A middle ear infection (otitis media) is an infection that causes inflammation of the middle ear.
The middle ear is the space behind your eardrum. It contains three tiny bones that move when sounds reach them. These transmit sound waves through your middle ear to your inner ear. Usually, your middle ear is filled with air, but if you have inflammation, the space becomes filled with mucus.
The Eustachian tube connects your middle ear with your throat and opens when you swallow. This allows air to pass up and down the tube from your throat to the middle ear and in the opposite direction. This equalises the air pressure inside your ear to the air pressure outside your ear. When it’s inflamed, the Eustachian tube doesn’t open properly and so mucus stays in the middle ear.
Middle ear infections are most common in children. Adults are affected too, but three out of four people diagnosed are children under the age of 10.
An acute middle ear infection comes on suddenly and typically clears up in about four days. It’s called an acute infection because it comes on suddenly, not because it’s severe.
An acute middle ear infection can be triggered soon after your child gets a cough or a runny nose. Symptoms can include:
You may also notice your child tugging at their ear. As mucus and pus build up in your child's middle ear, they may feel as though their ear is blocked, which can be very uncomfortable. Eventually, the eardrum may burst as a result of the pressure. After this happens, it's likely to be less painful. A burst eardrum sounds nasty, but they usually heal on their own within a few days.
The symptoms of acute middle ear infection usually clear up on their own within four days. If you’re concerned about your child’s symptoms or if they get worse at any time, see your GP.
Your middle ear is normally filled with air, but can become filled with fluid if you have a virus, such as a cold. This is because your Eustachian tube can become swollen or blocked and the fluid can't drain away. The fluid in your middle ear can then become infected with bacteria, which travel up the Eustachian tube from your nose or throat. White blood cells that help to fight the infection can build up in your middle ear as pus. This build-up of pus is what causes pain in your ear and hearing problems.
Acute middle ear infections are very common in children. This is partly because their immune systems are still developing and they are less well equipped to deal with infections than older children and adults. It's also because their Eustachian tube isn't fully developed. It's still quite short and horizontal at a young age, and so fluid and mucus can build up in the middle ear more easily.
An acute middle ear infection can also be caused by enlarged tonsils and adenoids. The adenoids are two small lumps of tissue similar to the tonsils, which sit at the back of your child's throat, beside the Eustachian tubes. If your child's adenoids are enlarged, they can block their Eustachian tubes or, if inflamed, can cause inflammation of the Eustachian tube entrances.
Other factors that can increase the chance of your child getting an acute middle ear infection include:
Boys tend to be affected more than girls and the condition is more common in winter than summer. Your child is also at an increased risk if they have a lot of contact with other children. For example, at a nursery or playschool, or if she or he has lots of siblings. Children who are born with a cleft lip or palate, or who have Down's syndrome are more likely to get middle ear infections.
Your GP will ask about your child's symptoms and examine your child. They may also ask about their medical history. Your GP will use an instrument called an otoscope to look at your child's eardrum.
Your GP may refer your child to have a tympanometry test if the infection keeps coming back or if they suspect glue ear. This is usually done by an audiologist – a technician or scientist who specialises in hearing and balance problems. This can measure how flexible your child’s eardrum is. If your child has an acute middle ear infection, their eardrum stiffens up because of the fluid behind it.
If your child is under three months old, your GP may advise that you take him or her to hospital for further assessment.
Often, the best treatment for an acute middle ear infection is to relieve your child’s symptoms with painkillers until the inflammation has cleared up. For example, paracetamol (eg Calpol) or ibuprofen (eg Nurofen for Children). Don’t give aspirin to children under 16. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. If your child’s condition doesn’t clear up after a few days, or it gets worse, see your child's GP.
Usually, acute middle ear infections clear up on their own within four days and no antibiotics are needed. For this reason, your GP may give you a ‘delayed prescription’, one which you can’t use until your child has had symptoms for at least four days.
If your child has already had symptoms for four days, your GP may prescribe antibiotics to start straight away. Also, if your child is under two and both their ears are infected, then antibiotics may be prescribed sooner. This may also be the case if they have a very high temperature or perforated eardrum (a hole or tear in their eardrum).
If your child is very young (under three months) your GP may recommend starting antibiotics straight away. Your GP may also refer your child to a hospital for further treatment.
If your child does have antibiotics, it's important to complete the course even if their symptoms get better. Decongestant or antihistamine medicines are unlikely to help. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.
If your child gets several acute middle ear infections in a six-month period, your GP may decide to refer them to an ear, nose and throat (ENT) specialist. They may also refer your child if a burst eardrum takes longer than one month to heal. Your child may need surgery if he or she has recurrent infections (three or more infections within six months).
Surgery may involve a procedure called a myringotomy. This procedure involves a small cut being made in your child's eardrum so that fluid can drain out. Ventilation tubes called grommets or tympanostomy tubes may also be inserted into the cut in your child's ear. These are small plastic tubes that allow air to get in and out of the ear. Ask your doctor for more information.
It’s important to make sure that all your child’s vaccinations are up to date, and make sure your child isn’t exposed to tobacco smoke. This includes not smoking in your house or car.
Encourage your child to have good basic hygiene and to wash their hands properly. Teach your child about the importance of hand washing from a young age.
Vaccines are currently being developed by scientists to help prevent acute middle ear infections. The vaccines, called pneumococcal conjugate vaccines (PCVs), aim to immunise young children against pneumococcal infections. These are common causes of middle ear infections. Research has shown that this vaccine may help to prevent acute middle ear infections. But more research is needed to prove it has a big enough effect.
Other research has shown that chewing gum that contains xylitol may reduce the number of acute middle ear infections in children under 12 years of age.
Reviewed by Alice Rossiter, Bupa Health Information Team, June 2014.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
Publication date: December 2011