How to tell if it’s really an ear infection from the doctor

Before I can tell you how to know if your child is pulling at their ears because of infection, I think it would be useful to explain a bit more about the ears. The ear is loosely made up of 3 different parts; the outer ear, middle ear, and the inner ear.

Ear Infection

The outer ear is lined with normal skin and produces wax which protects the canal from infection. The eardrum, also known as the tympanic membrane, is made from a very thin layer of skin, and separates the outer and middle ears. The middle chamber of the ear contains tiny bones which move when sound waves cause the eardrum to vibrate, and they transmit this sound to a nerve which then carries it to the brain. This nerve and the apparatus that control our balance are situated in the inner ear – a chamber surrounded by the temporal bone of the skull.

Now when we talk about an ear infection, it is the outer or middle ear that is affected. Outer ear infections, also known as Otitis Externa, often cause soreness or itchiness in the external canal, and sometimes you can see or feel a slight wetness. Otitis Externa doesn’t usually cause you to become generally unwell, and can be treated with a drop or spray containing an antibiotic. More unusually, the infection may penetrate deeper into the skin of the outer ear, requiring an oral antibiotic from your GP.

Middle ear infections, also called Otitis Media, occur behind the eardrum, and happen when bugs pass from the back of the nose and throat down a small tube which allows pressure changes either side of the eardrum, to the middle ear. Infections can be caused by both bacteria and viruses, but can cause some similar symptoms.

In bacterial Otitis Media, a child will complain of an earache or pain, and younger children and babies may pull on the affected ear. You might notice a fever and there might even be blood-stained, or thick yellow discharge from the ear. There will probably be an element of hearing loss too. Viral causes of ear infection tend to be associated with ‘head colds’; so your child will have other symptoms such as a runny nose, a cough, and a sore throat. These types of infections don’t usually require any treatment other than antipyretics and pain relief, but interestingly, neither do most bacterial ear infections.

If your child is particularly unwell with fever or vomiting, then you should see your doctor so they can consider antibiotics after having a look down the ear(s). Other reasons why your doctor might give antibiotics to your child include bilateral Otitis Media in a young child, recurrent ear infection, or symptoms lasting more than 4 days. If your child remains rather well, and the symptoms are well controlled with pain relief, it would be reasonable to wait 3-4 days before seeing your GP for an ongoing problem.

If there is any doubt, however, and you are worried that your child is unwell, please see your doctor.