Middle Ear Infections

What Is Middle Ear Infection?

Middle ear infection is an infection that occurs behind the eardrum, in the middle part of the ear. While it can happen in people of all ages, it mainly affects children. The medical term for middle ear infection is otitis media.

Middle ear infection is the most common childhood illness treated by pediatricians. It usually develops a few days after a child has a cold or the flu. Half of all children will have at least one middle ear infection while they’re growing up, most often before age 3.

Children generally suffer from one of three forms of middle ear infection:

  • Acute otitis media – a sudden but temporary inflammation in the middle ear.
  • Recurrent acute otitis media – ear infections that keep coming back, with the ear returning to normal between episodes.
  • Chronic otitis media with effusion (OME) – a persistent accumulation of sticky thick fluid in the middle ear, also called effusion, that is not painful; children most often say their ears feel stuffy. OME is also called glue ear.

Nice To Know:

Understanding how the ear works

The ear is divided into 3 parts: the outer ear, the middle ear, and the inner ear.

The middle ear is a small space between the outer and inner ear. It is separated from the outer ear by the eardrum. It contains three delicate bones (the hammer, anvil, and stirrup) that are important in hearing.

Here is how hearing works:

  • Sound creates vibrations in the air that are picked up by the eardrum.
  • When the eardrum vibrates, the tiny bones inside the middle ear also vibrate, transmitting the vibrations across the middle ear to the inner ear.
  • This causes fluid in the inner ear to move.
  • When fluid moves in the inner ear, it stimulates the nerve cells inside this part of the ear.
  • These nerve cells then send impulses to the brain along the “hearing nerve,” and we then hear the sound.

Tubes called the eustachian tubes connect the middle ear to the back of the throat. When functioning properly, the eustachian tubes do the following:

  • Equalize air pressure on both sides of the eardrum. When you yawn or swallow and your ears “pop,” it is your eustachian tubes adjusting the air pressure in your middle ear. Negative air pressure in the middle ear causes pain and a “full” sensation in the ear.
  • Allow drainage from the middle ear to the throat.
  • Protect the middle ear from germs that may enter the throat.

Facts About Middle Ear Infection

  • Half of all children have at least one ear infection by the time they are 3 years old.
  • The earlier a child has a first ear infection, the more susceptible the child is to having others.
  • Babies who breast-feed for more than 6 months have fewer ear infections than babies who begin bottle-feeding before they are one month old.
  • Children who are exposed to smoking at home tend to have more ear infections.
  • After age 5, nearly all children have outgrown their susceptibility to ear infections.
  • Middle ear infection is more common in boys than girls.
  • Middle ear infection occurs with greater frequency in children attending daycare centers.
  • Middle ear infection is most common in winter, less common in summer.
  • Children with middle ear infections are more likely to have family members who also have middle ear infections.
  • Middle ear infection is more common in American Indians, Alaskan and Canadian Eskimos, and Australian Aborigines


What Are The Symptoms Of Middle Ear Infection?

Before an ear infection ever develops, your child is likely to have symptoms of a cold.

  • At first your child may have the sniffles, with clear, runny fluid in the nose (mucous).
  • Nasal stuffiness, or congestion, may come next, marked by thicker, yellowish mucous.
  • Some children have a low-grade fever.
  • Sore throat is common.
  • Your child may develop a cough.

Within a few days, an ear infection (acute otitis media) may begin. The symptoms may vary depending on the age of the child. Infants may show the following symptoms:

  • Inability to stop crying (the most reliable symptom in babies)
  • Restlessness
  • Fever of 100 to 104 degrees Farenheit
  • Inability to sleep soundly
  • Tugging at the ear

Toddlers and children may show slightly different signs of an ear infection, including:

  • Complaints of an earache
  • Fever of 100 to 104 degrees Farenheit
  • Waking during the night

You also may see:

  • Redness around the ear, caused by repeated tugging
  • Clear, yellowish, or blood-tinged fluid coming from the child’s ear or on the child’s pillow, which could be a sign that the eardrum has ruptured as a result of the pressure from the fluid behind it

The doctor may see:

  • Redness of the eardrum
  • Fluid behind the eardrum
  • Bulging of the eardrum with pus, indicating a severe infection
  • Clear or pus-like material in the ear canal from a ruptured eardrum

Need To Know:

Is it dangerous if my child’s eardrum ruptures because of an ear infection?

