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Otitis Media (Middle Ear Infection)

What is otitis media (OM)?

Anatomy of the ear
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Otitis media is inflammation in the middle ear. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

Facts about otitis media

  • More than 80% of children have at least one episode of otitis media by the time they are 3 years of age.

  • Otitis media can also affect adults, although it is mainly a condition that occurs in children.

Who is at risk for getting ear infections?

While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections:

  • Being around someone who smokes

  • Family history of ear infections

  • A weak immune system

  • Spends time in a daycare setting

  • Absence of breastfeeding

  • Having a cold

  • Bottle-fed while laying on his or her back

What causes otitis media?

Middle ear infections are usually a result of a malfunction of the eustachian tube, a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a build up of fluid behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. The following are some of the reasons that the eustachian tube may not work properly:

  • A cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids)

  • A malformation of the eustachian tube

What are the different types of otitis media?

Different types of otitis media include the following:

  • Acute otitis media (AOM). The middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain, and hearing loss.

  • Otitis media with effusion (OME.) Fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and hearing loss.

  • Chronic otitis media with effusion (COME). Fluid remains in the middle ear for a prolonged period or returns again and again, even though there is no infection. May result in difficulty fighting new infection and hearing loss.

What are the symptoms of otitis media?

The following are the most common symptoms of otitis media:

  • Unusual irritability

  • Difficulty sleeping or staying asleep

  • Tugging or pulling at one or both ears

  • Fever

  • Fluid draining from ear(s)

  • Loss of balance

  • Hearing difficulties

  • Ear pain

The symptoms of otitis media may look like other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

How is otitis media diagnosed?

In addition to a complete medical history and physical exam, your child's health care provider will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the provider to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Tympanometry, is a test that can be done in most health care provider's offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to do in younger children because the child needs to remain still and not cry, talk, or move.

A hearing test may be done for children who have frequent ear infections.

Treatment for otitis media

Treatment may include:

  • Antibiotic medication by mouth or ear drops

  • Medication (for pain)

If fluid remains in the ear(s) for longer than 3 months, your child's health care provider may suggest that small tubes be placed in the ear(s). This surgical procedure, called typpanostomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from building up. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to 12 months.

Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx) if they are infected. Removal of the adenoids has shown to help some children with otitis media.

Treatment will depend upon the type of otitis media. Consult your child's health care provider regarding treatment options.

What are the effects of otitis media?

In addition to the symptoms of otitis media listed above, untreated otitis media can result in any of the following:

  • Infection that spreads to other parts of the head

  • Permanent hearing loss

  • Problems with speech and language development

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