otitis media, glue ear

What is it?

Middle ear infections (otitis media) happen when germs (bacteria) or viruses get into the fluid in the middle of the ear behind the eardrum.

They can be acute (happening just once) or chronic (not getting better or coming back again and again). During a middle ear infection, pus can build up behind the eardrum, causing pain. Also, fluid can remain in the middle ear after an acute middle ear infection, and this is commonly called 'otitis media with effusion' or 'glue ear'. Glue ear makes it harder to hear.

Ear infections are very common in children, particularly those under seven years old.

How did my child get it?

In children, the tube (Eustachian tube) that goes from the back of the nose to the middle of the ear is shorter than in adults, so bacteria and viruses can find their way deep into the ear much more easily. Ear infections are more common in late winter or early spring and after a child has had a cold. Children are more likely to get ear infections if they live in houses that are crowded or where someone smokes, if they go to day-care, or have brothers and sisters with ear infections.

How is it diagnosed? 

You will usually be the first to know your child has an ear infection. Very young children with ear infections usually get cranky, fussy and rub their ears. They may not hear, eat or sleep well. Older children will complain of earache, a feeling that the ear is 'full', or that they can't hear well.

They may have a fever, runny nose or a cough. If the infection is really bad, the eardrum may burst and pus will leak out of the ear. The doctor will ask how your child has been feeling and behaving, and will look inside their ears with a special instrument to see whether they have an infection and how bad it is.

What makes it worse?

Feeding babies lying down or putting them to bed with a bottle can help bacteria get into the ear. Breast-fed babies are less likely to get infections.

Having a lot of colds, infected tonsils or other infections, swollen adenoids or allergies makes infections more likely; try to get these treated early. 

What makes it better?

• Regular pain relief. Discuss with your chemist or doctor what type is best (do not give aspirin to children). To give your child maximum pain relief, make sure they take the medicine as directed, not only when they are 'crying' with pain.
• Gentle heat may help (eg, soak a flannel in hot water, squeeze out and place over the ear, taking care not to burn the delicate skin).
• Prop older children up on pillows to sleep: it may feel better if they lie with the sore ear on the pillow.
• Keep your child's ears dry and clean.
• Keep background noise in the home down. Loud noises can upset children with sore ears and make it harder for them to hear normal conversation. 

How can my doctor help?

It is always wise to let the doctor see your child when they have an ear infection. They can tell you how serious it is, whether or not treatment is needed, and what you can do to make your child more comfortable.

Pain relief, nose sprays or decongestants (to take away the 'stuffed-up' feeling) may help. Antibiotics may be needed, but they do not always help: your doctor is the best one to decide when they should be given, based on how old your child is, how bad the infection is, and how often your child has infections.

If the ear is always getting infected, and it is not getting better with antibiotics, your doctor may suggest small tubes (grommets) are put in the ear so air can get into the middle ear to ventilate it. You will need to visit a specialist doctor for this type of treatment.

What happens if it isn't treated?

A lot of children will get better without any treatment. Some, however, will go on to have one infection after another. If an infection is very bad, the eardrum can burst. It may heal without any damage, but if it happens too often, it may form a scar and hearing will be affected. An operation to fix the damaged part of the ear may be needed. Children who can't hear well can have trouble learning to talk and have problems at school later on.

For further information and support the New Zealand Guidelines Group (www.nzgg.org.nz) endorses the treatment guidelines for otitis media on their website, which includes patient information.

Written by Anna Mickell, RCpN. Reviewed by everybody.