Ear infections are a common problem in children worldwide. About 50 per cent 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 general signs such as loss of appetite and irritability. Some children get better without specific antibiotic treatment but most young infants benefit from use of drugs.

Ear infections often occur in children after they get a cold. Fluid can build up in the middle part of the ear behind the eardrum. This fluid can become infected and press on the eardrum, causing it to bulge and cause bothersome symptoms.

In some children, some fluid can stay in the ear for weeks to months after the pain and infection have gone away. Once not adequately treated, this fluid can impair hearing and can sometimes lead to problems with language and speech later in life.

In infants and young children, symptoms of an ear infection can include; a fever (temperature higher than 38ºC, pulling on the ear, being more fussy or less active than usual, having no appetite and not eating as much and sometimes vomiting or diarrhoea.

In adolescents and older children, symptoms of an ear infection commonly include ear aching or pain and temporary hearing loss. These symptoms usually come on suddenly.

If one suspects that their child has an ear infection, or the child portrays some of the above signs and symptoms, they need to see a doctor urgently to prevent possible complications of an untreated ear infection such as rupture of the eardrum due to a lot of fluid accumulation in the ear, hearing loss, although fortunately, these are usually reversible with appropriate medical intervention. The doctor will be able to tell if the child has an ear infection, usually by asking about the symptoms, doing an exam, and looking in the child’s ears.

Doctors commonly treat ear infections with antibiotics. These medicines kill the bacteria that cause some ear infections. But doctors do not always prescribe these medicines right away. That’s because many ear infections are caused by viruses, not bacteria and antibiotics do not kill viruses. Plus, many children get over ear infections without antibiotics.  

Doctors usually prescribe antibiotics to treat ear infections in infants younger than two years old. For children older than two, doctors sometimes hold off on antibiotics.

Sometimes, your child’s doctor might suggest watching your child’s symptoms for a day or two before trying antibiotics if; the child is healthy in general, the pain and fever are not severe, or if the ear exam did not show a definite ear infection.

Pain-relieving medicines, such as ibuprofen, paracetamol, or certain ear drops which contain a numbing medicine, may be used to reduce discomfort.

Children who are younger than two years and those who have language or learning problems should have a follow-up ear exam two to three months after being treated for an ear infection. These children are at risk for delays in learning to speak. This follow-up helps to ensure that the fluid collection (which can affect hearing) has resolved.

Sometimes, when the accumulated fluid in the ear fails to respond to medical treatment, surgery might be needed to drain this fluid from the ear in order to improve hearing in these children. This surgery is best performed by an ear, nose and throat (ENT) surgeon whenever required.

Dr. Ian Shyaka Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com