A. A ruptured eardrum almost always will heal in its own. In rare cases, if it does not, surgery may be performed to close up the hole in the eardrum. A ruptured eardrum can be painful – but for many children, it actually relieves the pain caused by a middle ear infection. That’s because the fluid that built up behind the eardrum, which caused the pain, is released through the hole.

Nice To Know:

Why is my child prone to middle ear infections?

A. The middle ear is filled with air that travels through the eustachian tube to the back of the nose. The eustachian tube equalizes middle ear pressure and helps drain fluids in the ear. In babies and toddlers, the eustachian tube is shorter, narrower, and less rigid than in an adult, so when the child has a cold, germs can more easily pass from the back of the nose and throat into the middle ear. When this happens, the eustachian tube swells and closes, trapping infected fluid in the middle ear, which creates a breeding ground for germs.

Nice To Know:

Keeping a watchful eye on symptoms

After seeing the doctor, children with mild symptoms should be watched for several days to see whether the infection clears. Those who have severe symptoms or who seem to be getting worse may need to be seen again. They may need treatment to clear the infection, perhaps antibiotics.

Children who do not respond to antibiotics may need an incision in the eardrum called a myringotomy to remove fluid and identify the bacteria.

What Causes Middle Ear Infection?

Many factors play a role in whether your child will get an ear infection.

  • Some of them involve the structure of the ear itself, particularly the eustachian tubes.
  • Others involve exposure to germs, such as bacteria and viruses.
  • Some are related to inflammation of the nasal passage as a result of allergies.
  • Other health problems may make a child more likely to have ear infections.
  • Still others involve a family’s lifestyle.

We consider these below:

The Role Of The Eustachian Tube

Ear infections almost always begin with swelling of the eustachian tube, usually because of exposure to bacteria, viruses, smoke, or allergens. When the eustachian tube is swollen, normal fluids formed in the middle ear cannot flow into the nose and throat.

  • The eustachian tube may also become plugged when the normally thin, clear mucus made by the lining of the nose and middle ear becomes thickened, such as when your child has a cold.
  • In infants and young children, the eustachian tube is shorter, narrower, and less rigid than in older children and adults, making it easier for bacteria from a cold to pass from the back of the nose and throat into the middle ear. In addition, a child’s narrower eustachian tube is more likely to become obstructed.
  • When the eustachian tube swells and closes, it traps infected fluid in the middle ear and creates a breeding ground for germs.

Bacteria And Viruses

The most common bacteria that cause ear infections includeHaemophilus influenzae (which is associated with respiratory infections in children), and Streptococcus pneumoniae (also called pneumococcus). Less common bacteria include Moraxella (Branhamella) catarrhalis and Streptococcus pyogenes.

Viruses such as respiratory syncytial virus (responsible for lower respiratory infections) and influenza viruses play an indirect role in ear infection by causing inflammation in the nasal passages and a stuffy nose, with thick mucus. Rhinovirus, which causes the common cold, has been found in one to eight percent of otitis media cases.


Allergic rhinitis is the runny nose, itching, and sneezing some people experience when exposed to an allergen, such as pollen or animal hairs. It is unclear whether allergic rhinitis actually causes middle ear infections. However, allergies that cause the nasal passages to become inflamed and congested, such as hay fever, seem to increase the likelihood of acute otitis media.

A Child’s Other Health Problems

Certain health problems increase the likelihood that a child will develop middle ear infections. For example, children with breathing disorders such as asthma have more ear infections than healthy children. The same is true of those with allergies and sinusitis.

Children with more complicated medical problems, such as Down’s syndrome, cleft palate, or illnesses that suppress the immune system, are also at higher risk for ear infections.


The incidence of ear infections has been on the rise in the U.S., in part because of the way many families live. Lifestyle risk factors for middle ear infections include the following:

  • Attendance in day care centers (where young children are exposed to the respiratory infections that often happen before an ear infection)
  • Exposure to second-hand smoke
  • Formula-feeding (because formula does not provide the immune-system protection present in mother’s milk)
  • Baby’s position during bottle-feeding (because eustachian tubes do not function as well when your baby is lying flat while sucking, compared to when he is held with his head up )
  • Pacifiers (because sucking may increase production of saliva, which serves as a vehicle for bacteria that can travel up the eustachian tubes to the middle ear)

How-To Information:

Preventing ear infections

Although they are not foolproof, there are certain steps you can take to help prevent ear infections:

  • Breast-feed infants for at least 6 months.
  • Serve your family plenty of fruits and vegetables.
  • Make sure your family gets proper rest.
  • Wash hands frequently.
  • Reduce stress, which can weaken the immune system.
  • Consider annual flu vaccinations and a one-time vaccination against pneumococcal pneumonia.
  • Avoid exposure to smoking.

