An expert's guide to ear infections in children

Ear infections occur when bacteria or a virus causes an infection deep within the ear. Esteemed consultant ENT surgeon Mr Guna Reddy-Kolanu explains why children are more susceptible to developing ear infections than adults. The Surrey-based surgeon outlines the symptoms a child with an ear infection might have and what recovery generally looks like, including whether doctor intervention is always necessary.  

What are the main causes of ear infections in children? 

Children under the age of 10 years are much more prone than older children and adults to infections in the middle ear, the small space that's deep behind the ear drum. Older children and adults usually get infections in the ear canal but not in the middle ear. 

The eardrum acts as a barrier, protecting the middle ear. The only direct connection to the middle ear is via a narrow tube, the eustachian tube, connecting it to the back of the nose passages. Infections in this area occur when bacteria or viruses that are breathed in, enter the back of the nose, travel up the eustachian, and infect the middle ear.  Young children, naturally, have not had the time to develop immunity to many of the bacteria or viruses in the air. As most children encounter large groups of people in enclosed spaces, such as at school or at nursery, they can easily breathe in infections.  

The purpose of the eustachian tube is to equalise the air pressure in the middle ear space with the surrounding environment. They normally mature to full functionality by the age of 10. In younger children, the eustachian tubes often do not work well. As a result, the middle ear space is under a different pressure from the child’s surroundings. This causes inflammation in this area and fluid fills the middle ear space. This fluid can harbour infections. 

A number of the main causes are unavoidable. They are firstly being young; having inefficient eustachian tubes and not having developed immunity to many infections. Secondly, being in large groups indoors, at school or nursery. The main significant factor that can be controlled, however, is exposure to smoke. Children in families of smokers are more prone to ear infections. 

How do you tell if your child has an ear infection? 

Identifying an ear infection in children can be difficult, especially in a child that is too young to tell you that their ear hurts. The basic symptoms are that the child is upset and has a temperature. Some children rub or pull at their ears. A doctor looking in a child's ear will see a red eardrum. Sometimes the infected fluid deep in the eardrum will cause a tear in the eardrum and blood with infected fluid will leak out of the ear. This is commonly called a burst eardrum. Once the eardrum bursts, often the child will feel much less pain. The majority of burst eardrums heal within a couple of weeks. 

Do I need to take my child to a doctor for an ear infection? 

If you feel your child has an ear infection, the first thing to do is to treat the pain with children's paracetamol and ibuprofen. It would be reasonable to contact the GP in the daytime for a routine appointment. At least half of all ear infections will settle within 3 days, so simply treating the pain until it settles is all that is needed. In some children, the infection will not settle and they may need a course of oral antibiotics. The GP will be able to record the infection in your child's notes and children having frequent ear infections will be referred to an ENT specialist. 

Children will rarely need to urgently go to the emergency department with an ear infection. In such instances, the child might have swelling that builds up behind the ear, pushing the ear forward. Also, if your child becomes drowsy and lethargic. These children will be admitted to the hospital for more intensive treatment. 

Will ear infections go away without antibiotics? 

At least half of children's ear infections will go away without antibiotics.  Most can be simply treated with regular children's paracetamol and ibuprofen. Most infections settle within 3 days. 

What happens if an infection goes untreated? 

If an infection does not settle within a few days and if no further treatment is used, firstly the child will remain in pain for a significantly extended period.  In this period, the infected ear will be deafer. Nevertheless, many cases may just require extra time to heal. 

If the infection progresses, the infection will spread to the bone behind the ear. From here, it may progress outwards, towards the skin, and start leaking out. It may track down the muscles lower down the neck and cause an abscess in the muscle. Most seriously it can spread inwards and cause a brain infection which is potentially life-threatening. 

If you would like to know more about treatment options for severe ear infections in children, you may be interested in booking a consultation with Mr Guna Reddy-Kolanu, which you can do directly via his Top Doctors profile.