Introduction

Otitis media is aninfectionof the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.

Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.

It's estimated that around one in every four children experience at least one middle ear infection by the time they're 10 years old.

Symptoms ofa middle ear infection

In most cases, the symptoms of a middleear infection (otitis media) developquickly and resolve in a few days. This is known asacute otitis media. The main symptoms include:

• Earache
• a high temperature (fever)
• being sick
• a lack of energy
• slight hearing loss if the middle ear becomes filled with fluid, hearing loss may be a sign of glue ear , also known as otitis media with effusion

In some cases, a hole may develop in the eardrum ( perforated eardrum ) and pus may run out of the ear.The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves.

Signs in young children

As babies are unable to communicate the source of their discomfort, it can be difficult to tell what's wrong with them. Signs thata youngchild might have an ear infection include:

• pulling, tugging or rubbing their ear
• irritability, poor feedingor restlessness at night
• coughing or a runny nose
• diarrhoea
• unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness
• loss of balance

When to seek medical advice

Most cases of otitis media pass within a few days, so there's usually no need to see your GP.

However, seeyour GP if you or your child have:

• symptoms showing no sign of improvement after two or three days
• a lot of pain
• a discharge of pus or fluid from the ear some people develop a persistent and painless ear discharge that lastsfor many months, known as chronic suppurative otitis media
• an underlying health condition, such as cystic fibrosis or congenital heart disease , which could make complications more likely

If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature.

Make sure any painkillers you give to your child are appropriate for their age. The adenoid can be removed if it causes persistent or frequent ear infections. These include:

• make sure your child is up-to-date with their routine vaccinations particularly the pneumococcal vaccine and the DTaP/IPV/Hib (5-in-1)vaccine
• avoid exposing your child to smoky environments (passive smoking)
• don't give your child a dummy once they'reolder thansix to 12 months old
• don't feed your child while they're lying flat on their back
• if possible, feed your baby with breast milk rather than formula milk

Avoiding contact with other children who are unwell may also help reduce your child's chances of catching an infection that could lead to a middle ear infection.

Further problems

Complications of middle ear infections are fairly rare, but can be serious if they do occur.

Most complications are the result of the infection spreading to another part of the ear or head, including:

• the bones behind the ear ( mastoiditis )
• the inner ear ( labyrinthitis )
• the protective membranes surrounding the brain and spinal cord( meningitis )

If complications do develop, they often need to be treated immediately with antibiotics in hospital.

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