Otitis Media in Infants

Otitis Media in Infants


Ear infections, also called otitis media, are a common problem in children. About 50 percent of infants have at least one ear infection by their first birthday. Ear infections can cause pain in the ear, fever, and temporary hearing loss and basic signs such as anorexia nervosa and irritation. Some children get better without particular antibiotic treatment however most young babies gain from use of an antimicrobial agent.

This subject will review the definition, causes, symptoms, diagnosis, treatment, and possible complications of ear infections in infants and children.

More in-depth details about ear infections is offered by membership. (See “Acute otitis media in children: Treatment”.)


Ear infection is likewise referred to as intense otitis media (otitis = ear, media = middle). Otitis media is an infection of the middle section of the ear. The majority of the time it is caused by bacteria that nearly all children have in their nose and throat at one time or another.

Ear infections frequently develop after a viral respiratory tract infection, such as a cold or the flu. These infections can cause swelling of the mucous membranes of the nose and throat, and diminish regular host defenses such as clearance of bacteria from the nose, increasing the amount of bacteria in the nose. Viral respiratory tract infections likewise can hinder Eustachian tube function. Regular Eustachian tube function is very important for maintaining regular pressure in the ear. Impaired Eustachian tube function alters the pressure in the middle ear (like when you are flying in an airplane). Fluid (called an effusion) might form in the center ear and bacteria and infections follow, resulting in inflammation in the middle ear (figure 1). The increased pressure causes the eardrum to bulge, causing the normal symptoms of fever, pain, and fussiness in kids.


Symptoms of an ear infection in teenagers and older children may include ear hurting or pain and temporary hearing loss. These symptoms usually come on suddenly.

In infants and children, symptoms of an ear infection can include:

  • Fever (temperature greater than 100.4 ºF or 38ºC, see the table for how to measure a child’s temperature level) (table 1).
  • Pulling on the ear.
  • Fussiness or irritation.
  • Decreased activity.
  • Absence of cravings or difficulty consuming.
  • Vomiting or diarrhea.
  • Draining fluid from the outer ear (called otorrhea).


If you suspect that your child has an ear infection, call your doctor or nurse to see if and when the child must be analyzed.

Although the examination is not painful, many infants and children do not like having their ears examined. To make the procedure simpler, hold your child in your lap and hug your child’s arms and body while the doctor or nurse uses an instrument (otoscope) to look inside the child’s ear. Frequently cerumen (ear wax) will have to be eliminated so your doctor or nurse can get an excellent view of the ear drum.

The doctor or nurse can inform if your child has an ear infection by taking a look at the ear drum (tympanic membrane) for the typical functions of an ear infection.

Otitis Media in Infants


Treatment of an ear infection might consist of:

  • Antibiotics.
  • Medicines to treat pain and fever.
  • Observation.
  • A mix of the above.

The “best” treatment depends upon the child’s age, history of previous infections, degree of disease, and any underlying medical problems.

Antibiotics– Antibiotics are routinely offered to babies who are below 24 months or who have high fever or infection in both ears. Children who are older than 24 months and have moderate symptoms may be treated with an antibiotic or frequently are observed to see if they enhance without antibiotics. (See ‘Observation’ listed below.).

Antibiotics can have side effects such as diarrhea and rash, and overusing antibiotics can lead to more difficult to treat (resistant) bacteria. Resistance indicates that a particular antibiotic not works or that greater dosages are required next time.

Observation– Sometimes, your child’s doctor or nurse will suggest that you watch your child at home before beginning antibiotics; this is called observation. Observation can assist to determine whether antibiotics are required.

Observation might be recommended in these scenarios:

  • If the child is older than 24 months.
  • If ear pain and fever are not severe.
  • If the child is otherwise healthy.

You can offer pain-relieving medications during observation to ease pain. (See ‘Pain management’ below.).

If your child is being observed instead of treated with antibiotics, you will have to call or go back to the doctor or nurse’s workplace after 24 hours for follow-up. If your child’s pain or fever continues or worsens, antibiotics are normally suggested; observation might continue if the child is enhancing.

