Otitis Media

What is Otitis Media?

An ear infection is contamination of the inner ear that causes pain, fluid buildup, and fever. An ear infection is also known as acute otitis media, middle ear infection, or acute otitis media. Ear infections are usually not serious and often get better on their own.

Otitis media affects children more often than adults. However, anyone can develop the condition. Someone with repeated ear infections can experience issues with hearing and balance. With prompt treatment, long-term problems are usually avoided.


Otitis media signs and symptoms differ in children and adults. The condition can affect one of your ears or both of them. When you only get otitis media in your left ear, it is called left otitis media. When you only develop otitis media in your right ear, it is called right otitis media.

Otitis media symptoms in children:

  • Reduced balance
  • Reduced appetite
  • Increased crying
  • Fluid drainage
  • Difficulty sleeping
  • Difficulty hearing
  • Headache
  • Ear pain
  • Ear pain when lying down
  • Pulling on the ear

Otitis media symptoms in adults:

  • Ear pain
  • Fluid drainage
  • Hearing problems


The most common cause of otitis media is a virus or bacteria in your middle ear. Usually, you get an ear infection from another condition, such as allergies or the flu. Any illness that causes swelling and congestion in your nose and throat can lead to a middle-ear infection.

Other otitis media causes involve your eustachian tubes and adenoids. Eustachian tubes are small passageways that lead from the middle ear to the back of your nose and throat. They help equalize air pressure between both of your ears, manage air pressure in your ears, and help drain fluid from your middle ear. If these tubes become blocked, fluid can build up and get infected.

Your adenoids are lymph tissue near the back of your nose. They help fight off infection by trapping germs and bacteria you breathe in through your nose. Swollen adenoids can obstruct your eustachian tubes.

Risk Factors

The most common risk factor for otitis ear infection is age. However, there are several other risk factors for developing the condition.

Risk factors:

  • Age — Young children are at higher risk because of underdeveloped immune systems, narrow eustachian tubes, and large adenoids. Between the ages of six months to two years, children are especially vulnerable.
  • Group Exposure — Children in group childcare settings experience more exposure to infections.
  • Seasonal Factors — Many people get ear infections in the fall or winter. People with seasonal allergies might get ear infections during periods of high pollen.
  • Air Quality — Poor air quality is a risk factor for otitis media. Pollution and smoke from tobacco can cause poor air quality.
  • Feeding — Infants who bottle feed, especially while laying down, are more prone to ear infections.
  • Physical Condition — Children with cleft palates possess different bone and muscle structure. This can reduce proper drainage of the eustachian tubes.
  • Heritage — Alaskan natives get ear infections more than other people groups.


Your doctor can usually make an otitis media diagnosis by examining your symptoms, ears, and breathing. The doctor will also look at the outer and inner parts of your ears with a lighted instrument called an otoscope.

A pneumatic otoscope is an instrument for the inspection and examination of the eardrum. Your doctor will use the pneumatic otoscope by inserting the tip of the instrument into your ear canal and blowing air against your eardrum. Usually, the resulting pressure differential between the air in front of your eardrum and just inside your ear canal will cause your eardrum to bulge outward. However, if excess fluid obstructs the middle ear, your doctor will see minimal movement.

Other possible diagnostic tests:

  • Acoustic reflectometry — This test is an indirect way to see how much sound your eardrum is absorbing. Normally, your eardrum absorbs the majority of the sound. But if your eardrum is filled with fluid, it absorbs less sound.
  • Tympanometry — This test measures how easily the eardrum moves. The machine seals off your ear canal and then changes the air pressure. This causes your eardrum to vibrate. The machine measures the vibration.
  • Tympanocentesis — Rarely, a doctor may poke your ear with a tiny tube to take fluid out of the middle ear. The doctor will then test the fluid for bacteria and viruses.
  • Additional tests — If your child experiences a lot of ear infections, the doctor might refer them to a specialist for hearing, speech, and other forms of development.


Otitis media treatment differs by your age and the severity of your symptoms. The most common forms of treatment for middle ear infection include monitoring, antibiotics, pain management, and ear tubes. 


Many ear infections fully resolve without treatment in one or two weeks. Symptoms might start improving within a few days. While antibiotics can help treat the condition, overuse of antibiotics can sometimes reduce the effectiveness of medicine.

Antibiotic Therapy

Depending on your child’s age and temperature, their doctor may prescribe antibiotics. Usually, the doctor will use antibiotics after an initial waiting period to see if the infection clears up on its own. However, doctors often use antibiotics instead of waiting when treating children under 6 months old.

Pain Management

The doctor may prescribe medication to help you or your child manage pain. Your doctor may also recommend anesthetic drops to reduce pain in your eardrum. However, your doctor will likely not recommend these drops if there is a hole or tear in your eardrum. 

Ear Tubes

Your child’s doctor may perform an outpatient surgical procedure to drain fluid from their ears. This procedure is called a myringotomy. Usually, this procedure is an otitis media with effusion treatment. Otitis media with effusion is when fluid repeatedly builds up in your child’s ear after an infection is healed.

This procedure is also used to treat chronic otitis media. Chronic otitis media is a long-term ear infection. Some tubes fall out on their own and other tubes must be surgically removed.


Ear infections rarely cause long-term complications. However, people who get repeated ear infections might experience chronic middle ear infection complications.

Middle ear infection complications:

  • Hearing impairment — Most hearing loss is temporary and episodic. Regular ear infections or fluid in your ear might cause more intense hearing loss. Permanent hearing loss is possible with severe damage to your eardrum or middle ear.
  • Spreading infection — Untreated infections can spread to other parts of your body. If you get an infection in the bone behind your ear, it can damage your bone and lead to cysts filled with pus. While rare, severe middle ear infections can also spread to the brain.
  • Speech or developmental delays — Infants and toddlers who suffer temporary or permanent hearing loss might experience speech or other developmental delays.
  • Torn eardrum — Eardrum tears generally heal within three days, or 72 hours. Some eardrum tears require surgical repair.


Middle ear infection prevention includes hygiene, infant feeding habits, immunizations, and avoiding environments conducive to ear infections.

How to prevent middle ear infection:

  • Avoid polluted or smoky settings.
  • Frequently wash and clean your hands.
  • Bottle feed with your infant sitting upright.

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