Ear infection (Otitis media)What is otitis media?Otitis media is another name for an infection ofthe middle ear. The middle ear is the spacebehind the eardrum. It can become infected bybacteria or viruses.

Causes of otitis mediaThe Eustachian tube connects the ear to the backof the throat and helps ventilate (air) and drainthe middle ear. Otitis media occurs when mucusor swollen tissues from a cold block theEustachian tube. The blockage has two mainresults.

It prevents the tube from ventilating themiddle ear. This leads to changes in airpressure and possible pain, much like whatoccurs in an airplane during take-off orlanding.It causes fluid to build up in the ear and trapany bacteria that are already there. The fluidbuild-up can become infected and putpressure on the eardrum, which makes itbulge. This can be painful.

Who is most at risk for otitis media?Otitis media is most common in childrenbetween the ages of six months and two years,

Ear anatomy

The ear has three sections: the outer ear, the middle ear, and the inner ear. Eachsection is made up of smaller parts that work together to help you hear.

but it can occur throughout childhood. Mostchildren will have at least one ear infection.Some children will have many of them.

Children are at higher risk for middle earinfections because their Eustachian tubes areshorter and more likely to be blocked byenlarged adenoids. However, as a child getsolder, their ear structures change and they growout of the tendency to have ear infections.

Symptoms of otitis mediaIf a child develops otitis media, it usuallyhappens after they have first had an upperrespiratory tract infection such as a cold. In

children, the signs and symptoms of otitismedia include:

feverearachepulling or rubbing the earcryingnot sleeping wellfluid draining from the ear.

In some children, the eardrum develops a smallperforation (hole) because of the pressure in theear. The ear then drains a cloudy or yellow fluid.The hole usually heals within a week or so. Insome children, repeated ear infections and

Otitis media

In otitis media, the Eustachian tube is blocked. Fluid and pressure then build up inthe middle ear. This makes the eardrum bulge outward and causes pain.

2

perforations can lead to scarring of the eardrumand longer-term hearing problems.

How your child's doctor diagnoses otitismediaYour child’s doctor will need to examine yourchild to properly diagnose otitis media. Theywill look for any fluid in your child’s ear andany change in the eardrum. The physical examwill also include a check of your child's neckand throat to see if there are any swollen lymphnodes.

How to care for your child with otitismedia

Pain and fever reliefGive your child acetaminophen or ibuprofen tohelp with any earache. These medicines usuallybegin to work within an hour. If your childneeds an antibiotic (see below), continue givingpain relief until the antibiotic takes effect. Thepain medicine will not affect the antibiotic.

AntibioticsNot all ear infections need antibiotics. If theotitis media seems mild and your child is olderthan six months, your doctor may suggestavoiding antibiotics for a day or so to see if theinfection goes away on its own.

Your child’s doctor is more likely to prescribeantibiotics when:

the otitis media looks worseyour child has a lot of pain or a high fever.

Your child’s doctor may also prescribe antibioticear drops if your child’s eardrum has burst and isdraining fluid.

Antibiotics will kill the bacteria that have causedthe ear infection. Although your child shouldfeel better in a few days, you must continue givethe antibiotic until it is finished. This will keepthe ear infection from returning and reduce thechance of your child getting an infection that isharder to treat with antibiotics in the future.

Day care and schoolYour child can go back to day care or schoolwhen the fever is gone and they feel better.Otitis media does not pass from one person toanother.

Other everyday activitiesYour child can go outside and need not havetheir ears covered. If the eardrum has perforated(burst), your child should avoid swimming untilit has healed.

FlyingFlying in an airplane with an ear infection canmake an earache worse and increase the chancethat the eardrum will burst. However, it does notcarry any other risks. Even still, you may decideto avoid flying until symptoms pass.

If flying is unavoidable, bring pain medicinewith you on the plane. During take-off andlanding, have your child suck on a pacifier(soother), drink fluids or chew gum. Swallowingoften will help your child balance the pressure intheir ears.

3

Follow-up appointmentOnce your child finishes the antibiotic, you maywant to make another appointment with theirdoctor. The doctor will make sure that your childno longer has symptoms and will check if anydamage to the eardrum has healed.

If there is fluid behind the eardrum, it can lastfor weeks or months. The fluid will normallyclear on its own, but your child's doctor maywish to monitor your child so they can check forany hearing loss. They may refer your child fora hearing test if needed.

How to prevent otitis mediaColds can lead to otits media. Try to keepyour child away from people with colds,especially before your child is 12 months old.For young children with frequent illnessesand repeated ear infections, you may want toavoid large day care centres during yourchild’s first year. Consider having a sitterwatch your child in your home or at a smallhome-based day care.Wash hands and your child’s toys often.Schedule your child’s vaccinations (shots)when they are due. Vaccinations such as theflu shot for influenza and the pneumococcalvaccine that is part of the routine vaccinationschedule offer protection against acute otitismedia.Protect your child from second-hand tobaccosmoke. Exposure to tobacco smoke canincrease the number of infections.If you can, offer your child only breast milkfor at least the first three months. Theantibodies in breast milk may reduce the rateof ear infections and reduce the risk of acute

otitis media for your baby during the first sixto 12 months of life.If you bottle-feed, avoid propping the bottle.This causes the baby to suck excessively andgenerate extra pressure within the Eustachiantube.If your child has had otitis media, try phasingout the use of a pacifier (soother). Using apacifier may increase the risk of repeated earinfections.Consider seeing your doctor if your toddlersnores or breathes through their mouth. Thiscan be a sign of large adenoids, whichincrease the risk of ear infections. Yourfamily doctor can refer your child to aspecialist to check their adenoids if necessary.

When to see a doctor about otitis mediaCall your child’s doctor if:

your child’s fever or pain is not better aftertaking an antibiotic for 48 hoursfluid is always draining from their earyou are concerned about your child’s hearing.

Take your child to the nearest emergencydepartment or call 911 if:

the pain gets worse, even after your childtakes pain medicineyour child’s neck gets painful or stiffyour child seems lethargic (sleepy) or veryirritable (cranky)your child is vomiting (throwing up)repeatedly and cannot keep down theirmedicines or enough fluidsyour child has redness and swelling behindtheir ear

4

your child’s ear seems to stick outyour child develops a rash, a puffy face orpuffy lips while taking the antibiotic.

Key pointsOtitis media is an infection of the middle ear.It is common in children, especially betweenthe ages of six months and two years.The infection can occur because of bacteriaor viruses.Give pain and fever medicine as needed. Waitand monitor your child before starting any

antibiotics if they are usually healthy andaged over six months.You can prevent repeat middle ear infectionsby washing your hands and your child’s toys,following routine vaccination schedules andprotecting your child from second-handsmoke.See your doctor if your child’s symptoms donot ease after taking an antibiotic for 48hours. Go to your nearest emergencydepartment if your child’s pain gets worse oryour child is lethargic or vomiting.

5