Ear Infections

Table of Contents

Ear Infections Introduction

Ear infections are a common cause of discomfort and hearing issues in children and adults. They can affect the outer, middle, or inner parts of the ear, with the two most frequent types being:

  • Acute Otitis Media (AOM) – an infection of the middle ear, behind the eardrum
  • Otitis Externa – an infection of the ear canal, also known as “swimmer’s ear”

These infections can cause pain, hearing loss, fever, and discharge. While most ear infections resolve without complications, recurrent or severe infections may require further treatment by an ENT specialist.

Causes

Acute Otitis Media

Acute otitis media is especially common in children under 5, due to the immature structure and function of their eustachian tubes. These tubes connect the middle ear to the back of the nose and help equalise pressure.

Common triggers include:

  • Viral upper respiratory infections (e.g., colds)
  • Allergies
  • Enlarged adenoids
  • Exposure to cigarette smoke
  • Bottle feeding while lying flat

Bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae) or viruses can infect trapped fluid behind the eardrum, leading to pain, fever, and sometimes pus or fluid leakage if the eardrum perforates.

Recurrent Acute Otitis Media (RAOM)

Some children (and occasionally adults) are prone to frequent middle ear infections, defined as:

  • ≥3 episodes in 6 months, or
  • ≥4 episodes in 12 months

Risk factors for recurrence include:

  • Attending childcare or early schooling
  • Family history of ear infections
  • Seasonal peaks (autumn and winter)
  • Underlying eustachian tube dysfunction

Otitis Externa

Otitis externa is an infection of the outer ear canal, often caused by:

  • Moisture retention (e.g., after swimming or bathing)
  • Trauma from cotton buds or ear scratching
  • Skin conditions like eczema

It is commonly caused by bacteria or fungi. The warm, moist environment in the ear canal makes it ideal for microbial growth.

Symptoms

Acute Otitis Media

  • Sudden ear pain (especially at night)
  • Irritability or crying in young children
  • Temporary hearing loss
  • Fever
  • Tugging at the ear
  • Fluid discharge (if eardrum bursts)

Otitis Externa

  • Ear canal pain, especially when touching or pulling the outer ear
  • Itching in the ear
  • Swelling or redness of the ear canal
  • Discharge (clear, yellow, or pus-like)
  • Fullness or temporary hearing loss

Diagnosis

Diagnosis is usually based on clinical examination by a GP or ENT specialist using an otoscope to look into the ear.

  • Tympanometry may be used to assess middle ear pressure or fluid
  • In recurrent cases, hearing tests (audiograms) or nasal endoscopy may be recommended
  • Ear swabs are occasionally taken in otitis externa for culture, especially if the infection is persistent or has failed previous treatment

Treatment options

Acute Otitis Media

  • Pain relief is the first step: paracetamol or ibuprofen
  • Antibiotics (e.g., amoxicillin) are sometimes prescribed, especially if:
    • Symptoms are severe or persistent
    • There is a high fever
    • The child is under 2 with bilateral infections
    • There is fluid discharge from the ear
  • Most cases resolve within 3–5 days without antibiotics

Recurrent Acute Otitis Media

  • Long-term antibiotics are not recommended due to resistance
  • If infections are frequent and impact quality of life, grommet (ventilation tube) surgery may be offered
    • Grommets help ventilate the middle ear and reduce infection risk
    • Adenoidectomy may also be considered in selected cases
  • For older children, treatment of allergies or nasal obstruction may reduce recurrence

Otitis Externa

  • Ear canal cleaning by a doctor to remove debris (aural toilet)
  • Prescription ear drops containing antibiotics, steroids, or antifungals
  • Keep the ear dry during treatment
  • Avoid inserting anything into the ear canal
  • Severe or spreading infections may require oral antibiotics

Prevention

To reduce the risk of ear infections:

  • Keep ears dry during showers or swimming (wear earplugs if needed)
  • Avoid using cotton buds or inserting objects into ears
  • Ensure children are up to date with vaccinations (e.g., pneumococcal vaccine)
  • Breastfeeding for the first 6 months may reduce the risk of AOM
  • Avoid bottle feeding while lying down
  • Manage allergies or nasal congestion that may affect ear drainage

Follow-up instructions

For children or adults with recurrent ear infections:

  • A follow-up hearing test may be advised
  • ENT review is recommended if:
    • There are multiple infections per year
    • There is persistent fluid in the ear for more than 3 months
    • The child is experiencing speech or learning delays

After grommet insertion:

  • Routine follow-up visits are needed to monitor hearing and grommet function
  • The grommet usually falls out on its own after 6–18 months

Book a consultation

If you’d like to discuss a procedure or explore suitable treatment options, please get in touch with Dr Nicholas Phillips’ clinic.