Middle Ear Infection
An infection of the space behind the eardrum, common in young children
Quick Facts
- Type: Ear infection
- Who it affects: Most common in young children
- Main symptoms: Ear pain, fever, fussiness
- Often follows: A cold or upper respiratory infection
Overview
A middle ear infection, known medically as otitis media, is an infection of the air-filled space behind the eardrum that contains the tiny bones of hearing. It is one of the most common reasons young children are brought to the doctor, though it can affect people of any age.
These infections often develop after a cold or other upper respiratory illness, when fluid becomes trapped behind the eardrum and germs grow in it. Most middle ear infections improve within a few days, and many clear up without antibiotics. Repeated or persistent infections, however, may need closer attention to protect hearing.
Symptoms
Symptoms can come on quickly and are often worse when lying down. In young children who cannot describe their discomfort, behavior changes may be the main clue.
- Ear pain, which may be sharp or throbbing
- Tugging or pulling at the ear in young children
- Fever
- Trouble sleeping, fussiness, or crying
- Reduced hearing or a feeling of fullness in the ear
- Fluid draining from the ear if the eardrum perforates
- Loss of balance in some children
Drainage of pus or fluid from the ear may mean the eardrum has developed a small hole, which usually heals as the infection clears.
Causes
Middle ear infections usually begin when a cold, flu, or allergy causes swelling and congestion in the nose, throat, and the eustachian tubes that drain the middle ear. When these tubes become blocked, fluid builds up behind the eardrum and bacteria or viruses can multiply.
Children are especially prone because their eustachian tubes are shorter and more horizontal, making them easier to block and slower to drain. This is why ear infections are so common in early childhood and tend to become less frequent as children grow. Enlarged adenoids near the opening of these tubes can also contribute by blocking drainage. While the infection itself is not usually caught from another person, the colds that lead up to it spread easily between children.
Risk Factors
- Young age, especially between about 6 months and 2 years
- Frequent colds and other respiratory infections
- Attending group childcare
- Bottle-feeding while lying flat
- Exposure to tobacco smoke or air pollution
- Seasonal allergies
- A family history of ear infections
Diagnosis
A doctor can usually diagnose a middle ear infection with a simple examination, taking into account the symptoms and how long they have lasted.
- Otoscopy: Looking into the ear with a lighted instrument to see whether the eardrum is red, bulging, or has fluid behind it.
- Pneumatic otoscopy: Gently puffing air to see how the eardrum moves, which is reduced when fluid is present.
- Tympanometry: A test that measures eardrum movement to detect fluid.
- Hearing tests: If infections are frequent or hearing concerns arise.
The doctor will also distinguish an active infection from simple fluid behind the eardrum that lingers after an infection has cleared, since the two are managed differently.
Treatment
Treatment focuses on relieving pain and clearing the infection. Many ear infections, especially milder ones in older children and adults, improve on their own.
- Pain relief: Acetaminophen or ibuprofen, used as directed for the person's age, and warm compresses.
- Watchful waiting: Doctors often monitor mild cases for a couple of days before deciding on antibiotics.
- Antibiotics: Prescribed when the infection is more severe, in very young children, or when it does not improve.
- Ear tubes: For repeated infections or persistent fluid, a minor procedure can place small tubes to help the ear drain.
Most symptoms ease within a few days. Follow-up may be advised to confirm the fluid has cleared, especially in young children.
Prevention
- Keep up with recommended childhood vaccinations
- Wash hands often to reduce colds and other infections
- Avoid exposing children to tobacco smoke
- Breastfeed infants when possible, as it offers some protection
- Feed babies in an upright rather than fully flat position
- Manage allergies that contribute to congestion
When to See a Doctor
See a doctor if ear pain is severe, lasts more than a day or two, or is accompanied by a high fever, or if a young child seems very unwell or has fluid draining from the ear.
Seek urgent care if there is severe headache, swelling, redness behind the ear, stiff neck, high fever with lethargy, or facial weakness, as these can signal a more serious infection that has spread and needs prompt treatment.
Frequently Asked Questions
Do middle ear infections always need antibiotics?
No. Many improve on their own, especially milder cases in older children and adults. Doctors often recommend watchful waiting with pain relief for a couple of days, and prescribe antibiotics for severe infections, very young children, or cases that do not improve.
Why are children more prone to ear infections?
Children's eustachian tubes, which drain the middle ear, are shorter and more horizontal, so they block and drain less easily. Combined with frequent colds, this makes ear infections especially common in early childhood, usually becoming less frequent with age.
How long does a middle ear infection last?
Pain and fever usually improve within a few days, although fluid behind the eardrum can take several weeks to fully clear. If symptoms persist or worsen, a follow-up visit is recommended.
Can a middle ear infection cause hearing loss?
It can cause temporary reduced hearing while fluid is present, which usually returns to normal as the infection clears. Frequent or persistent infections may have a longer effect on hearing, so children with repeated infections may need monitoring.
What are ear tubes?
Ear tubes are tiny tubes placed in the eardrum during a minor procedure to help fluid drain and air enter the middle ear. They are used for children with frequent infections or persistent fluid that affects hearing.
References
- American Academy of Pediatrics. Ear infections.
- Mayo Clinic. Ear infection (middle ear) — Symptoms and causes.
- National Institute on Deafness and Other Communication Disorders (NIDCD).
- MedlinePlus, U.S. National Library of Medicine. Ear infection — acute.