How To Information:

Warding off ear infections when your child has a cold

Children who get ear infections frequently when they have a cold can take the following precautions:

  • Take oral decongestants at the first sign of a cold.
  • Sleep with their head elevated on a few pillows.
  • Gargle with salt-water rinses.
  • Use spray decongestants cautiously to help keep the eustachian tube lining from getting so swollen that it stops functioning properly.
  • Avoid over-the-counter antihistamines, such as diphenhydramine or chlorpheniramine, for the treatment of colds because they thicken secretions.


How Is Middle Ear Infection Treated?

In deciding how to treat your child’s middle ear infection, the doctor will take into account:

  • The type of symptoms your child is having
  • How severe they are
  • How long they have lasted

The doctor will look inside your child’s ear for signs of redness or bulging of the eardrum, gently using an instrument (called an otoscope) with a cone-shaped tip and a small light attached. A pneumatic otoscope (one with a tiny air pump) may be used to gently blow air into the ear as a way to test the movement of the eardrum.

The first step may be to wait several days to see whether the infection clears up on its own. Other options include the following:


Antibiotics may be prescribed for treating a single ear infection or for preventing and treating recurrent infections.

  • Antibiotics such as amoxicillin (Amoxil, Larotid, Polymox, Trimox, Wymox) or amoxicillin-clavulanate (Augmentin, Clavulin) are forms of penicillin, the preferred drug for otitis media. To cure the infection, your child must take all of the medication as prescribed (usually for 10 days to two weeks).
  • If your child is allergic to penicillin, the doctor may prescribe trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra) or a combination of erythromycin and sulfisoxazole (Eryzole, Pediazole), unless he or she is also allergic to sulfa drugs. Your doctor may prescribe trimethoprim hydrochloride oral solution (Primsol).
  • If these treatments fail, your doctor may prescribe oral antibiotics called cephalosporins.
  • If you live in an area where bacterial resistance to antibiotics is high, your doctor may prescribe high-dose amoxicillin or newer cephalosporins (cefuroxime, axetil or cefpodoxime proxetil) or antibiotics known as macrolildes (clindamycin, azithromycin, and clarithromycin).
  • A once-daily dose of antibiotics may be given as a preventative measure if a child has recurrent ear infections (three episodes of acute otitis media in six months or four to five episodes in one year).

Need To Know:

Antibiotics: Why They’re Controversial

There is some debate over whether antibiotics should be the standard treatment for otitis media. Even though antibiotics may not be necessary or helpful in many cases, doctors often feel pressured by patients and families to prescribe them. Here’s what a parent needs to know about antibiotics for acute otitis media:

  • Ear infections account for about 25 percent of all antibiotics prescribed in the U.S.
  • Only about one-third of children with acute otitis media actually need antibiotics, according to recent studies. Most children get better on their own in two weeks without any treatment at all.
  • Doctors are becoming more reluctant to prescribe antibiotics because of concerns about overuse of these medications. If a child takes antibiotics too often or stops taking the medicine once her fever and earache go away, without finishing the entire prescription, dangerous “super bacteria” that can’t be killed with antibiotic treatment can develop. This is known as bacterial resistance, and health experts believe it is becoming a serious problem.

Still, many doctors and parents tend to favor the use of antibiotics, not only because children who have an ear infection may be in pain, but also because of the possibility of serious complications.

These include mastoiditis, a condition that results from spread of infection from the ear to the mastoid bone in the skull, sometimes causing deterioration of the bone. Mastoiditis may require long-term antibiotic treatment and sometimes even surgery to remove the infected skull bone. Another serious complication is hearing loss from recurrent or chronic otitis media.

Need To Know:

Q.Will antibiotics clear up my child’s ear infection?

