​Your child seems to have trouble hearing sounds and is constantly tugging at his ear; he cries more often and appears more irritable than usual. This unusual behaviour could be symptomatic of a middle ear infection, known medically as otitis media. It can cause irreparable hearing loss if the ear infection damages the eardrum, ear bones, and inner ear structures.

But a middle ear infection, especially if mild, “can go unnoticed as young children may not be able to articulate their condition,” says Associate Professor Low Wong Kein, Visiting Consultant, Centre for Hearing and Ear Implants, Singapore General Hospital (SGH), a member of the SingHealth group.

Parents ought to be on extra alert when their young children start showing such distress symptoms during a cold. Most middle ear infections begin with a cold.

According to the National Institute of Deafness and Other Communicable Disorders in the US, three out of four children would have at least one middle ear infection by age 3.

What causes middle ear infection?

When fluid or mucus starts building up in the middle ear, it can breed bacteria. Result: a middle ear infection that causes great pain, discomfort, and dulls the hearing.

Fluid build-up often occurs when the eustachian tube – the tube that links the back of the nose and upper throat to the middle ear – becomes inflamed and stops draining away normal fluids that accumulate in the middle ear. Inflammation of the sinuses and eustachian tubes is common during a bad cold.

The sensation of having a glued ear can lead to severe middle ear infection.

Inflammation of the adenoids, which are tissues in the upper throat, is another cause of painful ear infections. When the adenoids are enlarged, they block the eustachian tubes, thus allowing mucus to build up in the middle ear.

Children under age 5 are susceptible to middle ear infection because of their shorter and narrower eustachian tubes, which are more likely to become completely blocked.

Signs of middle ear infection in young children

  • Constant pulling at the ear      
  • Crying more than usual      
  • Acting more irritable than usual      
  • Trouble hearing      
  • Difficulty sleeping      
  • Speaking louder than usual      
  • Ear pain, especially when lying down      
  • Complains of a glued, sticky ear

How to reduce the risk of middle ear infection in young children

  • Keep your child’s ears dry      
  • Try not to let your child bottle-feed while lying down to prevent blocked eustachian tubes      
  • Keep your living environment smoke-free      
  • Strengthen your child’s immune system against colds      
  • Do not direct shower spray into the ears

Treatment for middle ear infection

Treatment usually involves pain relief medications and antibiotics (if infection is bacterial).

Preventive measures include: Giving your child oral decongestants at the first sign of a cold and using nasal sprays to prevent clogging of the eustachian tubes.

Complications are rare, but a persistent ear infection can lead to spread of infection, hearing loss, and speech developmental delays.

But not all ear pain comes from a middle ear infection. “Your child could be having a toothache which manifests itself as an ear ache due to the shared nerve network. This is known as ‘referred pain’,” says A/Professor Low.

Ref: U11