A middle ear infection (Otitis Media) occurs when bacteria or viruses reach the middle ear, an air-filled space behind the eardrum. When an infection develops in this area, fluid accumulates, leading to pressure on the eardrum, pain, and other symptoms. (1)

Otitis media is more common in children. Most cases resolve on their own without treatment. However, severe cases or those that do not show signs of improvement within a few days may require antibiotic treatment. (2)

Symptoms

The symptoms of middle ear infections typically appear suddenly and include: (3)

• Ear pain.
• Fever.
• Fatigue or general weakness.
• Hearing loss.
• Unusual secretions or fluid discharge from the ear.
• Pressure or fullness in the ear.
• Itchiness in or around the ear.
• Peeling skin in or around the ear.

Symptoms in Infants and Young Children

Infants and toddlers cannot verbalize their discomfort, so symptoms may appear as: (3)

• Frequent ear pulling or ear tugging.
• Lack of response to sounds, such as their name being called.
• Unusual irritability or excessive crying.
• Loss of appetite.
• Frequent loss of balance.

When to See a Doctor

It’s important to take your child to the doctor if: (4)

• Symptoms persist without improvement after 2-3 days.
• Fever or severe pain is present.
• The child is under two years old.
• There is discharge or pus from the ear.
• The child experiences recurrent ear infections.
• The child has chronic health issues, such as congenital heart disease.

Causes

Middle ear infections occur due to a blockage in the Eustachian tube, which connects the middle ear to the throat. Normally, this tube drains fluid from the middle ear to the throat, but certain factors can block it, causing fluid buildup and infection. (5)

Children are more prone to these infections because their Eustachian tubes are shorter and more easily obstructed. Common causes of tube blockage include:

• Respiratory allergies.
• Colds, flu, and sinusitis.
• Enlarged or inflamed adenoids.

Risk Factors

Some children are more at risk of middle ear infections due to: (5)

• Attending daycare or school.
• Drinking from feeding bottles or sippy cups while lying down.
• Teething, as it increases saliva and mucus production.
• Exposure to secondhand smoke.
• Using pacifiers.
• Cold or fluctuating weather.
• Lack of breastfeeding.
• Birth defects affecting the Eustachian tube.

Potential Complications

Most cases of otitis media resolve without complications. However, recurrent infections or untreated cases may lead to: (6)

• Hearing loss.
• Delayed speech or poor social skills due to impaired hearing.
• Spread of the infection to surrounding tissues in the ear or skull.
• A perforated eardrum.

Diagnosis

Diagnosis is based on symptoms and confirmed using an otoscope, which allows the doctor to closely examine the ear for signs of inflammation, or complications. (5)

For children with recurrent ear infections, a hearing test may be recommended to ensure no lasting damage.

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Treatment

Most middle ear infections in children resolve on their own within 3-5 days. To ease symptoms, doctors may recommend: (4)(1)

• Pain relievers such as paracetamol or ibuprofen.
• Ear drops for pain relief.
• Warm compresses applied to the ear.

When Are Antibiotics Recommended?

Antibiotics are usually unnecessary for viral infections, as they are ineffective against viruses. They are recommended only when there is clear evidence of a bacterial infection or a high risk of complications. (3)

Doctors may prescribe antibiotics in cases where:

• Symptoms do not improve after 2-3 days.
• Fluid or unusual discharge is coming from the ear.
• The risk of complications is high.
• The child is under two years old.

It’s crucial to complete the full course of antibiotics to ensure the bacteria are eradicated, and to prevent resistance, even if symptoms improve before the course is finished.

When Are Ear Tubes Recommended?

Doctors may recommend ear tubes for children with frequent, chronic middle ear infections, or in case of persistent fluid buildup after the infection clears. (6)

This procedure involves making a small incision in the eardrum to drain the fluid, and then inserting a tiny tube to maintain drainage. Some tubes fall out by themselves within 6–18 months, while others may require surgical removal.

Prevention

While it’s impossible to completely prevent middle ear infections in children, certain practices can reduce the risk: (4)

• Ensuring the child receives all recommended vaccines on schedule.
• Breastfeeding instead of using formula.
• Keeping the child away from smoke and smokers.
• Avoiding pacifiers after the age of one.
• Not feeding the child with a bottle while they are lying on their back.

Is Otitis Media Contagious?

Middle ear infections themselves are not contagious. However, the infections that cause them (such as colds or flu) are and can spread from person to person. (1)

References

1. Nemours Children's Health - Middle Ear Infections (Otitis Media) (for Parents)
2. Healthy Children - Ear Infections in Children: Information for Parents
3. NHS - Ear infections
4. NHSinform - Illnesses and conditions
5. Penn medicine - For Patients and Visitors
6. Mayo Clinic - Ear infection (middle ear)