A. Approximately 30 to 50 percent of ear infections are caused by viruses. In this case, antibiotics are useless, and the infection must clear on its own. Infections caused by bacteria, on the other hand, respond well to antibiotics.

While doctors commonly prescribe antibiotics for a single attack of acute otitis media, some prefer prescribing a short course of antibiotics only for those children who are at risk for complications.

Antibiotics may be given in liquid, tablet, or capsule form and usually must be taken for 10 days.

Even though ear pain may be completely gone after a few doses of medicine, the infection is still present, and you should be sure your child completes the full course-takes all the medicine-to reduce the likelihood that the infection will come back.

Pain Relievers

Until your child can be seen by a doctor, the most important thing you can do is help relieve the pain. Here are some steps you can take to partially relieve the pain of an acute attack of middle ear infection:

  • Rest your child’s ear against a heating pad at a low setting. Avoid allowing your child to go to sleep on the heating pad because of a potential danger of burns.
  • Give antihistamines and decongestants to your child only after checking with your doctor.
  • Give pain relievers, such as acetominophen (Tylenol) or ibuprofen (Advil).
  • Do not to give aspirin to children because of an associated condition called Reye’s syndrome, which can be very dangerous.
  • Administer ear drops containing benzocaine, glycerin, or antipyrine (Auralgan), if your doctor approves. Do not give ear drops to your child if fluid has leaked from the ear, since this may be a sign that the eardrum has ruptured.

How-To Information:

Administering Drops for Ear Pain

Your doctor may prescribe ear drops to treat the infection or relieve pain. If the pain continues after 2 days of antibiotics, your doctor should re-evaluate your child. Give the ear drops as follows:

  • Place your child on his or her side with the infected ear up.
  • Straighten the ear canal by very gently pulling the earlobe backward.
  • Drop the medication into the ear as directed on the bottle or by your doctor.
  • Encourage your child to remain in this position for several minutes to allow the medication to be absorbed.

Cold And Allergy Remedies

Over-the-counter medicines with decongestants, antihistamines, or a combination of the two can help relieve cold symptoms, but they are of little benefit in treating ear infections. These remedies should be given only when prescribed by the doctor.

Decongestant nasal spray or pills may help prevent ear-plugging from changes in air pressure during air travel in children with chronic otitis media with effusion. Decongestants do not prevent ear pain in young children during takeoff, but can help by causing drowsiness.


Vaccines may be effective for children susceptible to recurrent ear infections. Vaccines against flu and pneumonia viruses, which are usually given every fall, help protect against the current year’s specific flu strain and may offer protection against otitis media during flu season as well.

  • FluMist, a new vaccine in nasal spray form, boosts the immune factors in the mucous membranes of the nose that fight actual flu infections. It has been very successful in protecting against otitis media.
  • Pneumovaxthe pneumococcal vaccine used againstStreptococcuspneumoniae, provides protection for many years and is recommended for children with recurrent infections or chronic otitis media with effusion who are over two years of age. (Immunizing pregnant women may reduce the risk of ear infections in infants, since low levels of antibodies against Streptococcus pneumoniae have been found in the blood of the fetus cord.)
  • PNCRM7, a new pneumococcal vaccine, is considered safe and effective for infants.


If your child’s middle ear infection fails to respond to medication, your doctor may suggest one of the following procedures:

  • Tympanocentesis is a procedure in which fluid is drawn from the ear with a needle for laboratory testing.
  • Myringotomy is a surgical procedure that involves making a cut, or incision, in the eardrum. It may be necessary as a preventive measure if your child develops repeated ear infections even after taking antibiotics.
  • Tympanostomy tubes are small tubes that may be placed in the ears during myringotomy to help drain fluid that has been present for a long time (three or four months). These ear tubes also are effective in preventing repeated bouts of middle ear infection.
  • OtoLAM, a new laser procedure that involves making tiny holes in the eardrum, reduces the need for antibiotics and myringotomy.
  • Adenoidectomy, removal of the adenoids (located in the back of the throat), may be needed if they are enlarged and interfering with eustachian tube function.

In each case, it is important to prepare your child for surgery, so he or she knows what to expect.

What is tympanocentesis?

Occasionally it may be necessary for a child to have a procedure called tympanocentesis, particularly if he is not responding to antibiotic treatment.

