- Signs & Symptoms
- Home Remedies
What is middle ear infection or inflammation?
Middle ear inflammation is also called otitis media. Otitis media is inflammation of the middle ear; however, many doctors consider otitis media to be either inflammation or infection of the middle ear, the area inside the eardrum (tympanic membrane, see illustration). "Otitis" means inflammation of the ear, and "media" means middle.
This inflammation often begins with infections that cause sore throats, colds, or other respiratory problems and spreads to the middle ear. Infections can be caused by viruses or bacteria and can be acute or chronic. Both ears can be infected at the same time (double ear infection). These infections are not "swimmer's ear" (also termed otitis externa or outer ear infection because it occurs in the ear canal up to the eardrum), but not beyond. However, some people can have a swimmer's ear and a middle ear infection at the same time.
- Acute middle ear infections usually are of rapid onset and short duration. They typically are associated with fluid accumulation in the middle ear, signs or symptoms of infections in the ear, a bulging eardrum usually accompanied by pain or a perforated eardrum, and drainage of purulent material (pus, also termed suppurative otitis media). The person also may have a fever.
- Chronic middle ear infections are persistent inflammation of the middle ear, typically for a minimum of three months. This is in distinction to an acute ear infection that usually lasts only several weeks. Following an acute infection, fluid (an effusion) may remain behind the eardrum (tympanic membrane) for up to three months before resolving. It may develop after a prolonged period with fluid (effusion) or negative pressure behind the eardrum (tympanic membrane). This type of infection can cause ongoing damage to the middle ear and eardrum, and there may be continuing drainage through a hole in the eardrum. Chronic middle ear infections often start painlessly without fever. Ear pressure or popping can be persistent for months. Sometimes a subtle loss of hearing can result from chronic middle ear infections.
What is serious middle ear infection or inflammation?
Serious otitis media is inflammation in the middle ear without infection. Typically, the Eustachian tube is not functioning and cannot ventilate the ear normally. As a result, fluid accumulates in the middle ear.
This can lead to dullness or fullness within the ear along with diminished hearing.
What happens to the eardrum in chronic middle ear infection or inflammation?
The eardrum (tympanic membrane) has three delicate layers that help keep the eardrum thin but strong. A chronic middle ear infection causes changes in the eardrum that weaken it, and often lead to a hole in the eardrum (tympanic membrane perforation).
- Eventually, the eardrum loses its strength and begins to collapse into the middle ear space.
- When the eardrum collapses or retracts from negative pressure in the middle ear, it can attach to the other middle ear structures.
- The eardrum is frequently seen draped around the middle ear bones (ossicles) or the inner wall of the middle ear (promontory).
- This disrupts the conduction of sound through the middle ear and may diminish hearing.
What happens to the eardrum if a hole develops in it?
A hole that forms in the eardrum (tympanic membrane perforation) usually causes a chronic draining ear, or a condition called chronic otitis media with perforation. Often the drainage (otorrhea) will have a foul odor and can be seen draining from the ear.
Hearing can improve after the middle ear fluid is released, or it may worsen secondary to the inflammation in the middle ear.
How common is acute middle ear infection or inflammation?
This type of acute middle ear infection is an extremely common diagnosis.
In the U.S., it is estimated that most children experience at least one middle ear infection before the age of 3.
Why do infants and young children tend to have ear infections?
The Eustachian tube, a canal that runs from the middle ear to the back of the nose and throat, is shorter and more horizontal in infants and young children than in older children and adults. This allows easier entry into the middle ear for the microorganisms that cause infection and leads to otitis media. Young children also have more immature immune systems.
The result is that infants and young children are at greater risk of acquiring ear infections than adults.
How does the Eustachian tube change with age?
As a person ages, the Eustachian tube doubles in length and becomes more vertically positioned so that the nasopharyngeal orifice (opening) in the adult is significantly below the tympanic orifice (the opening in the middle ear near the ear drum) than in a child.
The greater length and particularly the slope of the tube, as it grows, serves more effectively to protect, aerate and drain the middle ear.
How do you get a middle ear infection?
Bacteria and viruses can cause middle ear infections:
- Bacteria such as Streptococcus pneumoniae (pneumococcus), Hemophilus influenzae, Pseudomonas, and Moraxella account for about 85% of cases of acute otitis media.
- Viruses account for the remaining 15%.
Affected infants under 6 weeks of age tend to have infections from a variety of different bacteria in the middle ear.
What are common causes of acute and middle ear infection?
Common causes of acute and middle ear infections include:
- Bottle-feeding: The position of the breastfeeding child is better than that of the bottle-feeding position in terms of the function of the Eustachian tube that leads into the middle ear. If an infant needs to be bottle-fed, it's better to hold babies rather than allow them to lie down with the bottle. Ideally, they should not take the bottle to bed. (In addition to increasing the chance of acute infection, falling asleep with milk in the mouth enhances the risk of tooth decay.)
- Upper respiratory tract infection: Children often develop upper respiratory infections before developing this type of infection. Exposure to groups of children (as in childcare centers) results in more frequent colds, and therefore more earaches.
- Exposure to air with irritants, such as tobacco smoke
- Birth defects: Children with cleft palate or Down syndrome are more prone to ear infections.
- Eustachian tube problems: Any problems with the Eustachian tubes (for example, blockage, malformation, inflammation) will increase the risk of infection. If the individual has allergies, he or she may have swelling and blockage of one or both Eustachian tubes.
- Immunosuppressed: Individuals with suppressed immune responses are at increased risk for ear infections.
