Ear infection

This factsheet is for people with an acute middle ear infection, or for their parents who want information.

Ear infections can affect anyone, but mostly affect children.¹ The most common type of ear infection affects the middle ear. The medical term for a middle ear infection is otitis media.

The middle ear

The middle ear is behind the eardrum. It contains three tiny bones that move when sounds reach them, transmitting the sound waves through the middle ear to the inner ear.

Your middle ear is usually filled with air but it also makes a thin watery fluid.

Illustration showing a cross-section of the ear

What is a middle ear infection?

A middle ear infection can affect one or both ears.

The main types of infection are listed below.

Acute otitis media, where "acute" refers to the length of time the condition lasts - it usually comes, and goes, quickly. Acute does not mean how severe it is.
Otitis media with effusion often called "glue ear", which is an ear infection with a build up of fluid.
Chronic acute otitis media, which means there are repeat attacks of ear infection over a long period of time.

How do you get a middle ear infection?

Acute middle ear infection

You can get an acute middle ear infection (acute otitis media) if viruses or bacteria from your throat travel up your eustachian tube. The eustachian tube connects your middle ear to your throat. It also connects your middle ear to the back of your nose and helps to regulate pressure in your ear.

An acute middle ear infection can cause a build up of pus and blood inside the middle ear, which may feel very uncomfortable. The eardrum may burst as a result of the pressure. In most cases, a burst eardrum heals by itself.²

Acute middle ear infections are most common in children.³Children aged less than 10 account for three quarters of those affected.¹

Children often get an acute middle ear infection from contact with other children, such as at a nursery.³

Other things that may make it more likely in children are:

the use of formula milk (rather than breast milk)³
the use of a dummy³
feeding in a flat, supine position³
exposure to cigarette smoke¹

Glue ear

You can get glue ear if the eustachian tube gets blocked. The blockage may be due to an infection, an allergy, or from enlarged adenoids (tissue at the back of the throat which help to fight infections).⁴

When this happens, the pressure inside your ear cannot be regulated. A sticky fluid builds up inside the middle ear and affects hearing, since the middle ear is filled with fluid rather than air.

Children are particularly vulnerable to glue ear because their eustachian tubes are shorter and lie in a more horizontal position, which makes it easier for them to become blocked.

Symptoms

Acute middle ear infection

The symptoms of an acute middle ear infection may come on around the same time as a runny nose or cough and include:

earache^1,5
deafness in the affected ear⁵
a feeling of "fullness" in the ear¹
fever⁵
blood and pus coming out of the ear if the eardrum ruptures⁵
a general feeling of being unwell or irritable, with loss of appetite^1,5

Children may also tug at their ear which can indicate that they have some discomfort.¹

Glue ear

There are usually no obvious symptoms of glue ear, which may develop after a bout of an acute middle ear infection.

Children sometimes complain that their ear feels "bunged up" but the main symptom is deafness, which, in small children, is often mistaken for lack of attention or even behaviour problems.¹

Diagnosis

To diagnose an acute middle ear infection, your doctor may:

look into the ears with an instrument called an otoscope
take a sample of any discharge for testing
do some simple hearing tests
refer you for more in depth hearing tests
occasionally request an X-ray or a CT scan to discover whether the infection has spread from the middle ear (but this is not usually needed)
occasionally take a sample of blood for testing to confirm the presence of an infection (but this is not usually needed)

Treatment

Acute middle ear infection

Four out of five acute middle ear infections clear up within three days, without treatment.⁵

Painkillers such as those you would normally take for a headache will help to relieve pain and fever.

Antibiotics may be an option for a bacterial infection. Your GP may suggest a prescription for antibiotics if improvement has not occurred after three days. If you are given antibiotics, this is usually for a five day course.¹ It is important to complete the course, even if symptoms have improved.

Many middle ear infections are caused by viruses and can't be treated with antibiotics.

Decongestants or antihistamines are unlikely to help and are not recommended.¹

If you or your child gets several acute middle ear infections in a six month period, or if a ruptured eardrum takes longer than one month to heal, your GP may decide to refer you to a specialist ear, nose and throat doctor (an otolaryngologist).⁵

Glue ear

One in every two children with glue ear gets better within three months with no treatment. About 95 out of 100 cases clear up within a year.⁶

However, the temporary deafness it causes can affect a child's educational and social development and it's important to see your GP if you think a child has glue ear.

Scientific studies have shown that taking antibiotics probably does not help with glue ear, unless there are symptoms of acute middle ear infection as well. Decongestants or antihistamines do not help either.¹

If glue ear is causing your child to have problems with hearing or speech, or if they are getting lots of infections, your doctor may recommend a myringotomy, or grommet insertion. A grommet is a tiny ventilation tube that can be inserted during a minor operation. This lets the ear drain continually, and usually restores hearing. The grommet usually falls out after six months to a year.⁴

There can be complications associated with grommets, the main one being infection, but this can be treated with antibiotics.⁴ Other risks of the operation include permanent scarring, although the long-term consequences of this are uncertain. The middle ear or eardrum can also be damaged.⁶

Taking the adenoids (lumps of tissue in the back of the nose) out may help glue ear.

If you choose not to have surgery for your child, it is important that he or she has regular hearing checks.¹

A hearing aid can be used to treat poor hearing and speech problems that are caused by glue ear. This would mean that your child would not need an operation.⁷

Auto inflation is a technique where a special balloon is blown up by the child using their nose. It puts 'back pressure' into the nose, and may help to open up the eustachian tube and allow better drainage of the fluid. Opinion is divided on whether this treatment works.^1,6

Your GP will be able to explain your available options to you.

Preventing middle ear infections

The section above explains what measures you can take to prevent acute middle ear infections and glue ear. For example, you can make sure that your child is not exposed to cigarette smoke.

Treatment of colds, flu, sore throats, hay fever and other allergies may also help. This means reducing symptoms as much as possible, with medications such as decongestants like xylometazoline hydrochloride (eg Tixycolds, which is suitable for children over two) and menthol capsules (eg Karvol, which are suitable for children over three months).⁸

Further help

Search for "ear infections" on healthinsite.gov.au

References

SIGN No 66, Diagnosis and management of otitis media in primary care: a national clinical guideline. February 2003. Page 3.
Infections of the ear. British Association of Otorhinolaryngologists Head and Neck Surgeons.
www.entuk.org
accessed 20 May 2005.
PRODIGY Guidance: Otitis media - acute. UK Department of Health. Prodigy.
www.prodigy.nhs.uk
accessed 29 April 2005.
Glue ear. British Association of Otorhinolaryngologists - Head and Neck Surgeons.
www.entuk.org
accessed 20 May 2005.
Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002: 782.
PRODIGY Guidance: Glue ear. UK Department of Health. Prodigy.
www.prodigy.nhs.uk
accessed 29 April 2005.
What are grommets? British Association of Otorhinolaryngologists - Head and Neck Surgeons
www.entuk.org
accessed 20 May 2005.
British National Formulary 49, March 2005.

The information on this factsheet is intended to be a guide only and is not intended to be nor should be relied on as a substitute for professional medical advice. It is also not intended to be for medical diagnosis or treatment. BUPA Australia makes no warranties or representations regarding the quality, accuracy or completeness of the information. BUPA Australia is not liable to readers of the information for any loss or damage suffered arising out of the use of or reliance on the information, except that which can be excluded by law.