Paediatric Ear, Nose and Throat Clinic

Our ear, nose and throat experts can treat your child for the following conditions:

  • Sinus disease and surgery, nasal disorders, allergy and allergy testing
  • Hearing loss, ear infections and ear surgery (ear tubes, eardrum repair, cholesteatoma surgery)
  • Airway obstructions, noisy breathing, surgical repair laryngomalacia (floppy voice box).
  • Balance disorders
  • Head and neck masses
  • Voice and speech disorders
  • Acid-reflux related issues, chronic cough
  • Snoring, restless sleep and sleep apnea disorders (tonsils and adenoid surgery, and other sleep related surgical procedures)
  • Infant feeding issues, tongue tie, lip tie and breast feeding specialty
  • Facial and neck trauma (bites, lacerations, fractures)
  • Drooling and bad breath
  • Tracheostomy

What is an ear infection? 

Infection in the middle part of the ear is the commonest cause of earache in children. It is also called otitis media. Three out of four children will develop an ear infection by the time they are 3 years old.   

How can I tell if my child has an ear infection? 

Suspect an ear infection if your baby has any of the following problems: 

Tugging or pulling at the ear(s) 

Fussiness and crying 

Trouble sleeping 

Younger children may have fever. 

Fluid may drain from the ears.  

What causes an ear infection in children? 

Ear infections mostly develop after a viral upper respiratory infection like the common cold. During these infections the linings of the nose and throat can swell and make it more difficult to clear them of germs. Bacteria and viruses can access the middle ear through shared openings. The tube that connects the middle ear to the back of the nose is called the eustachian tube. When it swells or is blocked it fails to function well. This can cause fluid to fill the middle ear and result in hearing loss and recurrent ear infections.  

Are there other types of ear infections? 

Otitis media with effusion (OME) refers to the presence of non-infectious fluid in the middle ear for more than three months. It is usually symptom free but one may have an occasional feeling of fullness in the ear. 

Chronic suppurative otitis media (CSOM) is middle ear inflammation of greater than two weeks that results in episodes of discharge from the ear. It is usually not painful. 

Ear infection becomes chronic when fluid or an infection behind the in the middle ear does not go away 

If the infection affects the outer ear (including the ear canal and ear lobes) It can cause swelling, ear pain that occurs more when the ear is tugged, even reduced hearing in some cases. The same symptoms could also be caused by allergies and certain problems of the immune system. This is called otitis externa. Children at greater risk of otitis media include: those with problems of dry itchy skin, those wearing hearing aids, those who go swimming, those who pick their ears, and those with conditions causing low immunity. 

Are children more likely than adults to get ear infections? 

Yes. Eustachian tubes are narrower in children. They don’t drain fluid out of the ear as efficiently as the wider ones in adults. They easily get blocked when viral infections like the common cold cause swelling and mucus accumulation in the nose and back of the throat. 

The immunity of the child is maturing and may not be as efficient in keeping away infections as the mature adult immunity.  

How is a middle ear infection diagnosed? 

The doctor will start by asking you about your child’s symptoms and general health. In addition to the general physical exam the doctor will look into the child’s eardrum and ear canal. He will be able to check if there’s any foreign body or too much wax. If a middle ear infection is present the doctor will see a red, bulging eardrum. The doctor may use a special otoscope (pneumatic otoscope) to check how mobile the eardrum is. A healthy eardrum can be moved more easily that one in an ear that is infected. 

 How is an acute middle ear infection treated? 

The most suitable treatment will depend on the child’s age, whether the child has had similar infections before, the severity of illness, and any underlying medical problems. 

Antibiotics are usually given to children who are younger than 24 months or who have high fever or in whom both ears are affected. Those older than two years, or who have mild symptoms, or in whom only one ear if affected may be observed for about two days to see if their symptoms get better without antibiotics. This can help avoid unnecessary use of antibiotics which can cause a variety of problems. Talk to your doctor to see if your child will need an antibiotic. He might recommend an appropriate one for your child. 

Pain and discomfort will be treated with simple painkillers like ibuprofen or paracetamol.  

How are the other types of ear infection treated? 

Treatment of external ear infection usually involves giving antibiotic drops or acetic acid,the stuff that vinegar is made of. 

Uncomplicated chronic ear fluid is treated with antibiotics or steroids. Ventilation tubes may be inserted in the eardrums to allow normal air exchange in the middle ear until the eustachian tube matures. 

More intensive treatment for infections that spread to the surrounding bone or the inner ear. 

Treatment also involves dealing with the problems which promote the chronic ear problems like allergies, adenoid enlargement, and upper respiratory tract infections. 

Your doctor will discuss treatment options with you. 

Will follow up be necessary? 

Symptoms of ear infection usually improve within 48 hours whether treatment is  given or not. If your child’s symptoms get worse or don’t improve at the end of 48 hours you will need to be reviewed by the doctor. 

Some children retain accumulated fluid in the middle ear even after treatment. Your doctor may schedule an appointment to make sure it has resolved. 

Children with language or learning problems may need to have a follow up ear exam 2 months after an ear infection. 

What happens when ear infections are not treated? 

For some people ear infections are a temporary inconvenience; part of the pain and discomfort that one cannot entirely escape in life; one that resolves with simple pain medicine and the passage of time. In some cases though, if it goes untreated it can become severe and cause permanent damage and complications.

Hearing loss can occur if some ear infections go untreated. Hearing deficits caused by severe or frequent ear infections can cause delay in a child’s speech or language development. Untreated ear infections can spread to the brain and cause serious conditions like meningitis and brain abscesses. Ear infection could also spread to the bone and cause serious complications. This is called mastoiditis. 

What happens if my child keeps getting ear infections? 

If the ear infections keep coming back and antibiotics are not helping your ENT doctor may  recommend a surgical procedure that places a small ventilation tubes in the eardrum to improve air flow and prevent buildup of fluid in the middle ear. The tubes are usually in place for six to nine months. Regular follow up may be needed until they fall off. 

If you notice your child showing typical signs of an ear infection as described above don’t delay seeking treatment. Get in touch with your healthcare provider for the child to be checked and started on treatment if necessary. If your child appears not to be hearing well contact your hearing healthcare provider for assessment, diagnosis and treatment.