Ear Infection

As a paediatric ENT surgeon, I regularly see babies, toddlers and young children who are struggling with ear infections. These are very common; almost all children will have had at least one middle ear infection (acute otitis media) by the age of three.

The middle ear is the small, air-filled space just behind the eardrum. After a cold or upper respiratory infection, viruses or bacteria can travel up into this space. The body will usually fight the infection off, but sometimes the infection builds quickly, and the pressure becomes too much. This trapped pressure causes intense ear pain, fever and an unwell little one.

In some cases, the eardrum may burst and release pus from the ear (which often relieves the pain and, in most cases, heals without complication).

Children can also suffer with outer ear infections known as otitis externa or “swimmer’s ear” — this affects the skin of the outer ear canal. It causes pain, irritation and tenderness of the external ear, especially when touched or moved, and you may notice discharge from your child’s ear.

While many ear infections are mild and get better on their own, recurrent infections or ongoing symptoms need specialist assessment — especially if your child is missing nursery or school, taking lots of antibiotics, struggling with sleep or not hearing well, impacting speech development.

When are ear infections considered “recurrent”?

Ear infections (acute otitis media) are considered recurrent if your child has:

3 or more episodes in 6 months

4 or more episodes in 12 months (with at least one in the last 6 months)

If your child is getting frequent ear infections requiring antibiotics and/or has hearing concerns it is very important to see an ENT specialist.

Diagnosis

When I see your child in clinic, I begin by listening closely to your concerns — from the number of infections to hearing changes, disrupted sleep or possible speech delays.

I carry out an ear exam using a light and lens to get a detailed look at the eardrum and middle ear. This is quick and painless.
I’ll arrange a hearing test with a paediatric audiologist, tailored to your child’s age. These are engaging and play-based for young children, or headset-based for older ones.
We may use tympanometry, a safe test that measures how well the eardrum moves — helping us detect fluid behind the eardrum in seconds.
If your child also has a blocked or snotty nose, I may recommend naso-endoscopy to examine the adenoids. This quick, gentle test uses a slim camera on a tube that goes into the nostrils and can be done while your child is awake.

If there have been frequent or prolonged infections, we may also explore subtle allergy or immune system issues to check if they’re playing a role.

Getting a clear diagnosis early allows us to plan the right support — whether that’s monitoring, medical treatment or hearing technology.

Treatments

Most ear infections are caused by viruses and improve without antibiotics. Pain relief like paracetamol or ibuprofen is usually all that’s needed in the early stages.

However, your child may need further treatment if:

The infection is severe or not improving after 3 days
There is pus leaking from the ear
Infections are affecting both ears in a child under two
Your child has recurrent infections within short intervals

Whatever the cause, early intervention makes a huge difference — helping your child develop speech, confidence and connection with the world around them.

Treatment of recurrent ear infections:

If your child meets the criteria for recurrent ear infections there are several treatment options we may consider together. Essentially there are 3 options:

Watch and wait – continue to treat individual infections as above when they occur, safe in the knowledge that many children will eventually “grow out” of recurrent ear infections as they get bigger.
Consider a long-term low-dose antibiotic, aiming to break the cycle of repeated infections. Typically this regimen would involve taking an antibiotic once a day, three times a week for a twelve-week period.
Consider grommet (ventilation tube) insertion. This can help to lessen the frequency of infections, and if glue ear is also present, helps to resolve any hearing loss associated with it. Depending on symptoms, we may also suggest removing the adenoids at the same time as placing the grommets in the ears. Adenoids can block the back of the nose, be a source of bacteria, and also contribute to the formation of glue ear.

Make an Enquiry

If your child is having repeated ear infections, ongoing discomfort or signs of hearing loss, it’s worth getting things checked. As a paediatric ENT specialist, I can carry out a full assessment of your child’s ears, hearing and overall ENT health, and help you make informed decisions. Clear hearing supports their development, confidence and everyday comfort.

Click here to make an enquiry.