Ear Infections in Children (Otitis Media)

Acute otitis media (AOM) — middle ear infection — is the most common reason children are prescribed antibiotics worldwide. It occurs when the middle ear space behind the eardrum becomes infected, usually following a viral upper respiratory infection (cold) that causes the Eustachian tube to swell and trap fluid.

Children are more susceptible than adults because their Eustachian tubes are shorter, more horizontal, and floppier — making it easier for bacteria to travel from the throat to the middle ear.

Symptoms in older children: ear pain (otalgia), especially at night; pulling or tugging at the ear; temporary hearing difficulty; fever. In infants (who cannot communicate pain): irritability, crying more than usual, difficulty sleeping, pulling at ear, feeding problems, fever.

Diagnosis is clinical — a doctor uses an otoscope to directly visualise the eardrum, looking for redness, bulging, and fluid. In the absence of fever or severe pain, many guidelines recommend watchful waiting for 48–72 hours before prescribing antibiotics, as 60–80% of AOM in children over 2 years resolves spontaneously. Amoxicillin is the first-line antibiotic when treatment is needed.

Otitis media with effusion ('glue ear') is a chronic collection of fluid in the middle ear without signs of acute infection. It is common after AOM and often resolves spontaneously within 3 months. If persistent, it can cause mild hearing loss affecting speech development. Grommets (ventilation tubes) may be recommended if glue ear is persistent and causing hearing problems.

Prevention: breastfeeding reduces risk; avoiding passive smoke exposure is important; dummy (pacifier) use after 6 months increases risk; ensure pneumococcal and influenza vaccinations are up to date.