According to the World Health Organization (WHO), about 60% of childhood hearing loss is caused by preventable factors, and over 30% is specifically linked to infections including vaccine-preventable diseases and chronic ear infections.
Globally, the burden of otitis media (middle-ear infection) continues to be significant. The Global Burden of Disease (GBD 2021) analysis estimated approximately 297 million new cases of otitis media among children (0–14 years) in 2021 alone. The incidence is highest in children under two years of age, highlighting the vulnerability of this age group. These infections are not just common, they pose a serious risk of long-term hearing impairment, especially when left untreated.
Sanjeev Mohanty, senior consultant and Head of ENT at MGM Healthcare, Chennai recounts one such case, the case of Aravinda , an infant whose parents barely noticed any outward symptoms — no pain, no discharge. What worried his mother was: by six or seven months, he did not respond as other babies his age did. “There was no obvious sign of illness. But on evaluation, we discovered bilateral profound sensorineural hearing loss,” Dr. Mohanty says. Though Aravinda’s ear structures were anatomically normal, their function was compromised. The child went on to receive a bilateral cochlear implant, and today he attends school and communicates fluently in multiple languages.
Hidden risks
R. Balaji, consultant ENT and head & neck robotic surgeon, Apollo Hospitals, Chennai, explains that many parents try to gauge whether an ear infection is “just a cold” or something more serious. He notes that ear infections broadly fall into two categories: otitis externa, affecting the outer ear, and otitis media, the middle-ear infection that tends to follow colds. “Small boils or mild irritation on the outer ear may resolve on their own,” Dr. Balaji says. “But if there is ear pain, fever, hearing loss or discharge, especially in a child recovering from a cold — that’s when it becomes serious.” He warns that delayed treatment can lead to dangerous complications: from eardrum perforation to more severe conditions, such as mastoiditis, brain abscess or thrombosis.
In one case, Dr. Balaji treated a child who developed facial paralysis because of a neglected infection. Only timely surgical and medical intervention saved the child from permanent damage.
Recurring infections, underlying causes
Recurrent ear infections often signal deeper problems. ENT experts urge parents to seek a comprehensive evaluation. Dr. Mohanty emphasises that in children, the Eustachian tube– a narrow tube that connects the middle ear to the back of the throat (nasopharynx), playing a key role in balancing pressure and draining fluid — is shorter, straighter and more horizontal than in adults, making it easier for nasal or throat infections to spread to the ear.
Gowri Shankar, senior consultant ENT, SIMS Hospital, Chennai, notes that structural issues including enlarged adenoids, chronic allergies or acid reflux are frequent culprits. He also points to environmental risks: crowded day-care centres, exposure to second-hand smoke, and poor nasal hygiene, can all contribute.
Vepamaninti Sreenivas, senior consultant, ENT, Narayana Health City, Bengaluru, adds that the way infants are fed matters. “Frequent bottle-feeding, pacifier use, and passive smoking raise the risk of repeated infections,” he says. He emphasis that breastfeeding in the first six months offers protection. He further warns that obesity and laryngopharyngeal reflux are emerging risk factors for recurrent ear disease.
Detecting infections
Very young children may not be able to tell you their ear hurts but behaviour often gives away the problem. Dr. Mohanty describes the signs: sudden night waking and crying, tugging at the ear, refusing feeds, or pausing while swallowing. “Sometimes, only one ear is affected, and children tilt their head or avoid touching the painful side,” he says.
Dr. Shankar adds that balance issues such as unsteady crawling or walking can also be a sign. Dr. Sreenivas cautions that any symptom lasting beyond 48 hours should prompt an ENT review, especially if accompanied by fever or discharge.
Treating infections
Despite the urge to treat every ear infection with antibiotics, ENT specialists recommend cautious use. Dr. Shankar says many ear infections, especially mild ones are viral, and can be managed with simple measures while monitoring for 24–48 hours. Antibiotics are reserved for children who are very young, or who have persistent fever, severe pain, discharge or both ears affected. Dr. Sreenivas supports this approach: “Over-prescribing antibiotics worsens resistance. A careful ENT assessment can help us decide when it’s truly needed.”
One of the most serious consequences of untreated otitis media is its impact on hearing and by extension, a child’s speech and learning. Dr. Balaji warns parents to watch for telltale signs: turning up the television volume, not responding when called, or showing inattention in class. These, he says, often point to fluid buildup behind the eardrum (“glue ear”), which may require referral to an ENT specialist.
According to Dr. Mohanty, even newborn screening is not enough. “If developmental milestones around speech, comprehension or listening aren’t met, it’s a red flag. Mothers often sense these changes first and their instincts are very important,” he says. Often, doctors recommend serial audiometry over weeks or months. If hearing does not improve, surgical or medical intervention may be needed to prevent long-term language delays.
Experts urge to take ear infections seriously. What may seem like a routine childhood illness can have long-term consequences if ignored. “Detect early, intervene early, prevent early and treat early,” Dr. Mohanty says.
Published – November 25, 2025 07:57 pm IST
