Middle-ear infection (otitis media)
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
What is it?
The middle ear is the space behind the eardrum, which is connected to the back of the throat by a passageway called the eustachian tube. Middle-ear infections, also called otitis media, can occur when congestion from an allergy or cold blocks the eustachian tube. Fluid and pressure build up, so bacteria or viruses that have traveled up the eustachian tube into the middle ear can multiply and cause an ear infection.
Middle-ear infections are the most common illness that brings children to a pediatrician and the most common cause of hearing loss in children. Middle-ear infections can also cause a hole (perforation) in the eardrum or spread to nearby areas, such as the mastoid bone. Adults also can get middle-ear infections.
Children in day care have an increased risk of middle-ear infections. The increased exposure to other infected children increases your child's chances of getting infected.
Symptoms
The most common symptoms of a middle-ear infection are pain and decreased hearing. Inside the middle ear, three tiny bones (ossicles) normally transfer sound vibrations from the eardrum to the inner ear, where they are turned into nerve impulses that your brain understands as sound. In people with otitis media, however, inflammation and infection may change this normal process. Other symptoms can include fever, headache, general body discomfort, rubbing or pulling of the ears in children, vomiting and diarrhea in infants, dizziness, loss of balance, and fluid draining from the ear.
Diagnosis
Your doctor will ask about ear pain, any discharge from the ear, and fever. He or she will examine the ears with an otoscope — an instrument with a lighted, cone-shaped end piece for looking in the ear canal at the eardrum. The doctor will look for redness and bulging of the eardrum and will check to see if it moves normally by blowing a puff of air through the otoscope. (Eardrums do not move if they are too stiff or if there is fluid behind them.) Your doctor may also do a hearing test called an audiogram to check for hearing problems or a test called a tympanogram that measures how the eardrum moves.
Expected duration
Symptoms of otitis media usually improve within 48 to 72 hours, but the fluid that has built up in the middle ear may last for up to three months.
Prevention
You may be able to lower your child's risk of otitis media by doing the following:
- Breastfeed your child, because breastfeeding seems to offer some protection against otitis media.
- Make sure your child gets all of his or her pneumococcal and Haemophilus vaccines.
- Avoid rooms with secondhand smoke, because environmental cigarette smoke may increase a child's risk of ear infections. Secondhand smoke disrupts the function of the eustachian tube and changes the protection mucus provides. If you smoke cigarettes, try to quit, or at least avoid smoking near children.
Treatment
The treatment of a middle-ear infection depends on how bad the symptoms are and what's causing the infection. Many infections will go away on their own, and the only treatment necessary is medication for pain. Up to 80% of ear infections may go away without antibiotics. Antibiotics are prescribed for any child younger than 6 months and for any person with severe symptoms. Sometimes a doctor will write a prescription for antibiotics but will ask the patient or family to wait 48 to 72 hours before filling it, to see if symptoms improve.
In cases of particularly severe infections or those that do not respond to treatment, a tube may need to be inserted through the eardrum. This is done by a specialist in illnesses of the ears, nose, and throat (an otolaryngologist), usually under anesthesia. If enlarged adenoids or tonsils cause recurrent or persistent infections, the specialist may recommend surgery to remove them.
When to call a professional
Call your doctor if you or your older child complains of an earache or has trouble hearing. If your baby child has a fever, is unusually irritable, or can't sleep, frequently rubs or pulls his or her ears, has vomiting or diarrhea, or does not respond normally to sounds (doesn't startle when a door slams or pots clang), call your doctor promptly.
Prognosis
The outlook in most people with a middle-ear infection is very good. The infection and its symptoms usually go away completely. In severe cases that go untreated, the infection can spread, causing an infection in the mastoid bone (called mastoiditis) or even meningitis, but this is rare. Hearing difficulties can occur. While they are not necessarily permanent, they can affect the speech and language development of younger children.
Additional info
National Institute on Deafness and Other Communication Disorders
https://www.nidcd.nih.gov/
American Academy of Otolaryngology — Head and Neck Surgery
https://www.entnet.org/
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
