Middle Ear Infection
(Acute Otitis; Ear Infection, Middle; Otitis Media)
With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.
The Middle Ear
In most cases, middle ear infections are caused by viruses. In other cases, specific bacteria may be the cause.
Middle ear infections are more common in infants and toddlers. They occur more often during the winter months. Other factors that may increase your chance of a middle ear infection include:
- Recent viral infection, such as a cold or flu
- Recent sinusitis
- Attendance at day care
- Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating
- Babies who are formula-fed
- Medical conditions that cause abnormalities of the eustachian tubes, such as cleft palate or Down syndrome
- History of allergies, such as environmental or food allergies
- Gastroesophageal reflux disease (GERD)
- Babies whose mothers drank alcohol while pregnant
- Pacifier use
A middle ear infection may cause:
- Ear pain (babies may tug or rub at the ear or face)
- Hearing loss (may be only temporary, due to fluid accumulation)
- Decreased appetite, difficulty feeding
- Disturbed sleep
- Drainage from ear
- Difficulty with balance
The doctor will ask about symptoms and medical history. A physical exam will be done. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.
The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.
Other tests may include:
- Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
- Hearing test—may be done if you have had many ear infections
- Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
Some doctors may take a wait and see approach. In some cases, the doctor may prescribe an antibiotic (oral or ear drops) for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective in decreasing unnecessary antibiotic use. Since viruses cause most ear infections, antibiotics won't make those infections go away faster. Most middle ear infections, including those caused by bacteria, tend to improve on their own in 2-3 days.
Other medications may include:
- Pain relievers
- Fever reducers
- Anesthetic ear drops
Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
Decongestants and antihistamines are not recommended to treat ear infections.
Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus. This is usually followed by the placement of a ventilation or tympanostomy tube.
To help reduce the chance of a middle ear infection:
- Avoid exposure to smoke.
- Breastfeed your baby for at least the first 6 months of life.
- Try to avoid giving your baby a pacifier.
- If you bottle-feed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
- Get tested for allergies if you or your child have chronic nasal congestion. Keep allergy symptoms well controlled.
- Treat related conditions, such as GERD.
- Practice good hand washing hygiene.
- Make sure your child's vaccinations are up to date.
- Consider getting a flu vaccine. Pneumococcal vaccine may prevent some ear infections, but the overall effect on ear infections is not known. If your child has a history of ear infections, talk to the doctor about long-term antibiotic use.
- Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum and prevent fluid build-up and infection.
American Academy of Otolaryngology—Head and Neck Surgery
National Institute on Deafness and Other Communication Disorders (NIDCD)
Caring for Kids—Canadian Paediatric Society
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Last reviewed August 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.