Middle Ear Infections

Overview

A middle ear infection, known medically as otitis media, is an infection of the small air-filled space behind the eardrum that contains the tiny bones of hearing. It is one of the most common illnesses in childhood and a frequent reason for doctor visits and antibiotic use, though it can occur at any age. Infections often follow a cold or other upper respiratory illness.

The middle ear connects to the back of the nose by a narrow channel called the eustachian tube. When this tube becomes blocked or swollen, fluid builds up behind the eardrum and can become infected. Most middle ear infections clear up on their own or with simple treatment, but some cause lingering fluid, repeated infections, or, rarely, complications that need closer attention.

Symptoms

Symptoms come on fairly quickly and vary with age. Babies and young children, who cannot describe their pain, may simply be irritable and unwell.

• Ear pain, often worse when lying down
• Tugging or pulling at the ear in young children
• Fever and feeling generally unwell
• Difficulty sleeping, crying, and fussiness in infants
• Reduced hearing or a feeling of fullness in the ear
• Fluid or pus draining from the ear if the eardrum perforates
• Loss of balance in some children

Drainage of fluid from the ear often relieves the pain because the pressure behind the eardrum is released.

Causes

Middle ear infections usually develop when the eustachian tube becomes blocked and fluid collects behind the eardrum, allowing germs to multiply.

• Viral and bacterial infection: colds and other respiratory infections cause swelling that blocks the eustachian tube; bacteria or viruses then infect the trapped fluid.
• Eustachian tube problems: in children the tube is shorter and more horizontal, so it blocks and drains poorly.
• Enlarged adenoids: tissue at the back of the nose can swell and block the tube, especially in children.
• Allergies: nasal swelling from allergies can contribute to tube blockage.

Risk Factors

• Young age, especially between 6 months and 2 years
• Attending daycare or group childcare
• Exposure to tobacco smoke or air pollution
• Bottle-feeding while lying flat
• Frequent colds and seasonal allergies
• A family history of ear infections
• Not being breastfed, which offers some protection

Diagnosis

A doctor usually diagnoses a middle ear infection by examining the ear and reviewing symptoms.

• Otoscope examination: a lighted instrument lets the doctor see whether the eardrum is red, bulging, or has fluid behind it.
• Pneumatic otoscopy: a puff of air checks whether the eardrum moves normally; reduced movement suggests fluid.
• Tympanometry: a test that measures eardrum movement and pressure in the middle ear.
• Hearing tests: used when fluid or infections are recurrent to check for hearing loss.

Treatment

Treatment depends on the age of the patient, the severity of symptoms, and how often infections occur. Many infections improve on their own.

• Pain relief: acetaminophen or ibuprofen eases pain and fever and is often the main treatment in the first day or two.
• Watchful waiting: for mild cases, doctors may monitor for 48 to 72 hours before prescribing antibiotics, as many infections clear without them.
• Antibiotics: prescribed for younger children, more severe infections, or symptoms that do not improve.
• Ear tubes: for repeated infections or persistent fluid affecting hearing, small tubes may be placed in the eardrum to drain fluid and improve airflow.
• Treating contributing factors: managing allergies or removing enlarged adenoids in selected children.

Prevention

• Keep up with recommended childhood vaccinations, including pneumococcal and flu vaccines
• Avoid exposing children to tobacco smoke
• Breastfeed infants when possible, which offers some protection
• Hold babies upright during bottle feeding rather than letting them feed lying down
• Wash hands often and limit the spread of colds
• Manage allergies that contribute to nasal and ear congestion

When to See a Doctor

See a doctor if ear pain is severe, lasts more than a day or two, or comes with a high fever, or if a child is very young or has fluid draining from the ear. Seek urgent or emergency care for:

• A high fever with a stiff neck, severe headache, or confusion
• Redness, swelling, or tenderness of the bone behind the ear
• Severe pain that suddenly stops along with drainage and ongoing illness
• Repeated infections or hearing loss that affect speech or learning

Related Topics

Frequently Asked Questions

References

1. American Academy of Pediatrics. Ear Infections in Children.
2. National Institute on Deafness and Other Communication Disorders (NIDCD). Ear Infections in Children.
3. Mayo Clinic. Ear infection (middle ear) — Symptoms and causes.
4. MedlinePlus, U.S. National Library of Medicine. Ear infection — acute.