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Middle ear infection - otitis media

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  • Strep throat

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  • Middle ear infections - also known as otitis media - are one of the most common illnesses affecting infants and young children. Most children have at least one ear infection by age 3. By age 7, almost all children have had an ear infection.

    Ear infections usually start with a cold, which can cause fluid to build up behind a child's eardrum. The fluid itself isn't necessarily a problem. But it's an ideal breeding ground for bacteria or viruses that cause infection.

    An acutely infected ear is very painful. But interpreting pain in a child who may be too young to communicate verbally can be a challenge. Signs other than pain may be more apparent. A child with an ear infection may also have a fever and be irritable or listless. Difficulty sleeping is common.

    Although ear infections can be extremely worrisome for parents and painful for children, the news is encouraging. Most children stop having multiple ear infections by the time they reach school age. In fact, the ear infection age range is 4 months to 4 years for the vast majority of children.

    Some ear infections require the use of antibiotics, but many ear infections may clear without using antibiotics. Together, you and your doctor can decide on the best approach for your child. A few simple measures can greatly reduce your child's risk of ear infection.

    Signs and symptoms

    Ear infections often affect children who are too young to describe how they feel. In addition, some of the signs of an ear infection, such as fever and sleeplessness, can be the result of many other medical conditions. That's why ear infections are sometimes hard to spot. Knowing what to look for can help. Keep in mind that ear infections often develop shortly after a cold and that your child will likely have the most discomfort in the first 24 hours after an infection develops.

    Infants who are in pain are listless, and their crying is different from crying associated with hunger or tiredness. As a parent, you're probably familiar with your baby's different cries.

    Young children may rub or pull on their ears and may not respond to sounds. Even though this may be a sign of fluid buildup in the middle ear, it's not necessarily a sign of an ear infection. Acute ear infections typically produce a lot of pain and are usually accompanied by a fever. Other signs and symptoms may include a loss of appetite or a feeling of dizziness or loss of balance. An older child may complain of an earache or a feeling of fullness or pressure in the ear.


    Your middle ear is a pea-sized chamber behind your eardrum (tympanic membrane) — a small circle of tissue that vibrates in response to sounds. It contains three tiny bones (ossicles) that send vibrations from your eardrum to your inner ear, where they're converted into the nerve impulses for sound. These impulses are what allow you to hear.

    Your middle ear is connected to the back of your nose and your throat by a narrow passageway called the eustachian tube. Normally, this tube helps equalize the pressure inside and outside your ear. It also helps drain fluids from your middle ear.

    Most ear infections begin with an upper respiratory infection such as a cold, which can cause swelling and inflammation in the eustachian tubes. A child's eustachian tubes are usually narrower and shorter than those of an adult. This increases the likelihood that inflammation will block the tubes completely, trapping fluid in the middle ear.

    Fluid buildup will temporarily affect your child's hearing to a slight degree. That's because it's harder for the eardrum and the tiny bones in the middle ear to send sound vibrations in fluid. Yet the fluid itself isn't necessarily cause for concern. Usually this fluid disappears on its own in a few weeks. But sometimes it may remain in the middle ear for months. Then it may impair your child's hearing to such an extent that his or her speech development is affected.

    Middle ear fluid also is an ideal environment for bacteria and viruses that cause infection. Inflamed fluid may cause inflammation and a buildup of pus that presses against the ear. This can be very painful for your child. Rarely, the pressure may rupture the eardrum.

    Risk factors

    All children are susceptible to ear infections, but some children are more likely to get them than others. Those most at risk include:

    • Boys

    • Children attending child-care centers

    • Children whose siblings have a history of recurrent ear infection

    • Children with a family history of asthma, allergies or eczema

    • Children who are exposed to secondhand smoke

  • Asthma

  • In addition, infants who are fed from a bottle are more likely to develop ear infections than are infants who are breast-fed for at least 4 months.

    When to seek medical advice

    If your child complains of an earache or pressure in the ear that lasts longer than a day or is associated with a fever, call your doctor. Also, see your doctor as soon as possible if you see a discharge of blood and pus. This may be a sign that your child's eardrum has ruptured.

    Ear infections often affect children who are too young to tell you what's wrong. In children who are between 4 months and 24 months of age, be alert for sleeplessness, irritability and poor appetite following an upper respiratory infection such as a cold. Your child may or may not have a low fever. Young children may also pull on their ears and may not respond normally to sounds. If these signs and symptoms last longer than a day, call your doctor. Although an ear infection isn't an emergency, it may make your child very uncomfortable.

    If an ear infection has been diagnosed in your child, see your doctor if the signs and symptoms don't improve with time or treatment or if they seem to become worse. In some cases, your doctor may schedule follow-up visits.

    Screening and diagnosis

    Middle ear infections are sometimes hard to diagnose. Your doctor can usually detect fluid in your child's middle ear. But there's no way to be sure the fluid is infected or if an infection is caused by a virus or a bacterium. Still, your child's doctor will try to make the best diagnosis possible based on your feelings about your child's pain, additional medical history and a physical exam.

    During the exam, your doctor will likely check your child's head and neck for conditions that may make your child more susceptible to ear infections. Your doctor will also use a lighted instrument (otoscope) to look inside the ear for redness of the eardrum and for evidence of fluid behind the eardrum. The combination of these two findings may suggest middle ear infection.

    In addition, he or she may check the eardrum to see whether it vibrates in response to air pressure. If the eardrum doesn't move freely, it's a sign that there may be fluid in the middle ear. A bulging eardrum or one that has changed color may indicate infection. Your child's doctor also may look for strep throat or enlarged, swollen tonsils.

    In some cases your doctor may recommend a tympanogram or an audiogram test, especially if your child has had fluid in the middle ear for some time. A tympanogram test measures how well the eardrum moves. An audiogram test uses tones of varying frequencies to check for signs of temporary hearing loss.


    Many untreated ear infections clear on their own with no complications. But long-lasting or recurrent infections can damage the eardrum, ear bones and middle ear structure and may cause permanent hearing loss. In young children, even short-term hearing loss can cause delayed speech development.

    In rare cases the pressure of an infected ear may cause your child's eardrum to rupture. You'll likely see a discharge of pus and blood that may be quite alarming. But the rupture actually relieves your child's pain, and in most cases the eardrum will heal on its own. If the eardrum continues to rupture repeatedly and doesn't heal, your child may require a surgical procedure to repair the eardrum and ensure that any infection is treated appropriately. It's also possible that your child's tonsils or adenoids may be enlarged and blocking the eustachian tubes. Any scar tissue that develops usually won't affect your child's hearing. Call your child's doctor as soon as possible if you suspect a ruptured eardrum.

    Middle ear infection > 1 > 2 > 3 > 4

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  • Tonsillitis

  • Middle ear infection

  • Croup

  • Airplane ear

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  • Diaper rash

  • Jaundice in newborns

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