Otitis media in children

What is otitis media?

Otitis media is the name that doctors use for middle ear infections. Acute otitis media is an infection of recent onset, and is generally associated with a build-up of fluid in the middle ear. Symptoms of acute otitis media usually include earache and fever.

Recurrent otitis media is defined as 3 or more separate episodes of acute otitis media within a 6-month period. Otitis media with effusion, also known as ‘glue ear’, describes fluid that remains in the middle ear after the infection has resolved. It is usually not painful.

Otitis media is a common childhood illness. It has been estimated that about 65 per cent of children will have had otitis media at least once by the age of 3 years. Acute otitis media occurs most often in children aged between 6 and 18 months, but is common up until 4 years of age.

A viral infection is the greatest risk factor for developing otitis media in children. This will be more likely to occur in children attending day care or living with brothers or sisters, but the risk is also increased in children exposed to tobacco smoke.

Signs and symptoms of otitis media

Most children with acute otitis media will complain of ear pain. Other symptoms may include irritability, restlessness, disrupted sleep, and fever. Because many cases of otitis media are caused by a viral infection, there are often other symptoms associated with the infection, such as a sore throat, runny nose or a cough.

Occasionally the eardrum will rupture, and there will be a discharge from the affected ear.

Your doctor will most often make the diagnosis of otitis media after looking at your child's eardrum with an instrument called an otoscope and making an assessment of any accompanying symptoms. Further tests are rarely needed.

Otitis media treatment

Because otitis media is often caused by a virus, the majority of children with the condition will get better regardless of whether they take antibiotics or not. (Antibiotics are only effective against bacterial infections, and do not have any effect on viruses.)

These days, it is often suggested that children over 6 months of age should initially be treated with pain relief alone. This involves pain relievers being given for 48 hours, and antibiotics only then being given if symptoms persist. Pain relievers, such as paracetamol or ibuprofen, should always be used at the correct dosage for your child's age and weight. Of course, if you are worried that your child is not improving, you should see your doctor.

Children younger than 6 months and children who are very unwell generally will need antibiotics straight away.

Occasionally, hearing impairment due to the development of glue ear can occur. In these cases, your doctor may perform a hearing test and will probably refer you to a specialist, who will assess whether tympanostomy tubes (grommets) should be inserted. Grommets are small tubes that are inserted into the eardrum to allow air to enter the middle ear, so that your child is able to hear normally.

Antihistamines, decongestants and complementary therapies have not been proven to provide any benefit in the treatment of acute or chronic otitis media.

Last Reviewed: 21 December 2012
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References

1. Otitis media (revised June 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2012 Nov. http://online.tg.org.au/complete/ (accessed Feb 2013).
2. Royal Children’s Hospital Melbourne. Clinical Practice Guidelines: Acute otitis media. http://www.rch.org.au/clinicalguide/guideline_index/Acute_Otitis_Media/# (accessed Feb 2013).
3. Royal Children’s Hospital Melbourne. Kids Health Info: Ear infections and otitis media (updated May 2010). http://www.rch.org.au/kidsinfo/fact_sheets/Ear_infections_and_otitis_media/ (accessed Feb 2013).
4. MayoClinic.com. Ear infection (middle ear) (updated 14 Apr 2011). http://www.mayoclinic.com/health/ear-infections/DS00303 (accessed Feb 2013).
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