Otitis media (middle ear infection)
- Otitis media (middle ear infection) is common, especially in children.
- It often starts with a cold, and will usually go away by itself without antibiotics.
- It can cause ear pain, reduced hearing and fever. You may see fluid leaking if the ear drum bursts.
- If your baby has otitis media, they may be very unsettled, pull on their ears or vomit.
- You can try to prevent your child getting otitis media by breastfeeding, keeping them away from cigarette smoke, practising good hygiene and limiting dummy use.
What is otitis media?
Otitis media is an infection of the middle ear. This is the part of your ear just behind the ear drum.
Otitis media is very common in children, but can also affect adults. Most children have at least one middle ear infection before they reach school age. Children usually get fewer middle ear infections as they get older.
What are the symptoms of otitis media?
Otitis media often starts with a cold — you may have a sore throat and a runny nose.
When the infection spreads to the ear, you may notice:
Babies and small children might:
- cry a lot at night
- pull or rub their ears
- be irritable
- lose their appetite or vomit
Sometimes, the pressure in the middle ear can cause the ear drum to burst. If it does, the pain may improve straight away and you will see yellow fluid coming from the ear.
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What causes otitis media?
Otitis media can be caused by bacteria or viruses. The middle ear is connected to the throat by a tube called the Eustachian tube. When you have a cold, the infection can spread up this tube from the back of your throat to the middle ear. The infection in the middle ear causes fluid build-up, which puts pressure on the eardrum.
Middle ear infections are common in young children because their Eustachian tubes are smaller and can become infected more easily.
When should I (or my child) see a doctor?
You should visit your doctor if you or your child experience:
- fluid leaking from the ear
- trouble hearing
- recurrent ear infections
Go to your nearest emergency department if there is redness, pain or swelling of the bone behind the ear or if the ear is pushed forward. This could be a sign of a serious infection called mastoiditis.
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How is otitis media diagnosed?
Your doctor or a nurse will examine you or your child with an otoscope to check for signs of a middle ear infection. An otoscope is a small instrument that has a magnifying lens and light to help see the eardrum.
If your child has had several ear infections, they may need a hearing test. Your doctor may refer them to an ear, nose and throat (ENT) specialist.
An adult who has repeated ear infections should see an ENT specialist to make sure there is nothing serious causing the infections.
How is otitis media treated?
Otitis media usually goes away on its own within a week. You or your child may need medicine for pain relief, such as paracetamol or ibuprofen. Check with your pharmacist to ensure you are using the right dose for your child’s age and weight.
Your doctor may suggest anaesthetic ear drops to relieve pain. Don’t use ear drops without first checking with your doctor that it is appropriate.
Antibiotics are generally not recommended for middle ear infections unless there are signs that your child is very unwell, such as fever or vomiting. It’s best to take your child back to the doctor to check their ears again after 1 to 2 days if they are not feeling better.
Children under 2 years of age, Aboriginal and/or Torres Strait Islander children and children with certain medical conditions are more likely to have complications from ear infections and are more commonly prescribed antibiotics.
Antihistamines or decongestants won’t help you or your child recover any faster.
Why don't doctors give antibiotics for otitis media just in case?
Often, otitis media will heal by itself after about 4 days. On average, children who take antibiotics will only experience only about 12 hours less ear pain than children who don’t take antibiotics.
On the other hand, if antibiotics are prescribed, some children will have side effects. Using antibiotics can also cause bacteria to become resistant to them, meaning that the antibiotics might not work in future.
Antibiotics are usually only prescribed if your child is at risk of developing complications. For more information, speak to your doctor or see this decision aid developed by the Australian Commission on Safety and Quality in Health Care.
Can otitis media be prevented?
Otitis media often comes from a simple cold. It’s hard to prevent colds, but good hygiene can help lower your chance of catching one.
There are some things you can do to lower your child’s risk of otitis media:
- Keep your child away from cigarette smoke.
- If your child uses a dummy, try to stop them from using it, or only let them use it for short periods.
- Breastfeed your baby if you can.
- Hold your baby upright when feeding them a bottle and don’t give them a bottle in bed.
Make sure your child gets all their vaccinations.
Complications of otitis media
Sometimes the infection clears up, but sticky fluid stays in the middle ear. This can prevent your child from hearing properly and they may need treatment. See your doctor if your child still can’t hear properly 3 months after a middle ear infection.
Ruptured ear drum
If the eardrum ruptures (bursts or tears), it will usually heal by itself. You should see your doctor after 6 weeks to make sure the tear has healed. It’s important not to get the ear wet while the ear drum is healing.
Otitis media can spread to the mastoid bone behind the ear. This is rare but can be very serious. Go to the nearest hospital emergency department if there is redness, pain or swelling of the bone behind the ear or if the ear is pushed forward.
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Last reviewed: October 2022