The doctor gently inserting a very thin needle into the middle ear to collect fluid from behind the eardrum. The fluid is then sent to a laboratory to identify the specific bacteria causing the ear infection.

The results of this laboratory test, called a culture, will help your doctor decide which antibiotic will be most successful in clearing the infection. Fluid drainage can also relieve severe ear pain.

What is myringotomy?

If your child’s ear infections don’t respond to antibiotics, the doctor may suggest a procedure called a myringotomy to drain the fluid.

  • A small incision is made in the eardrum to allow fluid to drain and keep the eardrum from rupturing. This procedure sometimes is performed to drain a severely infected ear or so that a laboratory test, called a culture, can be done to identify the specific bacteria that is causing the infection. The eardrum heals in about a week.
  • Myringotomy may also be performed to insert small ear tubes called tympanostomy tubes, or grommets, in the eardrum. These ear tubes allow the passage of air and aid further drainage of fluid.

What is tympanostomy?

Ear tube surgery, or tympanostomy, is performed in the hospital. Your child probably will be in the hospital for a total of two hours. Infants under three months may stay overnight. Here’s what to expect:

  • Ear tube surgery will be performed in the operating room.
  • Your child will receive general anesthesia and will be asleep for about 10 minutes.
  • The surgeon will reach the eardrum through the ear canal opening and will not cut the child’s skin.
  • The surgeon will make a small hole in the eardrum to remove any fluid from the middle ear.
  • The surgeon will insert a tiny metal or plastic tube into the hole in the eardrum to allow the remaining fluid and bacteria to drain through the ear canal.
  • After ear tubes are placed, hearing almost always returns to normal, and the likelihood of your child having more ear infections is greatly reduced.
  • Ear tubes stay in the ear for about six months to a year and then fall out on their own, and the eardrum closes.

Need To Know:

Q. Are there risks involved in having tubes inserted?

A. Sometimes, placement of ear tubes is the most effective treatment for chronic otitis media. This must be done in the operating room under general anesthesia, which always involves some risk. However, ear tubes are a last resort, used only after your child has suffered several painful ear infections and fluid in the ears.

In a small number of cases, ear tubes don’t fall out on their own and must be surgically removed. Also rare are cases in which the ear tube falls out, but the hole in the eardrum left behind does not close up on its own. Surgery may be necessary to patch the hole.

What is OtoLAM?

OtoLAM, a new procedure, involves making a tiny hole in the eardrum with a laser. The treatment may be performed in the doctor’s office. OtoLAM “ventilates,” or opens, the middle ear for several weeks, which may be long enough to cure 75 percent of ear infections. The benefits of OtoLAM include the following:

  • No general anesthesia is needed. Instead, topical anesthesia in the form of ear drops is used to numb the area so that your child will feel no pain.
  • There is less need for antibiotics, so repeated courses of antibiotics can be avoided.
  • The procedure is less traumatic. For example, your doctor may permit you to remain with your child during the procedure.
  • The procedure helps children who are prone to repeated infections.
  • Pain relief is immediate, as a result of the reduction in ear pressure from immediate fluid drainage.
  • The procedure is cost-effective and timesaving, since it means fewer prescriptions, doctor visits, and surgical fees, and less absenteeism from school.

What is adenoidectomy?

Adenoidectomy is a surgical procedure to remove the adenoids, which are small organs located in the back of the throat, behind the nose where they can’t be seen.

  • Adenoidectomy may be needed if the adenoids are enlarged enough to interfere with eustachian tube function.
  • Removal of the adenoids is an option in children who have had persistent middle ear infections.
  • Often, this procedure is done after myringotomy andtympanostomy, if the surgeon sees that the adenoids are enlarged.
  • There isn’t enough evidence yet to know for certain whether adenoidectomy improves middle ear infection in children under age four, but it does appear to be effective in older children.

How-To Information:

Preparing your child for surgery

  • You should explain in advance to your child what is about to happen, in as much detail as possible, while still keeping your explanation simple and reassuring.
  • Children who are scheduled for ear surgery should be warned that they may experience some discomfort from the incision in the eardrum, but that parents and medical personnel will do everything possible to minimize it, and it will go away quickly.
  • Bring a coloring book and a storybook to the hospital. These will help your child cope with the experience.
  • Once your child is admitted to the hospital, he should have unlimited access to parents or other adults who are important to him. Try to be with your child immediately before the trip to the operating room and at the bedside when he or she returns.

