The Facts

Otitis media is a middle ear infection that is most common in infants and young children under 4 years of age. By the age of one year, most children will have had one or more middle ear infections.

Although a middle ear infection can occur at any age, it's most common between the ages of 3 months and 3 years, and is much less common in older children and adults. Ear infections do not spread from person to person and they most commonly occur with a cold. Antibiotics are often used to treat ear infections, but in certain circumstances, a doctor may suggest waiting for 2 to 3 days before starting antibiotics.


The middle ear is connected to the throat by a small tube called the eustachian tube. It's protected from the outside by a thin shield called the tympanic membrane, or eardrum. Viruses and bacteria that normally live in the throat can sometimes cross into the middle ear through the eustachian tube, causing an infection.

Winter is high season for ear infections. They often follow a cold. Some factors that increase a child's risk for middle ear infections include:

  • crowded living conditions
  • attending daycare
  • exposure to second-hand smoke
  • respiratory illnesses such as the common cold
  • close contact with siblings who have colds
  • having a cleft palate
  • allergies that cause congestion on a chronic basis
  • not being breast-fed
  • bottle-feeding while lying down

Barometric trauma is another risk factor for a middle ear infection. The pressure in the middle ear rises when the airplane you are travelling on descends or when you ascend while scuba diving. If the eustachian tube is not open, the pressure in the middle ear cannot be equalized, and thus, may cause injury, which increases the risk of an acute ear infection.

Symptoms and Complications

Middle ear infections can be categorized as acute, serous, or chronic.

Common symptoms of acute otitis media are fever, pain, and irritability. In children, the ear infection often begins after the child has had a cold for several days. You may notice your child tugging at their ears, though this does not always mean an ear infection is the cause. Young children may also tug at their ears when they're teething, for example.

It's more difficult to detect signs of ear infection in young babies. You may notice a change in mood or feeding, and the infant will most likely have a fever. Because ear infections are usually painful, many babies will be irritable and cry – particularly when lying down.

If fluid builds up in the ear, the infection is called serous otitis media. (That's serous, referring to fluid, not serious.)

This occurs when the eustachian tube becomes blocked, and pressure in the middle ear drops. Under these circumstances, the child might experience hearing loss or impairment in the infected ear. This is usually only temporary. While this is usually no cause for alarm, anyone who experiences hearing loss or impairment should consult their doctor.

Seek immediate medical attention if you notice a fever of 39 °C or higher, pus or discharge coming from the ear, worsening symptoms or symptoms that last for more than 2 to 3 days.

Chronic otitis media refers to a long-lasting ear infection. This is often complicated by (or caused by) a hole in the eardrum (perforation) from any one of the following:

  • acute infection
  • blocked eustachian tube
  • injury from sudden air pressure changes
  • injury from an object entering the ear

Chronic ear infections often flare up after a cold, or, if the eardrum is perforated, when water enters the ear during swimming or bathing. Repeated or long-lasting infections can destroy the small bones in the middle ear, leading to long-term hearing loss. More serious complications include spread to nearby organs, appearing as inflammation of the inner ear, facial paralysis, and brain infections.

Making the Diagnosis

From a visual examination inside the ear with an otoscope (a lighted instrument for looking inside the ear) and description of the symptoms, your doctor can diagnose otitis media. In an infected ear, the eardrum usually appears red and swollen and pus may be seen behind the eardrum, which is usually clear and translucent.

When fluid or pus builds up in the middle ear, the doctor can perform a tympanometry. This is a simple hearing test that measures the pressure on both sides of the eardrums.

Treatment and Prevention

Otitis media is often treated with antibiotics. To lower the chances of the infection returning, it's very important to take the antibiotics regularly and finish the entire course of treatment even if the symptoms improve quickly (if you or your child experience bothersome side effects from the antibiotic, contact your pharmacist or doctor). Some ear infections are caused by viruses and some infections get better without antibiotic treatment. Over 80% of ear infections improve naturally on their own without antibiotic treatment and with no complications. A short period of watchful waiting for 24 to 48 hours rather than antibiotics may be appropriate for children over 6 months of age with minimal symptoms who do not have recurrent infections or structural differences in their ears, and are not at high risk for complications. There are several antibiotics that may be used to treat otitis media. When deciding which antibiotic is the best one, the doctor will consider whether the infections are recurrent and whether bacteria may be resistant to certain antibiotics, as well as, a history of medication allergies. Treatment is usually given for 5 to 10 days depending on age and on the severity of the infection.

Antihistamines may help people who have allergies and ear infections. But no medications other than antibiotics will cure the ear infection if it's caused by bacteria. Pain relievers (e.g., acetaminophen*, ibuprofen) can be used to ease the pain of the infection and to lower a child's fever. Whether or not medications are needed, getting enough rest and drinking plenty of fluids (e.g., water) will help a child feel better.

Young children cannot "pop" open their ears to equalize ear pressures like older children and adults because their eustachian tubes are straight. As the head grows, the tube starts to curve downward into a more angled adult configuration, beginning at about age 3.5 years. This explains why ear infections naturally decrease dramatically by age 4. It also means that starting at this age, children (like adults) can chew sugar-free gum (e.g., when going up or down in an airplane) to help "pop open" their ears, allowing air to enter and fluid to drain, reducing ear discomfort and the chance of developing an infection.

Fluid buildup in the middle ear can be drained surgically. In a procedure called a myringotomy, a tiny opening in the eardrum is made so that fluid drains away or can be suctioned out. This procedure also allows air to reach the middle ear, which equalizes the pressure and facilitates drainage down the eustachian tube. The cause of fluid accumulation must also be treated. For instance, if allergic reactions are to blame for blocking the eustachian tube, then antihistamines can be given to relieve allergies.

If there is chronic infection or fluid buildup behind the eardrum, and especially if there is a documented loss of hearing, a small tube may be inserted into the opening made by myringotomy. Called PE ("pressure equalization") tubes, these devices allow air to enter the ear and any fluid to drain out. Most are designed to fall out within 6 months to 2 years. In the rare case where symptoms occur again, the PE tubes can be replaced.

If the child has a permanent hole in their eardrum that's causing chronic otitis media, the eardrum itself may be repaired by a procedure called a tympanoplasty.

It's hard to prevent ear infections since many children, especially those who attend daycare, are susceptible to colds. Careful hand-washing regimens can help reduce the chance of catching colds, so it's important to remind your kids to wash up as often as possible.

Breast-feeding seems to lower the chances of developing ear infections among infants and children by helping to boost their immunity. Another good preventative measure is to keep your home smoke-free as exposure to second-hand smoke increases the risk of middle ear infections. Immunization with the pneumococcal vaccine can lessen the likelihood of getting ear infections caused by certain types of bacteria.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

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