Ear infections in young children are common and relatively easy to treat. In adults they are much rarer.

Ear infections in young children are common and relatively easy to treat. In adults they are much rarer.

A typical indication, which most parents will recognise only too well, is a three-year-old lying awake all night with high fever and a painful ear.

It often begins as a cold or runny nose, before the infection works its way into the hidden space behind the ear drum known as the middle ear. Pus collects and pressure builds behind the ear drum, which becomes bright red and very painful.

There is a simmering international debate about whether GPs should prescribe antibiotics for otitis media (the medical term for an infection behind the ear drum). But it takes a brave doctor who sees a feverish child with a bulging red ear drum to resist on the ground that the virus will cure itself with time and paracetamol.

It is rare to see a child today whose ear is persistently discharging pus because of a chronic infection. In the days before antibiotics, however, festering infections often caused children's ear drums to burst. And the infection would sometimes pass into the skull bone at the back of the ear, a condition called mastoiditis. In severe cases this can penetrate the skull, leading to meningitis and death.

Although better hygiene and nutrition may have played a part in eradicating chronic ear infections and their complications, it is also likely that the treatment of middle-ear infections with antibiotics had a big impact.

The fashion for treating children with recurrent ear infection has changed over the years. Before antibiotics were available doctors would make a tiny hole in the ear drum to allow the pus to drain out, in the hope that the hole would heal itself once the infection had been released.

From the 1950s to the 1970s, ear, nose and throat surgeons were keen to remove tonsils and adenoids, because enlarged tonsils and adenoids made ear infections more likely. In the 1950s in America, there was even a fashion for shrinking enlarged adenoids with radium treatment, until this was shown to cause thyroid cancer.

The latest surgical intervention is to instal grommets in the ear drum as a way of trying to prevent fluid accumulating behind the ear drum. Grommets don't treat ear infections but by clearing out the middle ear they improve hearing and reduce the chance of further infection.