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Ear Infections in Children

13 Aug 2008 8:42 PM -

Acute middle ear infections (otitis media) are very common in young children. Acute middle ear infections (otitis media) are very common in young children. 50% of children have had an episode of acute OM by their first birthday and 70% by their third birthday. About 30% of children will have multiple infections. This high incidence in children is due to their relatively higher incidence of upper respiratory infections and immaturity of the tubes that connect the middle ear to the back of the nose. The usual presentation of acute OM is development of ear pain after a couple of days of a cold. As the infection progresses and infected fluid builds up behind the ear drum, the child may develop more severe ear pain, fever and irritability. Preverbal children may pull and tug at the affected ear. Sometimes the pressure behind the ear drum reaches a point where the ear drum perforates, with a resultant bloody and mucky discharge from the ear and often partial resolution of the ear pain.

A great many episodes of acute OM are caused by respiratory viruses and up to 80% of theses infections will improve without any treatment other than pain relief. For this reason, most experienced GPs will suggest delaying antibiotic treatment for the first couple of days and will usually suggest pain relief such as paracetamol or ibuprofen syrup, with regular follow up. If the feverish illness and pain continues for more than a couple of days without little sign of resolution, antibiotic treatment is often contemplated. Following resolution of the acute infection, residual fluid in the middle ear cleft can sometimes cause partial reduction of hearing, but this will usually resolve spontaneously over a few weeks.

Children who suffer from regular episodes of acute OM should be assesses further for more chronic conditions such as chronic middle ear fluid (glue ear) and Eustachian tube blockage by enlarge adenoids and tonsils. Sometimes this children benefit from having their tonsils and adenoids removed and placement of a ventilation tube in the ear drum (grommets). There are some things parents can do to reduce the risk of acute OM in their children. Breast feed (where possible) for the first 6 months of life. Avoid smoking cigarettes near children or in the household. Dummies can sometimes increase the risk of ear infections.

Points to remember

  • Ear infections are common in young children
  • Antibiotics are not always needed
  • Breast feed to 6 months of age where possible
  • Avoid smoking – both for your sake and your child's
  • Most children outgrow middle ear infections