Need To Know:


Children with middle ear infection should not go swimming. Water pollutants or chemicals may worsen ear infections, and underwater swimming causes pressure changes that can cause pain. If you child swims with implanted ear tubes, be sure he or she uses earplugs or cotton balls coated in petroleum jelly to prevent infection.

Nice To Know:

Heads Up On ‘Xylitol’

Would you have ever thought that encouraging your child to chew gum or drink syrup that contains a sugary kind of alcohol would help ward off ear infections?

Studies show that xylitol, a sugar alcohol, contains properties that fight Streptococcus pneumoniaebacteria, a culprit responsible for middle ear infections.

Apparently, the chewing gum is more effective than drinking the syrup. Children in Europe chew xylitol gum to prevent cavities, and although the gum does not reduce bacteria in the nose and throat, it does appear to prevent ear infections.

Some drawbacks: The gum is not widely available in the United States, and studies are needed in children at high risk for otitis media – those between six and 18 months of age.


What Is Chronic Otitis Media With Effusion?

Chronic otitis media with effusion (also called secretory otitis media and glue ear, or chronic OME) is a persistent inflammation and accumulation of sticky fluid, or effusion, in the middle ear.

  • Chronic OME may develop within weeks of an acute episode of middle ear infection, but often the cause is unknown. (See What Causes Chronic OME heading below)
  • Chronic OME often occurs in both ears and may be difficult to detect, since it is not painful and doesn’t cause symptoms of an ear infection. (See Recognizing Chronic Otitis Media with Effusion heading below)
  • Different kinds of fluid may be present behind the eardrum, ranging from a yellow liquid to a thick, white material that resembles glue (hence the name, glue ear). Thicker fluid usually indicates more inflammation of the mucous membrane in the middle ear.

Recognizing Chronic Otitis Media With Effusion

Chronic OME can be much more difficult to diagnose than an acute middle ear infection, because it often has no obvious symptoms and the child usually does not appear to be ill.

  • Chronic OME is not painful.
  • The most common symptom a child may experience is a feeling of “fullness” in the ear.
  • Mild hearing loss is not unusual, but it may not be obvious. Instead a child might not respond to soft sounds or may appear to be inattentive in school.

How Is Chronic Otitis Media With Effusion Diagnosed?

Because there often are no clear symptoms to suggest that your child has chronic otitis media with effusion, your doctor may rely on one or several tests to make the diagnosis.

  • A physical examination may reveal fluid behind the eardrum and poor movement of the eardrum. The eardrum will look clear and have no signs of redness, but will not move in response to the air, as a normal eardrum would
  • A tympanometry test measures the amount of eardrum mobility, which is often very impaired.
  • A hearing test often shows some degree of hearing loss.

Need To Know:

What is a tympanometry test?

If your child has repeated bouts of middle ear infection, the doctor may suggest a tympanometry test to see whether there is a problem with the middle ear. This test will evaluate the eardrum (tympanic membrane) by observing its motion in response to waves of pressure, and measuring the air pressure of the middle ear.

  • A probe that your doctor will insert into the ear will emit a pure tone with a certain amount of sound energy. The probe measures how much sound energy bounces back off the eardrum, rather than being transmitted to the middle ear.
  • The more energy returned to the probe, the stiffer and more blocked the middle ear is.
  • Your child may feel some mild discomfort while the probe is in the ear, but the test is not risky.

An abnormal tympanometry test may indicate any of the following:

  • Fluid in the middle ear
  • Perforated ear drum
  • Impacted ear wax
  • Scarring of the eardrum
  • Lack of contact between the bones of the middle ear that conduct sound
  • A tumor growing in the middle ear

What Causes Chronic Otitis Media With Effusion?

Chronic OME may develop within weeks of an acute episode of middle ear infection, but in many cases the cause is unknown. It is often associated with an abnormal or malfunctioning eustachian tube, which causes negative pressure in the middle ear and leaking of fluid from tiny blood vessels, or capillaries, into the middle ear.

  • Problems with the eustachian tube can be caused by viral infections, second-hand smoke, injury, or birth defects (such as cleft palate).
  • Fluid from the ears of children with chronic otitis media with effusion usually does not show infection with bacteria. In some cases, however, the fluid may contain organisms such asStreptococcus pneumoniae, Haemophilus influenzae,Moraxella catarrhalis, or other bacteria.

