Otitis media: what you need to know about ear infections in children

by Kelly Nathan, audiologist
Baby Yum Yum - Otitis media – clearing the issue on ear infections
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Otitis media, or middle ear infections, are extremely common among babies, toddlers and preschoolers. Parents find themselves continuously making appointments with their GP or ENT, and grappling with the age-old conundrum – antibiotics or grommets?

What is otitis media?

Middle ear infections (otitis media) is a middle ear inflammation, which involves fluid in the middle ear cavity, either with or without the presence of an infection. There are three types of otitis media:

  1. Acute otitis media is an active infection with or without discharge from the ear. This is often associated with pain, fever and an inflamed or perforated (burst) eardrum.
  2. Chronic suppurative otitis media involves chronic discharge through a long-standing perforation of the eardrum. 
  1. Chronic otitis media with effusion, most commonly known as glue ear, involves inflammatory fluid in the middle ear with the eardrum intact and not inflamed. There is an absence of discharge and fever, and there is minimal discomfort. This type of otitis media can often go undetected for months and is the most diagnosed type of otitis media.

Why is otitis media so common in children?

Normal hearing relies on the eardrum vibrating to transmit sound through the middle ear to the cochlea, which is the organ of hearing. This requires the middle ear cavity being filled with air and a normal functioning Eustachian tube, which is a muscle that equalises pressure and assists with fluid drainage from the middle ear.

If the middle ear is full of fluid, the eardrum doesn’t vibrate as it should, resulting in a temporary hearing loss.

“Breastfeeding helps to prevent ear infections, but try feed in a ‘head up’ position, rather than lying flat. Tilting the head (with a pillow or wedge) may improve fluid drainage from middle ear.”

The Eustachian tube function is less efficient in children than it is in adults due to structural immaturity; it is shorter and more horizontal than in adults. This results in poor drainage of middle ear secretions.

As children mature, the Eustachian tube becomes longer and more downward sloping, thus becoming more effective in fluid drainage. Therefore, otitis media usually occurs before eight years of age, becoming less common as children get older.

How do I know if my child has an ear infection (otitis media)?

Some children don’t have any symptoms at all, but should your child experience any of the following symptoms, it could be otitis media and you should visit a medical doctor or audiologist:

  • Complains of mild to severe ear pain
  • Babies will often pull at their ears, although this can also be common with teething
  • Fever
  • Ear discharge that is smelly and yellow or bloody – this is usually preceded by pain and indicates that the eardrum has ruptured. This perforation will often self-heal in six to eight weeks.
  • Loss of appetite, vomiting or irritability
  • Trouble sleeping or crying when lying down
  • Difficulty hearing
  • Balance problems or dizziness

Possible causes and risk factors for ear infections (otitis media)

Viral infections:

Young children’s immune systems are not fully developed and they often suffer from infections, particularly in their first 2 years of life. Children at school have a higher rate of ear infections due to the higher rate of infectious viral transmissions.


Children under the age of two years do not produce antibodies against certain bacteria that cause ear infections and often present with acute otitis media.

Cigarette smoking:

Smoking has been shown to be a possible cause of otitis media with effusion in children.

Breast vs. bottle-feeding:

Breastfeeding can help to protect against otitis media. Feeding (breast or bottle) lying flat on the back has been associated with a higher incidence of otitis media. Feeding with the baby’s head slightly tilted upwards is recommended.

Enlarged tonsils or adenoids:

Children who snore or are mouth-breathers may have swollen or infected adenoids, which may cause ear infections. In addition, chronically infected tonsils have also been known to possibly cause ear infections.


Allergies such as hay fever and food allergies may cause inflammation of the nasal passages and/or Eustachian tube, resulting in ear infections.

Ear infections and hearing loss

Fluid build-up in the middle ear can block sound transmission, leading to temporary conductive hearing loss (not nerve damage). This type of hearing loss affects the conduction of sound from the sound source to the cochlea (organ of hearing) and is usually medically treated.

Persistent (chronic) otitis media often causes significant but variable conductive hearing loss, which can impact a child’s ability to:

  • communicate effectively
  • develop vital tools for language and literacy

A child with otitis media may:

  • not respond to sounds or certain speech
  • turn up the television or radio
  • talk louder or become withdrawn
  • appear to be inattentive at school (in own world)

These signs may fluctuate depending on the status of the fluid and severity of the hearing loss.

What can I do if my child has otitis media?

  • Breastfeeding helps to prevent ear infections, but try feed in a “head up” position, rather than lying flat. Tilting the head (with a pillow or wedge) may improve fluid drainage from middle ear.
  • Steam inhalations/humidifiers may also help to decongest the nasal passages and Eustachian tube.
  • Sucking a dummy, chewing or drinking (swallowing) will help the Eustachian tube to equalise pressure and prevent build-up of negative pressure, especially while flying.
  • Swim-plugs can be worn as a preventative measure for all water-activities to keep the ears dry.
  • Some find that warmth from a heat pack or hot water bottle provides comfort from painful ears.

Does otitis media clear without medical intervention?

It is possible and can usually take between six to eight weeks for an ear infection to clear on its own. This is usually the ideal time for a medical follow-up. However, always consult an audiologist or Ear Nose & Throat Surgeon (ENT) should you be concerned about ear infections.

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