Introduction

Earache is a very common event in children and is usually associated with a cold or flu-like viral illness. When there are signs of ear drum inflammation this is called acute otitis media (AOM). This can be caused by viruses or bacteria.

When inflammation, nasal mucus and congestion are present in the upper respiratory tract, the ear can feel blocked, and may be uncomfortable or painful. This is due to inflammation of the throat and nasal passages and associated blockage of the Eustachian tube, which connects the middle ear to the back of the nasal cavity.

If the Eustachian tube is blocked, the ear can no longer be cleared or air pressure equilibrated through swallowing, which may make the patient feel uncomfortable and deaf. Sometimes, the situation worsens when the middle ear fills up with fluid and is under pressure. When this occurs the ear can become acutely painful (otalgia) but normally resolves spontaneously. It is common in young children and usually the best treatment is pain relief medicine.

A secondary infection with inflammation may follow AOM but in many children and young people, symptoms settle rapidly without the need for antibiotic treatment – in three days in over 80 per cent of AOM cases. Resolution occurs naturally when the blocked Eustachian tube reopens and the middle ear drains. Most cases can be managed with pain relief such as paracetamol or ibuprofen.

Research shows that antibiotics provide most benefit in children under two years of age who have pain in both ears, or in those with a painful ear with discharge from that ear (i.e. otorrhoea following ear drum perforation). AOM has become less common in recent years, which may be due to the use of pneumococcal vaccine in children.

For the Pharmacy First scheme in England, individuals under one year of age or 18 years of age and over with suspected AOM and significant pain should be referred to a GP practice. This also applies to women who are pregnant (or with suspected pregnancy) under 16 years of age.