How Is Chronic Otitis Media With Effusion Treated?

For young children ages one to three years, most physicians prefer a conservative, or “wait-and-see,” approach, using antibiotics if the infection is persistent, the child is in pain, or there is evidence of hearing loss.

  • Most cases of otitis media with effusion get better within three months without any treatment.
  • If your child continues to have repeated episodes of OME, despite taking antibiotics your doctor may decide to try long-term, low-dose treatment with antibiotics, even after the condition has cleared.
  • If OME persists for over three months, despite antibiotic treatment, your doctor may suggest a hearing test.
  • If OME persists for more than four to six months, even if hearing tests are normal, your doctor may suggest surgery to drain the eardrum and implant ear tubes for continuous drainage.

Nice To Kow:

A pinch of relief

To relieve a feeling of fullness in the ear, have your child try this simple trick: Take a deep breath, close the mouth, and try to blow air out through the nose while pinching its end firmly closed. This may help to equalize the pressure between the middle ear and the air outside after air travel, and may help open the eustachian tubes in cases of otitis media with effusion. Just be sure to warn your child not to blow too hard.


What Are The Possible Complications Of Middle Ear Infections?

In some children, repeated episodes of middle ear infections or chronic otitis media with effusion may cause hearing problems.

Hearing problems can delay speech and language development and, consequently, may make it difficult to learn to read. Such delays in normal development can, in turn, cause problems with learning in general and with behavior.

  • The risk of developing learning and behavioral problems is particularly high in children with long-term mild hearing loss. This can happen when parents and doctors are unaware of the chronic otitis media with effusion, the child has severe repeated bouts of middle ear infection, or when these conditions do not respond to treatment.
  • The mild-to-moderate hearing loss that occurs with the temporary bouts of ear infections and chronic otitis media with effusion that comes and goes, rarely causes serious or permanent delays in normal child development, especially if treated promptly.

Although quite rare, severe or recurring middle ear infections can cause serious problems, some of which happen if the infection spreads to nearby bones or the brain. Complications to be aware of include the following:

  • Ruptured eardrums, which may heal on their own or which may need to be surgically repaired.
  • Infection of the mastoid bone (the honeycombed bone behind the ear). This condition, called mastoiditis, sometimes causes deterioration of the bone. It may require long-term antibiotic treatment and sometimes even having the bone surgically removed.
  • Brain abscesses, or pockets of pus, caused by spread of the infection to the brain.
  • Meningitis, an inflammation of the brain and spinal cord.
  • Facial paralysis, which is caused by involvement of the facial nerve that runs near the ear. The paralysis can be relieved by drainage surgery.
  • Cysts, called cholesteatomas.
  • Calcification and hardening in the middle or inner ear.

Always remember to:

  • Call your doctor or pediatrician if you are concerned about the possibility of a middle ear infection. In many cases, the infection will go away by itself, but sometimes antibiotics are needed.
  • Contact your doctor immediately if your child develops sudden hearing loss, headache, dizziness, chills, fever, stiff neck, or severe vomiting.

Middle Ear Infections: Frequently Asked Questions

Here are some frequently asked questions related to middle ear infection.

Q: Why is my child prone to middle ear infections?

A: The middle ear is filled with air that travels through the eustachian tube to the back of the nose. The eustachian tube equalizes middle ear pressure and helps drain fluids in the ear. In babies and toddlers, the eustachian tube is shorter, narrower, and less rigid than in an adult, so that when the child has a cold, germs can more easily pass from the back of the nose and throat into the middle ear. When this happens, the eustachian tube swells and closes, trapping infected fluid in the middle ear, which creates a breeding ground for germs.

Q: Will antibiotics clear up my child’s ear infection?

A: Approximately 30 to 50 percent of ear infections are caused byviruses. In this case, antibiotics are useless, and the infection must clear on its own. Infections caused by bacteria, on the other hand, respond well to antibiotics.

Q: What will happen if my child has many ear infections?

A: In the vast majority of cases, ear infections cause no permanent harm. In some children, fluid remains in the ear for months, which can impair hearing and speech development. Other serious complications may require surgery.

Q: Are there risks involved in having tubes inserted?

