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Otitis media (middle ear infection)

4-minute read

What is otitis media?

Otitis media (another name for a middle ear infection) is very common in children. It often disappears by itself, but sometimes it may need treatment. Otitis media can also affect adults.

What are the symptoms of otitis media?

The first symptoms of acute otitis media are usually those of a cold — a sore throat, a runny nose and a temperature. When the infection spreads to the ear, and the pressure on the eardrum builds, other symptoms appear.

Older children will complain of ear pain or a headache. They might have a fever and trouble hearing. Children who are too young to express themselves verbally might:

  • cry a lot
  • pull or rub their ears
  • have trouble sleeping
  • be irritable
  • lose their appetite

Sometimes, the pressure in the middle ear can cause the ear drum to burst or perforate. If it does, often the pain eases up straight away. A perforated eardrum usually heals by itself, but you should still get it checked by your doctor.

What causes otitis media?

Otitis media usually starts with a cold or a sore throat caused by bacteria or a virus. The infection spreads through the back of the throat to the middle ear, to which it is connected by the eustachian tube. The infection in the middle ear causes swelling and fluid build-up, which puts pressure on the eardrum.

Otitis media occurs in the middle ear when swelling and fluid build-up pressure the eardrum.

How is otitis media diagnosed?

Making a firm diagnosis of otitis media is not easy. The eardrum is not easy to see, especially in younger children, and the signs of an infection are not always clear.

Your doctor or a nurse will examine your child with an otoscope, an instrument that has a light to allow them to see your child’s eardrum. Your child might also have a tympanometry test, which checks how much your child’s eardrum moves.

If they have had several ear infections, they will need a hearing test.

How is otitis media treated?

If your child is in pain or has a fever, you should give them paracetamol. Your doctor may suggest anaesthetic ear drops. Encourage your child to drink plenty of water. Most kids will feel better within a day or two.

You should see a doctor if your child:

  • is still feeling unwell after 48 hours
  • has severe pain
  • has a discharge
  • has diarrhoea, vomiting or a very high temperature
  • seems to have trouble hearing
  • keeps getting infections
  • is younger than 12 months

In general, doctors are discouraged from prescribing antibiotics since they often don’t make a difference, although they can be useful at times.

Don’t use antihistamines or decongestants since they do not work.

Sometimes the infection clears up but sticky fluid stays in the middle ear. This can prevent a child from hearing properly. It is called glue ear and will need treatment. See your doctor if your child still can’t hear properly 3 months after a middle ear infection.

The Australian Commission on Safety and Quality in Health Care (the Commission) has developed a guide which can be used with your doctor to help you decide whether to use antibiotics when your child has a middle ear infection.

Can otitis media be prevented?

If you smoke, quit. This will reduce the risk of your child getting otitis media.

If you have young children, it helps to:

  • continue breastfeeding past 6 months
  • get rid of a dummy, if you use one, at 6 months

Older children should:

  • wash their hands after blowing their nose or coughing
  • wear ear plugs while swimming

Resources and support

The Sydney Children's Hospitals Network and the Raising Children Network have more information on children and ear infections.

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: June 2020

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