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Otitis media (middle ear infection)

3-minute read

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 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.

Otitis media symptoms

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 pain — either an earache, a headache or even neck pain. Children who are too young to express themselves verbally might:

  • cry a lot
  • pull or rub their ears
  • have trouble sleeping

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.

Diagnosis of otitis media

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

Treatment of acute otitis media

If your child is in pain or has a fever, you should give them paracetamol. A warm (but not hot) compress to the ear can also help. Encourage them 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 very bad 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.

Otitis media prevention

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

More information

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

Last reviewed: May 2018

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