A: Sometimes, placement of ear tubes is the most effective treatment for ear infections and chronic otitis media with effusion. This must be done in the operating room under general anesthesia, which always involves some risk, but the risk in this case is minimal. However, ear tubes are a last resort, used only after your child has suffered several painful ear infections and fluid in the ears.

Q: Is it dangerous if my child’s eardrum ruptures because of an ear infection?

A: A ruptured eardrum almost always will heal in its own. In rare cases, if it does not, surgery may be performed to close up the hole in the eardrum. A ruptured eardrum can be painful – but for many children, it actually relieves the pain caused by a middle ear infection. That’s because the fluid that built up behind the eardrum, which caused the pain, is released through the hole.

Middle Ear Infections: Putting It All Together

Here is a summary of the important facts and information related to middle ear infection.

  • Otitis media is the medical term for inflammation or infection of the middle ear.
  • In babies and toddlers, the eustachian tube is typically shorter, narrower, and less rigid than in an adult, which means that bacteria can more easily travel from the back of the nose and throat into the middle ear.
  • Treatment to manage the various forms of middle ear infection includes pain relief, antibiotics, and sometimes surgical procedures such as myringotomy or tympanostomy (inserting tubes in the ears).
  • Myringotomy with or without tympanostomy is a surgical procedure that involves making a small incision in the eardrum to draw out fluid.
  • Myringotomy is usually considered if the child continues to have ear infections, despite repeated treatment with antibiotics.
  • A new procedure called OtoLAM involves making a tiny hole in the eardrum with a laser to allow drainage.
  • Because most infections will eventually clear up regardless of treatment, some doctors prefer to let an infection run its course without taking any action. However, this approach is not widely embraced because it does not alleviate the sick child’s pain or the parents’ anxiety.
  • If left untreated, frequent ear infections can have serious consequences.

Middle Ear Infections: Glossary

Here are definitions of medical terms related to middle ear infection.

Acute otitis media: Infection of the middle ear that comes on quickly

Adenoidectomy: Surgical removal of the adenoids (tissue in the back of the throat)

Adenoids: Glandular swellings of lymphoid tissue at the back of the nose that help protect against infection

Allergen: Any substance that causes an allergic reaction because the body recognizes it as “foreign” or “dangerous”

Allergy: An unusual response to a small amount of a foreign substance that normally does not cause a reaction in another person.

Bacteria: Microscopic organisms; they generally respond to antibiotics, unlike viruses

Chronic otitis media with effusion: A persistent inflammation of the middle ear with fluid trapped in the middle ear; also called glue ear, it is not painful

Culture: A test to see if microorganisms grow in a certain environment

Eustachian tube: The tube that connects the middle ear to the back of the throat; its function is to equalize the air pressure in the ear

General anesthesia: Putting a person to sleep for an operation

Mastoiditis: Infection of the mastoid bone, the bone behind the ear

Myringotomy: An small incision made into the eardrum to allow fluid to drain from the ear

Otitis media: The medical term for a middle ear infection

OtoLAM: A procedure in which a tiny hole is made into the eardrum using a laser

Recurrent acute otitis media: Middle ear infection that occurs repeatedly

Reye’s Syndrome: A serious complication in children that may follow a viral infection or after taking aspirin; includes vomiting and drowsiness which may progress to coma and death

Rhinitis: Inflammation of the lining of the nose due to allergy

Topical anesthesia: Applying medication locally to numb that area only

Tympanocentesis: Withdrawing fluid from the middle ear using a needle

Tympanostomy: Making a hole in the eardrum to allow fluid to leak out

Virus: A microscopic organism; antibiotics have no effect on viruses

Middle Ear Infections: Additional Sources Of Information

Here are some reliable sources that can provide more information on middle ear infection.

American Academy of Otolaryngology Head and Neck Surgery 
Phone: (703) 836-4444


Association for Research in Otolaryngology 
Phone: (856) 423-0041


The Parent’s Complete Guide to Ear Infections

Alan R. Greene

Healing Childhood Ear Infections: Prevention, Home Care, and Alternative Treatment

Michael A. Schmidt, Doris Rapp

Breaking the Antibiotic Habit: A Parent’s Guide to Coughs, Colds, Ear Infections, and Sore Throats

Paul A. Offit, Bonnie Fass-Offit, Louis M. Bell

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