I have very vivid memories as a child of waking my parents up in the middle of the night crying and distressed with the intense pain of a middle ear infection.  I was one of those kids who was constantly back and forth from our local GP with recurrent infections and had multiple courses of oral antibiotics over the years (to this day I still can’t drink Dr Peppers as they remind me too much of the cherry flavoured antibiotics I had regularly).

Many parents will have the experience of ear infections themselves and more than likely in their children also. So why are they so common, what problems can they cause, and what can we do about them?

Why do kids get ear infections?

To understand ear infections we need to understand a little about the anatomy of the ear (for what it is worth the ear is one of my favourite body organs, I find it endlessly fascinating for its intricacy and complexity of function – cue the science geek in me!).

In humans, the ear is divided into the outer, middle and inner portions.  The outer portion involves the pinna (the ear we can see on the outside) and the outer canal, which leads down to the tympanic membrane or the ear drum.  The job of the outer ear is to funnel sound waves down the canal and to the drum, where each sound causes the drum to vibrate slightly differently.  Behind the drum sits the middle ear, which is usually an air filled cavity containing 3 little bones that sense the minute vibrations of the ear drum and transmit them through the middle ear to the inner ear.  The middle ear is connected to the top of the throat by a tube called the eustachian tube which helps to regulate the pressure in the middle ear.  The inner ear is a fascinating structure embedded in the bones of the skull that uses fluid and little hairs in the cochlea to transfer the vibrations of the middle ear bones to the auditory nerve, which is what allows our brain to interpret those sounds.  Just think that every little sound you hear in the world has to travel this complex series of steps before you can ‘hear’ it, and almost always with more than one sound at a time… clever little organs aren’t they!  The inner ear also contains 3 semicircular canals filled with fluid that help regulate your balance and sense of where you are in the world.

In children ear infections are relatively common and this is often due to the fact that their ear structures differ somewhat to adults.  The outer ear canals are generally shorter and smaller in diameter so fluid doesn’t drain away as easily.  Likewise the eustachian tubes are shorter, narrower and flatter than in adults, making it easier for bugs to travel from the throat up to the middle ear and making the tubes more likely to block up with fluid that can encourage infection.

What are the types of ear infections and how do they differ?

Outer ear infections (“otitis externa”) are relatively common, especially here in Queensland during the summer months, where lots of swimming and water play can cause a build-up of fluid in the outer ear leading to infection.  Often children with outer ear infections are well within themselves but may have a smelly, irritating or offensive discharge from one or both ears.  The external ear (pinna) may be quite tender to touch and they will likely be quite tender to examine.  These infections are often caused by bacteria or occasionally a fungus.

Middle ear infections (“otitis media”) are arguably the most common.  These are often associated with fever and upper respiratory symptoms such as runny nose, sore throat and cough.  Kids with acute ear infections are often in quite a bit of pain, especially at night and often look unwell, and may be off their food.  Their hearing may be affected in the infected ear due to all the fluid accumulated inside the middle ear.  It is not uncommon for both ears to be infected at the same time.  The vast majority of these infections are viral, especially if associated with other symptoms of viral infection, though they can also be bacterial.

Inner ear infections are relatively uncommon in children.  The usual course is of some upper respiratory symptoms followed by dizziness or balance issues which signals inflammation within the fluid-filled tubes of the inner ear.  These infections are almost always viral in nature and often will resolve on their own.

What can be done if my child has an ear infection?

If you are worried that your child may have an ear infection the first port of call is your family GP.  We see many, many children with ear infections in general practice and the majority of us will be well versed in their diagnosis and management.

If your GP diagnoses an outer ear infection then the primary management is to try to keep the ear clean and dry. If your child is old enough, your GP may recommend ear suction to clear out the build-up of debris and fluid in the ear canal.  Otherwise they may teach you the technique of ‘tissue spears’ to try to dry the ear out at home.  Your child may require some antibiotic ear drops to clear the infection.  Once the infection is cleared it may be recommended for you to keep your child’s ear dry when swimming or bathing using ear plugs, swimming caps over the ears, or using drying drops such as Aqua Ear after swimming.

If your child is diagnosed with a middle ear infection then the management will depend on how old your child is, how unwell they are, the duration of the infection, any other symptoms and their potential risk of developing complications.  The vast majority of ear infections, even the bacterial ones, will get better on their own and do not require antibiotics.  In fact, the data suggests that even for bacterial ear infections, giving antibiotics only shortens the course of the infection by around 24hrs.  Plus antibiotics come with all the potential for side effects such as allergy, diarrhoea or vomiting, and the risk of developing antibiotic resistant bugs.  Middle ear infections are usually painful however, so your child is likely to need a good regular dose of pain relief like ibuprofen or paracetamol (or both) until their symptoms settle down.  It is important to encourage your child to take some fluids even if they are not eating, to prevent dehydration.  Your GP may want to review your child in a day or two to check on their progress and reassess their treatment.

What are some of the complications of ear infection?

Complications of ear infections can include:

• Hearing difficulty – this is usually temporary and often resoles as the fluid is drained away after the infection
• Persistent middle ear effusions – fluid in the middle ear that may require surgical drainage with grommets if ongoing
• Perforation of the ear drum – The ear drum may ‘burst’ from the pressure of the infected fluid inside.  This often gives a lot of relief to the child as the pain suddenly lessens.  Most of these will heal on their own but you should see your GP as your child may require ear drops and they will likely keep an eye on it to ensure proper healing.
• Spreading infections – very rarely outer or middle ear infections may spread into the soft tissue around the ear or even into the air spaces in the nearby bones.  These can be very serious infections and need to reviewed and managed quickly.

When do children need review by a specialist?

For some children the GP may feel that a review with an Ear, Nose and Throat specialist is warranted.  This may occur where there are recurrent or persistent infections, spreading or severe infections, hearing loss which continues even after an infection has cleared, ongoing middle ear effusions or “glue ear”, or an ear drum perforation that doesn’t heal as it should.  Your GP can arrange referral to a local specialist if required.

So what is the bottom line?

Ear infections in children are common and are often painful, but they are usually self-limiting in nature.  They can be easily assessed by your child’s GP and appropriate management strategies and follow up discussed with you and your child.  Don’t hesitate to make an appointment if you are concerned about a possible ear infection.