcare – pēpi and tamariki are exposed to more colds and viruses
• having an older brother or sister in childcare or early primary school
• the season – ear infections are more common during the autumn and winter months
• having significant nasal allergies (allergic rhinitis or 'hayfever').

Can you catch middle ear infections?

Ear infections can't be passed on from one person to another, but the cold or other infection which caused them can.

The pain from an ear infection comes on quickly and usually doesn't last long. It usually improves within 24 to 48 hours.

After an ear infection, it's normal to have some fluid behind the eardrum (effusion). This can take a few weeks to drain away (down the eustachian tube). It may cause your child to have an ongoing feeling of discomfort or blockage in their ears. It's more a dull, abnormal feeling than a nasty, sharp pain. The fluid also causes a short-term decrease in hearing in that ear, which goes back to normal as the fluid clears away. They may hear some crackling or popping noises, which is a good sign that the fluid is clearing.

Symptoms in older children

Symptoms of an ear infection in older tamariki can include:

• significant ear pain
• fever
• feeling unwell
• complaints of reduced hearing in the affected ear
• problems with balance.

Symptoms in babies and younger children

In pēpi and younger tamariki, sometimes the only sign of an ear infection is a fever.

Younger tamariki may also:

• cry a lot and become generally irritable
• be hard to settle and have very disturbed sleep, getting more upset when they lie down
• become 'clingy' and 'grizzly'
• not drink or eat as much as usual.

Burst ear drum

Sometimes pus will burst through the eardrum. The pus can look like snot coming out of the ear. When the eardrum bursts, tamariki often feel better as the pressure causing the pain is suddenly released. The burst eardrum usually heals without treatment or future problems. 

See a healthcare provider if you think your child has a burst eardrum. They may give your child antibiotic ear drops.

Go to your healthcare provider if you think your child has an ear infection

If you think your child has an ear infection, take them to see a healthcare provider. 

When to take your child back to a healthcare provider

Go back to a healthcare provider if:

• your child's earache isn't settling after 2 days
• fluid starts coming out of your child's ear
• your child seems more unwell.

When to go back to a healthcare provider urgently

There are some very rare complications of ear infections. Go back to a healthcare provider urgently if your child:

• has any swelling, redness or tenderness in or around the ear (this could be mastoiditis)
• isn't feeding well
• is floppy, sleepy or drowsy
• is becoming less responsive
• is not interested in their surroundings (lethargic)
• complains of a stiff neck or light hurting their eyes (this could be meningitis).

Go to your healthcare provider again 4 to 6 weeks after the ear infection

Always take your child to your healthcare provider for an ear check after any ear infection, to make sure the ear fluid has gone. Go to your healthcare provider again 4 to 6 weeks after the ear infection.

If your child gets frequent ear infections, they may need to see an ENT (ear, nose and throat) specialist to consider grommets.

Your healthcare provider will talk to you about your child’s symptoms and look into their ears with an otoscope. An otoscope is a small powerful light with a magnifying lens.

Holding your child while the health professional looks in their ears

Most pēpi and tamariki don't like having their ears examined. To make it easier, your healthcare provider will probably encourage you to:

• hold your child sitting sideways on your lap
• wrap one of your arms gently over their arm
• gently hold their head against your chest with your other hand.

Video: Ear exam with an otoscope

This video shows a health professional looking inside a young boy's ear canal with an otoscope. 

Pain relief

Regular pain relief is important to help your child feel more comfortable. Paracetamol and/or ibuprofen can help reduce pain and lower fever, which can make your child feel better. You must follow the dosage instructions on the bottle. It's dangerous to give more than the recommended dose. You can use our paracetamol dose calculator and ibuprofen dose calculator to find out how much to give your child.

Antibiotics are often not needed

Ear infections don't usually need treatment with antibiotics, particularly if your child is over 2 years of age. After one week, at least 3 out of 4 tamariki will be better, whether they take antibiotics or not. 

The decision about whether or not to use antibiotics may depend on some of the following:

• whether your child has a high fever or severe pain
• how old your child is – your healthcare provider is more likely to give antibiotics if your child is under 2 years of age
• if your child still has pain or discomfort after 48 hours of pain relief
• how often your child has had middle ear infections before
• whether your child has ever had complications from ear infections before, like a burst eardrum
• whether your child has any other medical conditions
• your views on how to best manage your child's ear problems.

Things you can do at home when your child has an ear infection include:

• giving your child regular pain relief, as recommended by your healthcare provider
• giving your child lots of comfort and cuddles
• letting your child rest
• keeping your child home from child care or school while they're unwell or have a fever.

There's no evidence that decongestant medicines (including nose sprays) and antihistamines are of any benefit in the treatment of acute ear infections. Don't use them as they can have unwanted side effects.

Most tamariki outgrow ear infections and will have normal, undamaged ears and normal hearing.

The fluid that collects behind the eardrum (called an effusion) can last for weeks to months after the pain of an ear infection is over. The fluid clears up within 12 weeks for 80% of tamariki. 

Hearing loss

Hearing loss is the main complication of ear infections. Make sure your child has the B4 School Check and has their hearing tested.

A hole in the eardrum that doesn't heal

If your child has had a hole in the eardrum (eardrum perforation) after an infection, it'll usually heal on its own. If perforation happens more than once, or if the infection causes a larger hole, sometimes it doesn’t heal. Tamariki sometimes need an operation to repair the hole, but usually this isn’t done until after the age of 8. 

A hole in the eardrum can sometimes cause problems with frequent leaking from the ear. Your child may need earplugs or other measures to try to keep their ear healthy until they're old enough to have the hole repaired.

It isn't easy to prevent ear infections, but the following may help reduce the risk:

• making sure your child's environment is smoke-free
• breastfeeding your baby for at least 6 months is thought to be protective against the early development of ear infections – this may be because breastfeeding boosts the immune system
• keeping your child's room warm and dry – read more about how to keep your home warm in winter
• making sure your child has all their immunisations on time.