Ninety per cent of children will have at least one episode of ear infection before they reach adulthood. It is usually due to a viral or bacterial infection of the middle ear or otitis media. The child becomes inconsolable — crying, refusing feeds — and may keep tugging at the affected ear, which hurts if pressed or pulled. It may or may not be accompanied by fever.

Those who have been immunised against pneumococcal, H. influenzae and flu tend to have fewer infections. They are, however, still susceptible to ear infections from other bacteria and viruses.

There is a narrow pipe-like connection between the middle ear and the back of the throat — the eustachian tube. Initially, this connection is straight. As a child grows, it becomes angulated. Therefore, in children, food can easily pass from the throat to the ear, but not in adults. This contamination also causes infection of the ear.

Frequent infection of the ear in children occur:

If they are fed liquids while they are lying down, particularly if they are put to sleep holding a bottle in their mouth. The milk can easily enter the middle ear.

If they come in contact with pollutants, especially cigarette smoke and vapourising mosquito repellents.

When they attend school. This risk increases if cross-ventilation in the classroom is not adequate or if the room is air-conditioned.

Climate change, especially during the monsoons.

These infections require nose drops to clear the back of the nose and upper throat so as to equalise the pressure between the middle ear and the environment. Antihistamines dry the nasal secretions and paracetamol or brufen can help relieve the pain. Antibiotics are needed for 7-10 days if the fever persists for more than 48 hours.

Neglected infections can cause a discharge and end up perforating the eardrum. If left untreated, the infection can spread to a bone called the mastoid, at the base of the skull, and also, eventually, to the brain itself and cause meningitis. It can cause loss of hearing and affect balance too.

On examination, some children may be found to have large “adenoids” — a collection of lymphoid tissues at the back of the throat. Large adenoids can block the eustachian tube leading to frequent infections.

Children may place foreign bodies, like dal or seeds, in the ear. Sometimes they forget having inserted it. Do not try to use earbuds to dislodge it as that may push it further inside. Seek professional help to safely remove the object.

Ear infections, of course, are not limited to children. In adults, an infection of the external ear canal (otitis externa) can occur if the delicate skin lining the canal is damaged. This can be caused when foreign objects such as earbuds or pins are inserted to clean ear wax or relieve itching. The ear becomes painful, red and swollen. Usually, antibiotic drops are all that may be required for 5-7 days.

Fungus can also grow in the external ear canal. This can occur in people who immerse their ears in water for a long time, such as swimmers. This manifests as a fluffy, white discharge that causes intense itching. To prevent this, a few drops of liquid paraffin can be placed in the ears before swimming. The ear can be dried after the swim with a hair dryer. Topical antifungal drops are usually all that’s needed in case of an infection.

An infection may also happen if an insect enters the ear and gets lodged there. If a powerful flashlight is shone into the ear, the insect may fly out. If it doesn’t, put a little warm liquid paraffin or baby oil in the ear.

The writer is a paediatrician with a family practice at Vellore and the author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in