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Middle Ear Infection – Causes, Symptoms & Treatment

A middle ear infection (otitis media) is an inflammation of the middle ear, most commonly affecting children and caused by bacteria or viruses.

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Things worth knowing about "Middle Ear Infection"

A middle ear infection (otitis media) is an inflammation of the middle ear, most commonly affecting children and caused by bacteria or viruses.

What Is a Middle Ear Infection?

A middle ear infection, medically known as otitis media, is an inflammation of the middle ear – the space located behind the eardrum. It is one of the most common conditions in childhood but can also affect adults. The infection usually develops as a complication of an upper respiratory tract infection and may be acute or chronic in nature.

Causes

Middle ear infections are most commonly triggered by bacteria or viruses that travel from the nose and throat through the Eustachian tube into the middle ear. Common causes include:

Bacteria such as Streptococcus pneumoniae or Haemophilus influenzae
Viruses such as rhinoviruses (common cold viruses) or respiratory syncytial virus (RSV)
Previous colds, flu, or allergies
Enlarged adenoids that block drainage from the middle ear

In infants and young children, the Eustachian tube is shorter and more horizontal than in adults, making it easier for pathogens to reach the middle ear and increasing the risk of infection.

Symptoms

The symptoms of a middle ear infection can vary depending on the age of the person affected:

In Children

Severe, often sudden-onset ear pain
Irritability, crying, and sleep disturbances
Fever (often above 38 °C / 100.4 °F)
Tugging or pulling at the ear
Hearing loss or reduced response to sounds
Purulent or watery discharge from the ear (if the eardrum has ruptured)

In Adults

Ear pain and a feeling of pressure in the ear
Reduced hearing ability
Tinnitus (ringing in the ears)
General feeling of illness and occasional fever

Diagnosis

Diagnosis is typically made by a doctor using otoscopy – an examination of the ear canal and eardrum with an otoscope. The doctor may observe redness, bulging, or a perforation of the eardrum. Additional diagnostic tools include:

Tympanometry: Measurement of eardrum mobility to assess a potential fluid buildup in the middle ear
Audiometry: Hearing tests to detect hearing loss
Swab culture: If there is ear discharge, a sample may be taken to identify the causative organism

Treatment

Treatment depends on the cause and severity of the condition:

Watchful Waiting

For mild to moderate cases, particularly in children over two years of age, clinical guidelines recommend an initial watchful waiting period of 48 to 72 hours, as many cases resolve on their own.

Pain Management

Pain relievers such as ibuprofen or paracetamol (acetaminophen) to relieve pain and fever
Warm compresses applied to the ear can help reduce discomfort

Antibiotics

Antibiotic treatment is recommended when:

The child is under two years of age
Symptoms are severe or affect both ears
There is no improvement after 48 to 72 hours
The eardrum has ruptured with visible discharge

The first-line antibiotic is usually amoxicillin. Alternative antibiotics are used in cases of penicillin allergy.

Surgical Treatment

For recurrent or chronic middle ear infections with persistent fluid buildup, insertion of tympanostomy tubes (ear tubes or grommets) into the eardrum may be recommended to allow fluid drainage and improve hearing.

Complications

Untreated or frequently recurring middle ear infections can lead to the following complications:

Chronic middle ear effusion (glue ear)
Permanent hearing loss
Eardrum perforation
Mastoiditis (infection of the mastoid bone behind the ear)
In rare cases: meningitis or brain abscess

Prevention

Vaccinations against pneumococcal bacteria and Haemophilus influenzae type b reduce the risk
Breastfeeding infants lowers the risk of infection
Avoiding exposure to secondhand smoke
Good hand hygiene to prevent respiratory infections

References

World Health Organization (WHO): Chronic suppurative otitis media. Burden of Illness and Management Options. Geneva, 2004.
Lieberthal AS et al. - The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3):e964-e999.
Qureishi A et al. - Update on otitis media - prevention and treatment. Infection and Drug Resistance. 2014;7:15-24.

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