Otitis media happens when the middle ear becomes inflamed due to an infection. It is common in children and can follow a sore throat, respiratory infection, or cold.

Around 4 out of 5 children will get acute otitis media in their lifetime. It is the second most common cause of emergency department visits in children, following upper respiratory infections.

This article discusses otitis media and its symptoms, causes, risk factors, related conditions, complications, and treatment. The article also considers how to prevent it and when to speak with a doctor.

A male child having their ear examined by a medical professionalShare on Pinterest
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Otitis media is the inflammation of the middle ear, an air-filled space that contains the three hearing bones: hammer, anvil, and stirrup. The middle ear is found between the eardrum and the cochlea of the inner ear.

Otitis media can be due to viral, bacterial, or coinfection. In many cases, it resolves on its own. In some cases, a doctor may need to prescribe antibiotics.

It is an umbrella term for several diseases, including:

  • Acute otitis media: This type often occurs suddenly following a cold or an infection. The infection may cause mucus and fluid to remain trapped in the middle ear, causing pain and fever.
  • Otitis media with effusion: Noninfected fluid may remain in the middle ear without signs of infection after the initial infection resolves. A person may report feeling fullness in their ears, affecting their hearing.
  • Chronic suppurative otitis media: This is the repetitive inflammation of the middle ear often caused by a ruptured eardrum, or tympanic perforation. It presents with recurrent ear discharge and may cause hearing loss.

A diagram showing symptoms of otitis media in a childShare on Pinterest
This illustration depicts various symptoms of otitis media in a child, including tugging or pulling the ear, fussiness or crying, ear pain, and ear fullness. Infographic by Wenzdai Figueroa.

The condition may be difficult to detect in children because they may not be able to communicate their symptoms. Common symptoms to look for in children include:

Otitis media in adults

Adults with otitis media may experience:

Drainage is less common unless there is an underlying chronic ear disease, such as chronic suppurative otitis media.

Learn more about ear infections in adults.

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This illustration demonstrates structures of the middle ear and signs of inflammation of the middle ear consistent with otitis media, including fluid collection in the middle ear and auditory (eustachian) tube narrowing. Infographic by Wenzdai Figueroa.

There are several causes of middle ear infections.

A dysfunction in the tube that connects the ears to the back of the throat, which is known as the eustachian tube, is a common cause of middle ear infection in adults and children.

Children’s eustachian tubes are not as developed. They are shorter, more horizontal, and narrower. This makes these tubes much harder to drain and easier to become clogged.

A cold or an allergy can also cause the nose, throat, or eustachian tube to become congested or swell. This prevents fluids from draining, causing fluid buildup. This buildup allows bacteria and viruses to grow, leading to an infection.

A person may call a doctor if they experience the following:

  • severe ear pain
  • persistent fever or fever that does not go away after 48 hours of taking antibiotics
  • constant ear pain even after 3 days of taking antibiotics

It is best to seek medical help immediately if a person notices any of the following:

While anybody can get otitis media, specific individuals are at a higher risk of developing it:

  • being a younger age, as 80–90% of children will have otitis media with effusion before school age
  • having an upper respiratory tract infection
  • having allergies
  • having congenital disorders of the face or head, like cleft palate
  • having Down syndrome
  • being exposed to smoke and other irritants
  • attending a day care center
  • having a family history of ear infections
  • using a pacifier
  • bottle feeding instead of breastfeeding
  • bottle feeding in a lying position
  • having a weak immune system
  • having vitamin A and D deficiencies

Complications from ear infections are not common, but they can occur in children and adults. These include:

Treatment for otitis media depends on the following:

  • person’s age
  • person’s overall health
  • nature of the infection, whether it is occuring for the first time or is recurrent
  • severity of the condition

If the patient is a child, the doctor will also consider their tolerance for medications and procedures, as well as the preference and opinion of their parents.

Medications and observation

Generally, doctors will recommend observing the child for several days and seeing if the condition goes away on its own before prescribing antibiotics. However, they may provide medications for the child’s pain and fever.

Doctors may prescribe ear drops for holes or tears in the eardrum caused by repetitive or ongoing infection. They may use a device to clear the fluids.

Adults may take topical intranasal vasoconstrictors, like phenylephrine drops, every 3 hours. However, they should not take them for more than 4 days to avoid rebound congestion.

Oral decongestants and antihistamines may also help.

Ear tubes

If a child has frequent ear infections (three infections in 6 months or four infections in 1 year), or if the infection does not resolve with antibiotics, a doctor may recommend a type of surgery called myringotomy with ear tube placement.

Myringotomy involves making a small opening in the eardrum to relieve the pressure from the middle ear and drain the fluid. A doctor may recommend this for children who are developing their language and speech.

Ear tubes usually last 6–18 months. Some long-term ear tubes can last longer.

Stopping smoking

A 2020 study found that passive smoking is highly associated with serous otitis media in children. Not exposing a child to secondhand smoke can reduce their risk of ear infections.

Managing allergies and preventing colds and infections

Allergies, colds, and infections can block the eustachian tube, making ear infections more likely.

Proper hygiene and attending a smaller day care can help decrease a child’s exposure to colds.

Ensuring that a child’s vaccinations are up to date can help prevent infections that can lead to otitis media.

Breastfeeding

The American Academy of Pediatrics (AAP) recommends that parents exclusively breastfeed their infants, at least for the first 6 months. Breastmilk contains antibodies that reduce the likelihood of ear infections.

This lowers the infant’s risk of acute otitis media, among other health benefits. The benefits are most notable in the first 2 months, based on a 2019 longitudinal study.

Stopping pacifier use

The American Academy of Family Physicians (AAFP) joins AAP in advising parents to reduce or wean their children’s pacifier use from 6 months to prevent ear infections.

A 2021 report found that children using pacifiers are nearly twice at risk for ear infections.

Bottle feeding in an upright position

Feeding a baby lying flat can cause fluids to fall back into the eustachian tubes. Feeding them with their heads higher than their stomachs can prevent this.

Leaving a bottle in bed at night with a child is also not advised. This is to discourage them from drinking on their back.

Removing enlarged adenoids

Constantly breathing through the mouth or frequently snoring may indicate that a person has enlarged adenoids, a tonsil-type tissue at the back of the throat.

Enlarged adenoids may contribute to ear infections. Adenoids can be removed through adenoidectomy, and ear tubes may be placed simultaneously when more than one set of tubes is needed.

Vaccination

Studies have shown that vaccinated children are less likely to get ear infections. The National Institute on Deafness and Communication Disorders (NIDCD) recommends that children get the flu and pneumococcal vaccine every year.

Ear infections are common in children, but adults can also get them. Most of the time, these infections are not serious and typically resolve on their own within 3–5 days.

When antibiotics are necessary, a person can expect relief within 48–72 hours. If symptoms do not get better by this time, they should contact a healthcare professional.