Middle Ear infections happen when the middle ear becomes inflamed. The middle ear is the small space behind the eardrum. Middle ear infections are also called acute otitis media. They can happen in one or both ears.

Middle ear infections are among the most common sicknesses during childhood and can be painful. Many children will have at least one acute middle ear infection by the time they turn 1 year old. Middle ear infections are common in children because the passage between the middle ear and the back of the throat (Eustachian tube) is smaller and more horizontal in children than in adults.

Sometimes children get fluid in their middle ear but don’t have an infection. This is called otitis media with fluid. You may also hear or see the term “otitis media with effusion” or “fluid in the middle ear.”

A small number of children will have three or more cases of otitis media with fluid by age 3. When fluid is present in the ear for a prolonged period of time, this can pose a risk of hearing loss. Hearing loss at a young age can affect typical speech and language development.

What are the signs of an ear infection?

It can be hard to know whether your child has an ear infection. This is especially true if your child is too young to say, “My ear hurts.” Signs of an ear infection include:

• Tugging or pulling at the ear
• Crying more than usual
  • Fever
  • Not responding to sounds
• Trouble sleeping
  • Drainage from the ear

How are ear infections treated?

Acute ear infections can be treated by waiting for the virus to pass, or in the case where bacteria is suspected, using antibiotics prescribed by your doctor.

Ear infections with fluid can be treated by:

• Waiting for the fluid to go away. For many children, ear fluid will go away in a few months.
• Surgery to put a tube (grommet) in your child’s ear if he or she has repeated ear infections.

Talk with your child’s doctor about what is best for your child. It is important to keep follow-up appointments.

How can ear infections affect my child’s hearing?

Fluid in the middle ear makes it harder for your child to hear sounds because of conductive hearing loss. Imagine if you were trying to hear something underwater. That is what it might sound like to your child.

While some children with an ear infection have no change in their hearing, other children may have a short- term hearing loss. The hearing loss may go away once the fluid is gone from their middle ear. However, when ear infections occur over and over again, permanent damage can occur. Therefore, it is critical that ear infections be treated properly.

Cases of fluid in the middle ear (that do not involve an actual infection) present a special problem because symptoms of pain and fever are usually not present. Weeks and even months can go by before parents suspect a problem. During this time, the child may miss out on some of the information that can influence speech and language development.

What should I do if I think my child has an ear infection?

Ear infections require immediate attention, most likely from a gp, pediatrician or otolaryngologist (ENT). If your child has frequently recurring infections and/or chronic fluid in the middle ear, two additional specialists may be consulted: an audiologist and a speech-language pathologist.

An audiologist’s evaluation will assess the severity of any hearing impairment—even in a very young or uncooperative child—and will indicate if a middle ear disorder is present.

A speech-language pathologist will measure your child’s specific speech and language skills and can recommend and/or provide remedial programs when they are needed.

Reference; The Sydney Children’s Hospital Network patient fact sheet; otitis media (middle ear infection) 2019.