Middle Ear Infection
(Acute Otitis; Ear Infection, Middle; Otitis Media)
The middle ear is located behind the eardrum. An infection can enter this area and cause swelling and pain.
|The Middle Ear
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Most middle ear infections are caused by viruses. Others may be caused by a bacteria.
Most ear infections develop after a cold or flu. A tube called the eustachian tube runs from the middle ear to the back of the throat. If you have a cold or flu the infection can pass from the throat, through the tubes and up to the ears.
Middle ear infections are more common in infants and toddlers because their eustachian tubes are shorter. 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
- 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
History of allergies, such as environmental or
Gastroesophageal reflux disease
Babies whose mothers drank
- 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
The doctor may choose to wait and see, since most ear infections will pass on their own within 2-3 days. During this time period, medications will not be prescribed. Infections that are severe, last longer than expected, or occur in children 6 months and under may need more treatment.
Medications may be used to help manage symptoms. Options include:
- Pain relievers
- Fever reducers
- Anesthetic ear drops—pain relievers
Antibiotics are not often needed. They are used for severe infections caused by bacteria. Mild infections caused by bacteria can pass on its own without antibiotics. Using antibiotics when not needed can actually make you more ill, than letting the infection pass on its own.
Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
Note: Decongestants and antihistamines are not recommended to treat ear infections.
may be done to drain fluid from the inner ear. A tiny cut is made in the eardrum to drain fluid and pus.
An ear tube may also be placed to let fluids continue to drain.
Habits that may help decrease the risk of 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.
- Make sure your child's vaccinations are up to date.
Consider getting a
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
Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM. Updated May 17, 2016. Accessed September 25, 2017.
Hurst DS, Amin K, Seveus L, Venge P.
Evidence of mast cell activity in the middle ears of children with otitis media with effusion.
Ear infections in children.
National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
Updated May 12, 2017. Accessed September 25, 2017.
10/12/2006 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial.
9/23/2008 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children.
Cochrane Database of Syst Rev.
6/5/2009 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media.
Cochrane Database Syst Rev.
7/21/2009 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T909558/Pneumococcal-vaccination: Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis.
11/30/2010 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review.
12/16/2011 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age.
Cochrane Database Syst Rev.
3/18/2014 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder AG. A trial of treatment for acute otorrhea in children with tympanostomy tubes. N Engl J Med. 2014;370(8):723-733
3/31/2014 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM: Vernacchio L, Corwin MJ, Vezina RM, et al. Xylitol syrup for the prevention of acute otitis media. Pediatrics. 2014;133(2):289-295.
- Reviewer: EBSCO Medical Review Board
Marcie L. Sidman, MD
- Review Date:
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