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Middle ear infection – Otitis media

Otitis media is an infection of the middle ear common in younger children.
Most ear infections occur in infants aged 6-18 months, though anyone can get an ear infection. For reasons that are unclear they are more common in boys than girls.
Signs that your child might have an ear infection include:
pulling, tugging, or rubbing their ear
a high temperature (38°C or above)
poor feeding
restlessness at night
runny nose
unresponsiveness to quiet sounds
loss of balance
Symptoms of middle ear infection

In most cases the symptoms of an ear infection (otitis media) develop quickly and resolve in a few days – often referred to as acute otitis media.
Main symptoms of acute otitis media include:
a high temperature (fever) of 38°C (100.4°F) or higher
being sick
lack of energy
slight deafness
Babies with ear infections will be hot and irritable. As babies are unable to communicate the source of their discomfort, it can be difficult to tell what is wrong with them. However, your baby may have an ear infection if they are unsettled in this way.
Other signs to look for in younger children include:
pulling, tugging or rubbing their ear
poor feeding
restlessness at night
a runny nose
unresponsiveness to quiet sounds or other signs of difficulty hearing, such as sitting too close to the television or inattentiveness
loss of balance
Sometimes, in cases of middle ear infection, the eardrum will become perforated (a hole will form in it) and pus may run out of the ear. This can help to relieve the pain by releasing the pressure on the eardrum, but it may also lead to re-infection.
When to seek medical advice
Speak to your GP if your child’s symptoms show no sign of improvement after 24 hours, they seem to be in a lot of pain, or you notice a discharge of  pus or fluid from their ear.
Long term ear infection
Ear infections that last for many months are known as chronic suppurative otitis media (CSOM). This condition is less common, affecting around 1 in 100 children and 1 in 50 adults.
The most common symptom of CSOM is a persistent and usually painless drainage from the affected ear.
Some degree of hearing loss in the affected ear is also common.
When to seek medical advice
Most ear infections clear up quickly so it is not always necessary to see your GP.
However, it is recommended that you contact your GP for advice if:
symptoms show no sign of improvement after 24 hours
your child seems to be in a lot of pain
you notice fluid coming from the ear
You should also contact your GP if your child is more vulnerable to the effects of infection, for example due to certain medical conditions.
Treating an ear infection
Most ear infections clear up within a couple of days. Paracetamol or ibuprofen (appropriate for the child’s age) can be used to relieve pain and high temperature.
Antibiotics are usually only required if symptoms persist or are particularly severe.
Read more about the treatment of otitis media.
What causes an ear infection?
The middle ear is directly behind the eardrum. It is made up of three tiny lever-like bones that carry sound vibrations from the eardrum to the inner ear.
Most cases of otitis media are caused by a bacterial or viral infection. Often an infection of the respiratory tract (sinuses, throat, airways or lungs) such as the cold or flu can spread into the middle ear.
Younger children are particularly vulnerable to this type of infection as their middle ear is smaller and narrower than an adults’ which makes it easier for an infection to take hold.
The risk of developing an ear infection is increased if your child:
attends a nursery or day care centre – this increases exposure to infection from other children
is exposed to passive smoking
is not breastfed
Read more about the causes of ear infection.
Complications of ear infections are uncommon but when they do occur they can be troublesome and include:
infection spreading into the bones underneath the ear (the mastoids) which is known as mastoiditis
the infection spreads into the protective membranes that surround the brain and spinal cord (the meninges), which is known as meninges

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