Middle ear infection (otitis media)

Symptoms of a middle ear infection

In most cases, the symptoms of a middle ear infection (otitis media) develop quickly and get better in a few days. This is known as acute otitis media.

Symptoms include:

• earache – it is the most common symptom in adults and older children
• slight hearing loss – if the middle ear becomes filled with fluid, hearing loss may be a sign of glue ear, also known as otitis media with effusion

In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. 

The earache pain caused by the build-up of fluid stretching the eardrum then begins to get better as the fluid drains and the pressure drops.

Younger children may rub or tug at an ear, but usually the symptoms are not specific including:

• crying or irritability with a high temperature (fever)
• being sick or reduced feeding
• a lack of energy

Other signs a young child has an infection that might also involve ear infection include:

• coughing or a runny nose
• diarrhoea

Less common signs that suggest possible ear problems include:

• unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness
• loss of balance

When to seek medical advice

Most cases of otitis media pass within a few days, so there's usually no need to see your GP.

See your GP if you or your child have:

• symptoms showing no sign of improvement after three days
• symptoms in both ears (if your child is under two)
• other symptoms of being generally unwell, apart from the earache
• a discharge of pus or fluid from the ear – some people develop a persistent and painless ear discharge that lasts for many months (known as chronic suppurative otitis media)
• swelling around the ear
• hearing loss or a change in hearing
• an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely
• a weakened immune system – because of chemotherapy, for example

How middle ear infections are treated 

Most ear infections clear up within three to five days and don't need any specific treatment.

If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature. Never give aspirin to children under 16.

Make sure any painkillers you give to your child are the right ones for their age. 

Antibiotics aren't routinely used to treat middle ear infections. They may occasionally be prescribed if symptoms persist or are particularly severe.

Causes of middle ear infections 

Infections may be caused by a virus or bacteria. Viral infections will not respond to an antibiotic, and clear up without treatment.

Most middle ear infections occur when an infection such as a cold (viral infection), leads to a build-up of mucus in the middle ear.

This causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked.

This means mucus can't drain away properly. This makes it easier for an infection to spread into the middle ear.

An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections.

Younger children are particularly vulnerable to middle ear infections as:

• the Eustachian tube is smaller in children than in adults
• adenoids are much larger in children than in adults

Certain conditions can also increase the risk of middle ear infections, including:

• having a cleft palate – a type of birth defect where a child has a split in the roof of their mouth
• having Down's syndrome 

Preventing middle ear infections

It's not possible to prevent middle ear infections. There are some things you can do that may reduce your child's risk of developing the condition. These include:

• make sure your child is up-to-date with their routine vaccinations 
• avoid exposing your child to smoky environments (passive smoking)
• consider avoiding using a dummy, or reducing use - use of a dummy is associated with more ear infections
• don't feed your child while they're lying flat on their back
• breastfeeding reduces the risk of infections

Avoiding contact with other children who are unwell may also help reduce your child's chances of catching an infection that could lead to a middle ear infection.

Further problems 

Complications of middle ear infections are fairly rare, but can be serious if they do occur.

Most complications are the result of the infection spreading to another part of the ear or head, including:

• the bones behind the ear (mastoiditis)
• the inner ear (labyrinthitis)
• the protective membranes surrounding the brain and spinal cord (meningitis)

If complications do develop, they often need to be treated immediately with antibiotics in hospital.

Other complications include:

• hearing loss (usually temporary)
• perforation of the ear drum
• facial nerve problems
• chronic infection and cholesteatoma

More useful links

• Ear infections
• How to use your health services