Ear Infection Treatment in Sydney

Ear infections (otitis media) are among the most common reasons for ENT referral, particularly in children. A middle ear infection occurs when bacteria or viruses cause inflammation and fluid build-up behind the eardrum, leading to ear pain, hearing loss and sometimes fever. While many ear infections resolve with treatment, recurrent or persistent infections require specialist assessment to prevent long-term hearing and developmental consequences.

What Is Otitis Media?

Otitis media refers to infection and inflammation of the middle ear: the air-filled space behind the eardrum that contains the tiny vibrating bones responsible for transmitting sound. The condition is classified into several types:

Acute otitis media (AOM): a sudden-onset infection with ear pain, fever and a red, bulging eardrum. This is the classic painful ear infection in children.
Otitis media with effusion (OME): commonly called glue ear, where fluid persists behind the eardrum without active infection, causing hearing loss.
Chronic suppurative otitis media (CSOM): a long-standing ear infection with persistent discharge through a perforated eardrum lasting more than six weeks.
Recurrent acute otitis media: defined as three or more episodes in six months or four or more in twelve months.

Symptoms of Ear Infections

The symptoms of an ear infection vary depending on the type and the patient's age. Common signs include:

Ear pain (otalgia): often severe and throbbing, worse when lying down
Hearing loss or muffled hearing in the affected ear
Fever, particularly in acute infections
Ear discharge (otorrhoea): may be clear, yellow or blood-tinged
Feeling of fullness or pressure in the ear
Irritability, poor feeding and disrupted sleep in infants and young children
Balance difficulties in some cases
Tugging or pulling at the affected ear (in young children)

In children, hearing loss from recurrent ear infections can affect speech development, language acquisition and school performance, making timely specialist assessment important.

Causes and Risk Factors

Ear infections develop when the Eustachian tube, a narrow passage connecting the middle ear to the back of the throat, becomes blocked or swollen, trapping fluid in the middle ear where bacteria or viruses can multiply.

Upper respiratory infections: colds and flu are the most common trigger, causing Eustachian tube swelling
Age: children aged 6 months to 3 years are most susceptible due to immature Eustachian tube anatomy
Adenoid hypertrophy: enlarged adenoids can block the Eustachian tube opening
Allergies: allergic rhinitis causes nasal and Eustachian tube congestion
Childcare attendance: group childcare increases exposure to respiratory viruses
Passive smoke exposure: cigarette smoke irritates the Eustachian tube lining
Bottle-feeding while lying flat: can allow milk to enter the Eustachian tube
Family history: genetic factors influence susceptibility to ear infections

Diagnosis

At Central Sydney ENT, our specialists provide thorough assessment of ear infections. A typical evaluation includes:

Otoscopy and microscopy: Examination of the eardrum using an otoscope or operating microscope to assess its appearance, position, mobility and any perforation. A red, bulging eardrum suggests acute infection, while a dull, retracted eardrum with visible fluid level indicates effusion.

Tympanometry: A painless test that measures eardrum movement and middle ear pressure. A flat trace (Type B tympanogram) confirms fluid in the middle ear, while a negative pressure trace suggests Eustachian tube dysfunction.

Audiometry (hearing test): Formal hearing assessment to determine the degree of any hearing loss. This is particularly important in children with recurrent infections or persistent effusion, where even mild hearing loss can impact development.

Nasendoscopy: A flexible camera examination of the nose and back of the throat to check for enlarged adenoids or other causes of Eustachian tube obstruction.

Treatment Options

Treatment depends on the type, frequency and severity of ear infections, and whether there is associated hearing loss.

Medical Management

Watchful waiting: many acute ear infections resolve spontaneously within 48-72 hours, particularly in children over two years with mild symptoms
Antibiotics: prescribed for severe acute infections, children under two, bilateral infections, or infections that fail to improve after observation
Pain relief: paracetamol and ibuprofen for symptomatic management
Topical ear drops: antibiotic-steroid drops for chronic suppurative otitis media with a perforated eardrum
Nasal steroid sprays: to reduce Eustachian tube inflammation, particularly when allergies are contributing

Grommet Insertion (Myringotomy and Ventilation Tubes)

For children and adults with recurrent acute otitis media or persistent middle ear effusion, grommet insertion is the most effective surgical treatment. The procedure involves making a tiny incision in the eardrum (myringotomy) and placing a small ventilation tube to allow air into the middle ear and drain trapped fluid.

Grommet insertion is performed as a day procedure under brief general anaesthesia and takes approximately 10-15 minutes. Recovery is rapid, with most children returning to normal activities within a day. Grommets typically remain in place for 6 to 18 months before naturally extruding.

Our otology-trained surgeons: including Dr Sam Hwang, Dr Philip Yeung and Dr Arjuna Ananda: perform grommet insertion and paediatric ear surgery across all five Central Sydney ENT locations.

Adenoidectomy

When enlarged adenoids are contributing to recurrent ear infections or Eustachian tube dysfunction, adenoidectomy (removal of the adenoids) may be performed alongside grommet insertion. This combination is particularly effective in children over three years with both ear and nasal symptoms.

Tympanoplasty

For patients with chronic ear infections that have resulted in a persistent eardrum perforation, tympanoplasty (eardrum repair) may be recommended. This microsurgical procedure uses the patient's own tissue to repair the hole, restore hearing and prevent further infections.

When to See an ENT Specialist

You should seek a referral to an ENT specialist if:

Your child has had three or more ear infections in six months, or four or more in twelve months
Fluid behind the eardrum has persisted for three months or longer
There is hearing loss affecting speech, language or school performance
Ear discharge has continued for more than six weeks
An ear infection has not responded to appropriate antibiotic treatment
There are complications such as facial weakness, severe pain, swelling behind the ear, or high fever

Related Conditions

Ear infections are closely linked to several other conditions treated at Central Sydney ENT:

Glue Ear (Otitis Media with Effusion): persistent fluid behind the eardrum causing hearing loss
Cholesteatoma: an abnormal skin growth in the middle ear, sometimes developing from chronic infections
Adenoid Hypertrophy: enlarged adenoids that block Eustachian tube drainage

Common Questions

Ear Infection FAQ

What causes ear infections in children? +

Ear infections in children are most commonly caused by bacteria or viruses that enter the middle ear through the Eustachian tube. Children are more susceptible because their Eustachian tubes are shorter, narrower and more horizontal than adults, making drainage more difficult and infection more likely after a cold or upper respiratory infection.

When should I take my child to an ENT specialist for ear infections? +

You should see an ENT specialist if your child has had three or more ear infections in six months, four or more in twelve months, persistent fluid behind the eardrum lasting more than three months, hearing loss affecting speech or development, or ear infections that do not respond to antibiotic treatment.

What are grommets and how do they help? +

Grommets are tiny ventilation tubes inserted through the eardrum during a short procedure under general anaesthesia. They allow air to enter the middle ear, equalise pressure, and drain fluid. Grommets typically remain in place for 6 to 18 months before falling out naturally. They significantly reduce the frequency and severity of ear infections.

Can adults get middle ear infections? +

Yes, adults can develop middle ear infections, though they are less common than in children. Adult ear infections may be associated with upper respiratory infections, allergies, Eustachian tube dysfunction, or underlying conditions. Persistent or recurrent ear infections in adults should be assessed by an ENT specialist to exclude other causes.

Does Central Sydney ENT treat ear infections? +

Yes. Central Sydney ENT has seven FRACS-qualified ENT surgeons experienced in managing ear infections in both children and adults. We offer comprehensive assessment, medical management, grommet insertion, and ear surgery across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.