Otitis Media

  • What Is A Middle Ear Infection?

    Otitis media—middle ear infection—is the most common cause of earache. It affects the cavity between the eardrum and the delicate structures of the inner ear. Typically, otitis media occurs when viruses causing an upper respiratory tract infection (such as a cold) or bacteria migrate along the Eustachian tube, the passageway between the nasal passages and the middle ear. Infection often causes the tube to become blocked, producing a vacuumlike effect and preventing the mucus, pus, and other fluids produced during an infection from draining out of the middle ear. This causes pain as these fluids exert pressure on the eardrum, possibly rupturing it. Otitis media is very common in children (because the Eustachian tube is smaller and positioned differently than in adults), and it tends to recur, especially in winter. With prompt treatment, the chances of full recovery are excellent. Persistent forms of the disorder, chronic otitis media, produce milder symptoms. Left untreated, however, chronic otitis media may eventually cause severe structural damage in the ear and skull, resulting in irreversible hearing loss, spread of infection to surrounding structures or facial nerve weakness.


    Who Gets Middle Ear Infections?

    It can occur at any age, though it is especially common among children up to age eight. Some children will experience middle ear infections only occasionally, but in other children they can be chronic, occurring frequently and/or not clearing up readily. Middle ear infections can afflict one or both ears, and they typically occur in the winter and early spring months, when respiratory tract infections are common.

    Ear infections are one of the most common childhood illnesses diagnosed in the United States.



    • Sensation of fullness in the ear, eventually leading to severe pain.
    • Some temporary hearing loss in affected ear.
    • Fever (when bacterial infection is present).

    • Dizziness.

    • Nausea and vomiting.
    • Clicking or popping sounds in the ear when moving the jaw.
    • Pain when pulling on the earlobe.

    • Persistent pus seepage and mild hearing loss, often without earache (the primary symptoms of chronic otitis media with perforation of the eardrum).
    • Young children may act extremely irritated and/or cry persistently as well as tug at their ears.


    Causes/Risk Factors

    • A viral or bacterial infection of the upper respiratory tract is the most common underlying cause.

    • Nasal allergies or childhood adenoids may cause blockage of the Eustachian tube. Because the Eustachian tube is smaller and more horizontal during early childhood, which helps spread infection from the upper respiratory tract to the middle ear, may be why children are more vulnerable to the infection.
    • A ruptured eardrum facilitates the entrance of infectious agents into the middle ear.
    • Children with congenital problems of the facial skeleton (such as cleft lip) and those with Down syndrome are at greater risk of middle ear infection.
    • Certain groups of people (such as Native Americans) have a hereditary predisposition to ear infections.
    • Second-hand exposure to cigarette smoke raises the risk of middle ear infection in children.

    • Recurrent bacterial ear infections may result in chronic otitis media.


    What If You Do Nothing?

    Otitis media can clear up spontaneously within 10 days. Some infections can persist for weeks. Because the pain and discomfort are often too much to bear, treatment by a physician, supplemented by home treatment, is advisable. Also, in some cases an untreated ear infection can worsen to the point where the eardrum becomes inflamed or pressure causes the eardrum to rupture. Hearing loss is another possible complication, though it is usually reversible.



    • The doctor will examine the ear canal with an otoscope, a small, lighted viewing instrument.

    • A culture of the fluid discharge may be taken.



    Whenever you (or a child) develop middle-ear symptoms, these measures can alleviate some of the discomfort. Nonetheless, you should also contact your doctor, since most middle ear infections can be cleared up quickly with medication.

    • Warm the ear. Hold a heating pad or warm compress to the ear.

    • Try baby oil if there is no discolored drainage coming out of the ear canal. Warm the oil to room temperature and put a few drops into the sore ear. While this won’t treat the cause of the ear infection, it may offer some relief before you get to see your physician.
    • Raise your head when sleeping. Use pillows to keep your head comfortably raised. This will help drain fluids from your middle ear.
    • Relieve pain and fever. Over-the-counter anti-inflammatories—aspirin, naproxen, and ibuprofen—or acetaminophen may help relieve pain symptoms and fever. Children should be given acetaminophen only.
    • Take an over-the-counter decongestant. Decongestants can help shrink mucous membranes to open the Eustachian tube and relieve middle ear pressure and discomfort. It’s important to follow warnings and instructions carefully when taking these medications. Some are made for adults and contain ingredients that are harmful when taken by children.
    • Once an ear infection has been diagnosed, medications, including prescription nose drops or sprays, may be prescribed to help open up the Eustachian tubes.
    • Antibiotics (to be taken for the full term prescribed) may be needed to treat a bacterial infection.
    • Your doctor may make a small incision (myringotomy) in the eardrum to allow pus to drain. This incision usually heals by itself in two to three weeks. A tube may be placed within the myringotomy to aerate the middle ear when fluid repeatedly accumulates.
    • Enlarged adenoids may require surgical removal.

    • Rarely, the mastoid process, a bone just behind the ear, becomes infected and must be surgically removed (mastoidectomy).
    • If your child frequently has fluid in the middle ear that interferes with hearing, his or her pediatrician may recommend ear tubes. Ear tubes, also called ventilating or tympanostomy tubes, allow the fluid in the middle ear to drain into the outer ear canal. Ear tubes can improve hearing and reduce the number and severity of ear infections in children.



    • It is usually not possible to prevent otitis media. But children who have recurrent infections may be able to take medications to prevent bacterial infections.
    • Protocols for hand washing with soap and warm water should be established for both children and caretakers in schools and daycare settings.

    • At home, wash bed linens, towels, and heating pads regularly to prevent reinfection from pus residues. Discard cotton balls and swabs after use.


    When To Call Your Doctor

    • Call a doctor if you or your child develops an earache that persists despite treatment, especially if symptoms worsen or are accompanied by swelling around the ear, change in mental status, facial twitches, or severe ear pain that suddenly ceases (indicating eardrum rupture).


    Reviewed by Alan Lipkin, M.D., Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network.