{"id":3889,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/earinfectionsinchildren\/"},"modified":"2026-10-27T09:36:22","modified_gmt":"2026-10-27T09:36:22","slug":"earinfectionsinchildren","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/earinfectionsinchildren\/","title":{"rendered":"Ear infections in children"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Generally there are 3 categories of ear infections in children:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>\u00a0(Recurrent) acute otitis media &#8211; (R)AOM\u00a0\u00a0 \u00a0 common<\/li>\n\n\n\n<li>&nbsp;Otitis externa &#8211; OE&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; common<\/li>\n\n\n\n<li>Chronic suppurative otitis media &#8211; CSOM&nbsp;&nbsp; uncommon<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.M &amp; G.T &#8211; 27-10-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Recurrent Acute Otitis Media (R)AOM<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In young children this is very common and <strong>less than 5 episodes in a year (or 4 in 6 months) do not constitute recurrence or need for intervention<\/strong>, unless the child is exceptionally unwell and adequate medical measures have failed.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Otitis Externa (OE)<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If no improvement despite appropriate management, refer to ENT<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><strong>Chronic Suppurative Otitis Media (CSOM)<\/strong> <\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If no improvement despite appropriate management refer to ENT<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><span style=\"text-decoration: underline\">(R)AOM (see separate RefHelp page)<\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>History:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually develops after\/with an URTI, often on the background of OME.<\/li>\n\n\n\n<li>Symptoms: Pain (deep-seated ache), discharge, fever, malaise<\/li>\n\n\n\n<li>Examination: drum dull, red, bulging.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Otoscopy:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Can include discharging ear if tympanic membrane perforation (\u201cabscess draining\u201d).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Management:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Supportive care (analgesia, antipyretics)\n<ul class=\"wp-block-list\">\n<li>If child &lt;2 and especially unwell consider antibiotics (usually amoxicillin).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If ongoing ear discharge, topical ear drops &#8211; Ciprofloxacin \/ Betamethasone<\/li>\n\n\n\n<li>Prolonged course of antibiotics (usually amoxicillin, 1\/3 of daily dose for 3 months) if recurrent and troublesome but less than 5 episodes\/year. This can provide protection from infection until natural immunity has improved.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Refer urgently if complications (mastoiditis).<\/mark><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><span style=\"text-decoration: underline\">Otitis Externa (<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/earinfectionsinchildren\/chronic-suppurative-otitis-media-cholesteatoma\/\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/earinfectionsinchildren\/chronic-suppurative-otitis-media-cholesteatoma\/\" rel=\"noreferrer noopener\">see separate RefHelp page<\/a>)<\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>History:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually develops after swimming \/ water exposure (but not always)<\/li>\n\n\n\n<li>Symptoms: Pain, tender to touch \u2013 <strong>particularly pressure on tragus or pulling backwards of pinna to examine canal<\/strong>; discharge, usually systemically well<\/li>\n\n\n\n<li>Examination: Sharp pain as above, discharge in canal, often oedematous.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Otoscopy:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Wet, discharge in canal, can be smelly and bloody.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Management<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Take swab (might be fungal)<\/li>\n\n\n\n<li><strong>Topical<\/strong> antibiotic drops: Flumetasone \/ clioquinol (not for age under 2),Gentamicin \/ Hydrocortisone<\/li>\n\n\n\n<li>If perforation suspected: Ciprofloxacin, Ciprofloxacin \/ Betamethasone<\/li>\n\n\n\n<li>If fungal infection: long term course of clotrimazole (at least 6 weeks \u2013 and 2 weeks <strong>after symptoms have disappeared<\/strong>)<\/li>\n\n\n\n<li>Oral antibiotics do generally not work and are only indicated if the infection has spread to cause facial cellulitis.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\"><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><span style=\"text-decoration: underline\">CSOM (see separate RefHelp page)<\/span><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Either due to chronic perforation or cholesteatoma<\/li>\n\n\n\n<li>Very rare, usually unilateral<\/li>\n\n\n\n<li>Complications:\n<ul class=\"wp-block-list\">\n<li>If cholesteatoma, can lead to mastoiditis, meningitis, cerebral complications.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>History:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recurrent infection, often very smelly, often painless without other symptoms<\/li>\n\n\n\n<li>Initial response to topical\/oral treatment short lived-frequent relapses.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Examination:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Copious smelly discharge, often little else to see<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Management:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Topical <strong>and<\/strong> oral antibiotics &#8211; if no resolution or recurrence:\n<ul class=\"wp-block-list\">\n<li>Refer to ENT OPD<\/li>\n\n\n\n<li>Refer urgently if complications.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Generally there are 3 categories of ear infections in children: C.M &amp; G.T &ndash; 27-10-26<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4246,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[167],"class_list":["post-3889","page","type-page","status-publish","hentry","category-earinfectionschildren"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/earinfectionschildren\/\" rel=\"tag\">Ear infections in children<\/a>","rttpg_excerpt":"Generally there are 3 categories of ear infections in children: C.M &amp; G.T &ndash; 27-10-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3889"}],"version-history":[{"count":1,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889\/revisions"}],"predecessor-version":[{"id":30575,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889\/revisions\/30575"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3889"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3889"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}