Middle Ear Infections in Children

What is the middle ear?

Middle ear is the space behind the eardrum. A healthy middle ear has air in it. The pressure valve that controls the air and its pressure is called the Eustachian tube. This connects the Ear to the back of the nose. There are three small bones in the middle ear, that amplify and transmit sound from the eardrum to the Inner Ear. .

What middle ear problems do children get?

There are various types of middle ear infections in children.

1) AOM (Acute Otitis Media) is pus or infected fluid in the middle ear, that usually comes after a cold. Children usually get a fever and pain when this happens.

2) OME (Otitis Media Effusion) is fluid in the middle ear, without signs or symptoms of an acute infection. If the fluid is thick like snot, its called glue ear.

3) Recurrent AOM (recurring infections) : 4 or more episodes in one year or three or more episodes in one six month period

Bulging eardrum | Middle ear infection | AOM

Fluid | Glue ear | Dull eardrum

How common is this?

This is very common around the age: 6-11 months and declines around 18-20 months.

70% experience one or more attacks before two years of age.

It is a higher incidence in indigenous and in siblings or parent with these issues.

This peaks in winter months

What causes this condition?


Some viruses

Peak 2-4 days after a cold and most develop within two weeks.

Some children with cleft palate can get OME due to weakness in the Eustachian tube function.

What are the complications of middle ear infections?

With antibiotics and modern surgical treatments, the complications have substantially reduced. However the possible complications of untreated ear infections are,

- Mastoiditis: abscess formation in the bone

-Long-term thinning, damage or scarring of the eardrum: May lead long-standing

-hearing loss or need of eardrum surgery.

-Cholesteatoma: skin growth into the Ear which usually requires mastoid surgery

-Language and learning disability: Directly related to the hearing loss, and related learning issues.

What Symptoms & Signs should I look out for?

Hearing loss/ fever

The drum may perforate and discharge

Irritability of a child

Poor language development, concerns at school (Glue ear may go unnoticed as these no pain or fever)

What do the doctors check?

Relevant history

Examination of the ears, nose throat.

Tympanic membrane: in acute infection-Red---Budging--- perforation

Glue ear: dull looking ear drum and not painful

Suspect mastoiditis if swelling behind the ear.

The doctors/ ENT surgeons will do necessary investigations if needed.

What do we do?

We do a middle ear pressure check to see if the drum moves as expected. We also conduct relevant tests to see if the child can hear tones and if they can hear words. All the information will be sent to relevant doctors and affiliated health professionals for further input. We also re-test after surgery or for ongoing monitoring.

What are grommets?

Grommets are put in by ENT surgeons, if children require drainage of middle ear fluid. Some children who have multiple ear infections also benefit from grommets. You may ask further questions from your doctor.

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