Pain management– Pain-relieving medications, consisting of ibuprofen (sample trademark name: Motrin) and acetaminophen (sample trademark name: Tylenol), might be used to decrease discomfort.

Complementary and alternative medical treatments– There are a wide range of complementary and alternative medical (WEBCAM) treatments promoted to treat ear infections. These may include homeopathic, naturopathic, chiropractic, and acupuncture treatments.

There are couple of clinical research studies of WEB CAM treatments for ear infection, as well as less research studies that reveal CAM treatments to be effective. As an outcome, these treatments are not suggested for ear infections in children.

Decongestants and antihistamines– Cough and cold medications (which generally consist of a decongestant or antihistamine) have not been proven to speed healing or reduce complications of ear infections in children. In addition, these treatments have side effects that can be dangerous. Neither decongestants nor antihistamines are recommended for children with ear infections.

Follow-up– Your child’s symptoms need to enhance within 24 to 48 hours whether or not antibiotics were prescribed. If your child does not enhance after Two Days or becomes worse, call your doctor or nurse for suggestions. Although fever and pain may continue after beginning antibiotics, the child ought to get a little better every day. If your child appears more ill than when seen by his or her healthcare service provider, get in touch with the supplier as quickly as possible.

Children who are younger than two years and those who have language or knowing issues need to have a follow-up ear exam 2 to 3 months after being treated for an ear infection. These children are at risk for hold-ups in discovering how to speak. This follow-up helps to guarantee that the fluid collection (which can impact hearing) has solved.


Tympanic membrane rupture– Among the common complications of an ear infection is rupture of the ear drum, also referred to as the tympanic membrane. The tympanic membrane can burst when fluid presses on the membrane, reducing blood circulation and causing the tissue to deteriorate. It does not hurt when the membrane ruptures, and lots of children actually feel much better because pressure is launched. Luckily, the tympanic membrane generally recovers rapidly after bursting, within hours to days. Rupture of the ear drum is an indicator for antibiotic treatment of an ear infection.

Hearing loss– The fluid that gathers behind the eardrum (called an effusion) can persist for weeks to months after the pain of an ear infection deals with. An effusion causes difficulty hearing, which is typically temporary. If the fluid continues, nevertheless, it might interfere with the procedure of discovering how to speak. (See “Otitis media with effusion (serous otitis media) in children: Clinical features and diagnosis” and “Otitis media with effusion (serous otitis media) in children: Management”.)

Effusions usually resolve with no treatment. Nevertheless, if the effusion continues for more than 3 months, the child may require treatment with a surgery. The choice to treat is based upon how much the effusion impacts the child’s hearing and the child’s risk of speech problems.

Children who are not dealt with for an effusion should be kept an eye on in time. This includes an ear test and hearing screening every 3 to six months until the effusion disappears.


Some children establish ear infections regularly. Reoccurring ear infections are specified as three or more infections in six months, or 4 or more infections within 12 months. In addition to receiving the pneumococcal and influenza vaccines, as suggested for all children, a number of interventions can help in reducing the risk of persistent infections. These include avoidance of tobacco smoke, breastfeeding, continuous low dosage antibiotics, and/or surgical positioning of tubes in the ears. (See “Intense otitis media in children: Prevention of recurrence” and “Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)”).

Preventive antibiotics– Children who have recurrent ear infections are often treated with a preventive program of a day-to-day antibiotic during the fall, winter, and early spring months. Although preventive antibiotics might help in reducing the number of ear infections, it is still possible for the child to get an infection. There is likewise a risk that taking antibiotics for a long period of time can cause bacteria that are resistant to standard antibiotics. Talk to your child’s doctor or nurse about the potential advantages and threats of this approach.

Surgery– Some studies show that having surgery to location tympanostomy tubes in the ears assists to avoid recurrent ear infections. Tympanostomy let fluid to drain from the middle ear (figure 2), let air into the middle ear, and keep the pressure in the middle ear and the ear canal the same. Other studies reveal no advantage of tympanostomy tubes for avoidance of reoccurrences. Speak with your child’s doctor about the risks and benefits of surgery.


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