‘E’ is for Ear – Otitis Media

Middle ear infections are a very common reason for kids to come and see their doctor and are a leading cause of hearing loss, particularly in developing countries. This is the first of three articles on Ear Nose and Throat (ENT) issues

What is otitis media?

Otitis media occurs when there is inflammation and infection of the middle ear, which can be caused by a virus or bacteria. Often it is associated with a cold or respiratory infection. The middle ear sits behind the tympanic membrane (or eardrum). It contains the three tiny ‘hearing bones’ that transmit sound from the eardrum to the inner ear, and connects to the eustachian tube ending in the upper throat.

Some children develop glue ear (or otitis media with effusion), often after an episode of otitis media. This tends to last a bit longer, sometimes several weeks, in which time a thick, glue like material collects behind the ear drum. It is so thick, it can struggle to drain through the eustachian tube.

Around 75% of children in Australia will have had an episode of otitis media before they start school. It becomes less common as we get older because, in a growing ear, the angle between the eustachian tube and wall of the upper throat changes and coughing and sneezing causes the passage to close, making it harder for infected mucus to move into the middle ear. Also, as the eustachian tube grows, it is easier for mucus to drain back out again.

It is no surprise it happens more in winter, and, interestingly, affects boys more than girls.

How do I know if my child might have Otitis Media?

If your child has developed an acute otitis media, you may notice they are tired, may become irritable, and have poor feeding. They could have a temperature, or complain of pain, and younger children may pull at their ear. If a doctor examines your child’s ear, we might see a discoloured eardrum that may be bulging, and even have an air-fluid level visible, like a spirit-level!

Other things that may cause pain in the ear include, infection of the ear canal, referred pain from teeth, trauma or the presence of a foreign body, for example a tiny piece of LEGO!

What should I do?

If you think your child has an ear infection, take them to a GP.

Some children may be sick enough to need to go straight to hospital.

All babies, under the age of 3 months, with a temperature of 38C or more, need to be seen in hospital immediately.

Generally, however, most children will be fine with paracetamol and ibuprofen to manage their fever and pain, plenty of drinks and lots of rest. A warm washer over the ear can also help to ease the pain.

In most cases, antibiotics are unlikely to make any difference to symptoms but may cause side effects and contribute to antibiotic resistance. If antibiotics are prescribed, be sure to complete the full course as advised, to prevent complications such as mastoiditis.

It has been shown that 60% of children will improve in 24 hours, and 80% will improve within three days.

If your child has had more than three episodes in six months, or more than four episodes in a year, it may be time to ask your GP to consider a referral to an Ear Nose and Throat (ENT) specialist. Similarly, if your child has speech, language or developmental problems, with recurrent infections, or glue ear, a specialist may consider inserting grommets (tiny tubes) into the ear drum. These help drain fluid from the middle ear.

Surgery aside, repeat episodes can be reduced by avoiding exposure to cigarette smoke, by trying to avoid the use of dummies, and by feeding your baby in a tilted position, rather than flat.

Very importantly, we all need to make sure, if possible, our children are up to date with their immunisations. The introduction of the pneumococcal vaccine has helped to dramatically reduce the incidence of otitis media and its complications.

So… In Summary

· Otitis media is a common condition in young children, with 75% of children having an episode before school age

· If you are concerned your child may have an ear infection, take them to their GP

· 60% of cases will improve within 24 hours

· In most cases antibiotics will make no difference to how bad the symptoms are, or how long the condition persists

· You must get your child checked again if their symptoms get worse, if their symptoms continue for more than a few days or if you are worried

· Ask about seeing a specialist if your child has had 3 or more symptoms in 6 months, 4 or more episodes in 12 months, or if your child has recurrent infections or persisting glue ear and speech, language or behavioural issues

About the author

Dr Samantha Pethen
Dr Pethen arrived in Australia in 2008 having worked on the South Coast of the UK since 1996. She has been with this practice ever since.
She is passionate about the art of General Practice as a whole, but particularly enjoys paediatrics, adolescent medicine and chronic disease management.

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