Signs to spot: Ear infection in children

Monday January 13 2020


By Ali Khatau

A few weeks ago, I started my rotations in the paediatric department of the hospital which deals with all cases of children under 18 years of age.

The department gets all kinds of cases from viral stomach infections and ear infections to tonsillitis and pneumonia.

One such case was of Lucy*, a 9-month-old baby with signs of fever and vomiting for 2 days. She experienced more than 10 episodes of vomiting with high grade fevers and also had a reduced appetite through the span of 2 days.

When we examined her ears, we discovered both the eardrums were inflamed and red and we made a diagnosis of acute otitis media or commonly referred to as an ear infection. Another interesting case was of

Ronald*, a 2-year-old who came with a complain of fever for 2 days.

He didn’t have any other symptom such as vomiting, diarrhoea, a reduced appetite or ear irritation and on examining his ears, we found an infection in his right ear.


What’s an ear infection?

Acute otitis media is basically infection and inflammation of the area behind the eardrum called the middle ear. It is usually caused by bacteria but can also be caused by viruses.

How common is it?

Acute otitis media is one of the most common infections in children under 5 and approximately 80 per cent of children are affected during their first 5 years of life.

The disease burden is greatest between 6 months and 18 months of age according to researches published on

It is the most common medical condition in children under 5 in the US as research reports.


Children with acute otitis media usually have fevers which are high grade, along with vomiting, diarrhoea, headaches and reduced appetite.

In younger children, you might notice ear pulling while older children may complain of ear pain, reduced hearing as well as a feeling of fullness in the ear.

Sometimes, there might be very few ymptoms, which may be very vague as in the case of Lucy who only had fever, vomiting and a reduced appetite or Ronald who only had fever.

Who is at risk?

Children between the ages of 6 months and 3 years old have a higher risk of getting Otitis Media.

Other significant risk factors include attending day care, poor hygiene, exposure to cigarette smoke or polluted air, sudden changes in climate and recent colds, recent sinus infections or ear infections which haven’t been treated properly leading to recurrent infections.


For diagnosis, an otoscope which is an instrument used to check the ear drum is used to check for any redness, inflammation, bulging, pus, or perforation to confirm an ear infection.

A hearing test may also be done to determine if there is any hearing loss due to the condition.


Multiple studies show that in low and middle-income countries, around 50 per cent of otitis media cases will have an associated hearing impairment, although it will usually be mild.

There may also be perforation of the ear drum, mastoiditis which is an infection of the mastoid space behind the ear and in rare cases, brain complications such as meningitis and brain abscess.


There are a number of measures in place to reduce the risk of developing ear infection.

These include vaccinations against influenza virus and pneumococcus, exclusive breastfeeding which builds up significant immunity against infections and avoiding exposure to smoke including tobacco smoke, which can result from being around regular cigarette smokers.


Acute otitis media, which is bacterial usually requires a high dose of antibiotics along with anti-pyretics for reducing fever which may be very high grade.

However, we must ensure we avoid self-medication due to its potential risks and make sure we see a doctor for such conditions.

I personally have had a lot of hospital visits due to ear infections during my childhood and have also been admitted in severe cases.

Currently, I see many cases of ear infections at my workplace and realise how common ear infections are in children.

So the next time you notice ear pulling in your infant or get a complaint of ear pain, fever, vomiting, diarrhoea or poor feeding from your child, keep in mind, you might be dealing with an ear infection.

The author is medical doctor interning at Aga Khan Hospital in Dar es Salaam.