Treating children's ear infections with antibiotics.

What is otitis media (middle ear infection)?

Otitis media is an infection of the middle ear (the space behind the eardrum), caused by bacteria or a virus. Middle ear infections often occur at the same time as a cold, allergies, nose and throat infection, or enlarged adenoids (glands at the top of the throat). Middle ear infections usually clear up without problems or long-term effects.

otitis media

The ear structure and function

There are three main parts of the ear: outer, middle and inner:

  • The outer ear is the opening outside of the body.
  • The middle ear houses delicate bones that aid in hearing.
  • The inner ear holds organs that control hearing and balance.

The Eustachian tube regulates air pressure within the middle ear, connecting it to the back of the nose and throat.

Who is most likely to get otitis media (middle ear infection)?

Middle ear infection is more common in children and is the most common childhood illness (other than a cold). Ear infections occur most often in children who are between age three months and three years, and are common until age eight. One-fourth of all children will have repeated ear infections; five to ten percent will develop a hole on the eardrum from fluid pressure. This hole usually heals in one week.

Children usually get more ear infections than adults. They usually get more colds and respiratory infections than adults, and the Eustachian tube is shorter and has less of a slope in children than in adults.

Other factors that can lead to middle ear infections include the following:

  • Age: Infants and young children are at greater risk for ear infections.
  • Sex: Boys tend to get ear infections more often than girls.
  • Heredity: The tendency to get ear infections can be hereditary (runs in the family).
  • Colds: Having colds often increases the chances of getting an ear infection.
  • Allergies: Allergies cause inflammation (swelling) of the nasal passages and upper respiratory tract, which can cause blockage of the Eustachian tube or enlargement of the adenoids.
  • Chronic illnesses: People with chronic (long-term) illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as cystic fibrosis and asthma.

What are the causes of otitis media (middle ear infection)?

  • Acute otitis media: Allergies, colds, respiratory infections, and inflamed or enlarged adenoids can block the bottom of the Eustachian tube, allowing normally produced fluids to build up in the middle ear. Trapped fluid can become infected by a virus or bacteria, causing pain and swelling of the eardrum.
  • Otitis media with effusion: Symptoms of acute otitis media will disappear, but the fluid may remain. Trapped fluid may cause temporary and mild hearing loss. This is called otitis media with effusion and may last for up to three months.

What are the symptoms of otitis media (middle ear infection)?

Ear infections can be painful. Trapped fluid puts pressure on the eardrum, causing it to bulge. Other symptoms include:

  • Ear pain: This symptom is obvious in older children and adults. In children who cannot yet speak, you should watch for other signs, like irritability or a great deal of crying.
  • Loss of appetite: This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
  • Irritability: Any kind of continuing pain may cause irritability in children and adults.
  • Poor sleep: Pain may be worse when the child is lying down, as fluid is shifting.
  • Fever: Ear infections can cause temperatures up to 104° F.
  • Drainage from the ear: Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured (broken).
  • Difficulty hearing: Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.

Last reviewed by a Cleveland Clinic medical professional on 03/08/2019.

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