- Ear infections later in childhood: Children who have episodes of acute infections before six months of age tend to have more later in childhood.
What causes chronic middle ear infection or inflammation?
Causes of chronic middle ear infection or inflammation include:
- The Eustachian tube normally prevents the accumulation of fluid by allowing fluid to drain through the tube.
- Chronic otitis media develops over time and often starts with a chronic middle ear effusion (fluid) that does not resolve.
- This persistent fluid will often become contaminated with bacteria, and the bacteria found in chronic otitis media are often different from those found in acute otitis media.
- Therefore, anything that disturbs the function of the Eustachian tube can lead to chronic otitis media.
- In some individuals that are ill from other diseases, and there is pus draining from the ear, there is a danger that otitis media (especially bacterial-caused) may invade the mastoid bone and reach the brain.
- These individuals need to be seen urgently by a healthcare professional.
- Do not delay treatment by trying home remedies.
Symptoms of acute middle ear infection in infants, toddlers, and children
Depending on the age of the baby, toddler, or child, signs of middle ear infections may include the following:
- Young nonverbal children may be irritable and pull or tug at their ear(s).
- Young children with middle ear infections may be irritable, fussy, or have problems feeding or sleeping.
- Older children may complain about pain and fullness in the ear (earache)
Other signs and symptoms may include:
- Fever: A child of any age may have a fever.
- Pain and hearing loss: The buildup of pus within the middle ear causes pain and dampens the vibrations of the eardrum (so there is usually temporary hearing loss during the infection).
- Pus drainage: Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal. The hole in the eardrum from the rupture usually heals without medical treatment.
Symptoms of middle ear infections in adults
Are ear infections contagious?
Subscribe to MedicineNet's General Health Newsletter
Which specialties of doctors diagnose and treat middle ear infections?
The majority of children and adults are diagnosed and treated by pediatricians, primary health care doctors, emergency or urgent care medical providers, or other health care professionals. Ear, nose, and throat (ENT) specialists may be consulted for some individuals.
On rare occasions, a neurologist or neurosurgeon may be needed to treat a severe infection that may extend to other organ systems.
How is acute middle ear infection diagnosed?
The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) have determined the criteria needed to diagnose acute otitis media (AOM), acute onset, middle ear effusion (MEE), and middle ear inflammation.
- The new guidelines describe this as "moderate to severe bulging of the tympanic membrane (ear drum) or new onset of otorrhea (ear drainage) not due to external otitis (inflammation of the ear canal) or mild bulging of the ear drum, and recent ear pain (holding, tugging, rubbing ear in a nonverbal child) or intense reddening of the ear drum."
- The guidelines also strongly recommend that clinicians should not diagnose AOM without the presence of MEE.
- Recurrent acute otitis media is defined as at least three well-documented and separate acute otitis media episodes in 6 months or four well-documented and separate AOM episodes in the past 12 months with at least one in the past 6 months.
- There is no definitive lab test for acute otitis media.
Identification of the three criteria is dependent on clinical observation; middle ear effusion and middle ear inflammation are the most difficult to observe and as a consequence, some studies suggest acute otitis media is overdiagnosed.
- One method that helps determine acute otitis media versus otitis media with effusion is pneumatic otoscopy (the normal eardrum moves readily with pressure changes) and the appearance of the tympanic membrane (acute otitis media has an abnormal appearance; otitis media with effusion does not).
- However, not everyone is skilled at this technique; pediatricians, family practice physicians, ENT specialists, and ER doctors who work in pediatric ERs are likely to be skilled in the diagnostic procedure.
How is acute middle ear infection or inflammation treated?
The treatment for acute otitis media varies depending on the age and symptoms of the child. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend the following:
(Otorrhea with AOM or Unilateral or
Bilateral AOM with Severe Symptoms)
(Bilateral AOM without Otorrhea)
(Unilateral AOM without Otorrhea)
|6 months-23 months||Antibiotics||Antibiotics if severe illness;
*Observation without antibiotics if non-severe illness
|> 2 years||Antibiotics||Antibiotics if severe illness;
*Observation of non-severe illness
|Antibiotics if severe illness;
*Observation without non-severe illness
*Observation is an appropriate option only when follow-up can be ensured and antibacterial agents can be started if symptoms persist or worsen within 2-3 days. The guidelines also recommend "shared decision-making" with the caregiver. Non-severe illness is represented by mild ear pain and fever <39 C (102.2 F) in the past 24 hours. Severe illness is defined as moderate to severe otalgia (ear pain) or any ear pain for at least 48 hours or a fever of 39 C. These 2013 guidelines are current.
If antibiotics are initiated, amoxicillin is usually recommended as the first-line treatment. This is usually prescribed for 10 days. Some children do not respond within the first 48-72 hours of treatment, and antibiotic therapy may have to be changed. Even after antibiotic treatment, some children are left with some fluid in the middle ear, which can cause temporary hearing loss lasting for up to 3-6 weeks. In most children, this fluid eventually disappears spontaneously (on its own). Ceftriaxone (50mg/kg/d) injection is recommended for children who cannot take oral antibiotics; 3 days of this antibiotic is usually more effective than a single injection.
Children who have recurring bouts of otitis media may be referred to an otolaryngologist (ear, nose, and throat specialist or ENT). Some of these children may benefit from having an ear tube placed (tympanostomy tube) to permit fluid to drain from the middle ear. In addition, if a child has a bulging eardrum and is experiencing severe pain, a procedure to lance the eardrum (myringotomy) may be recommended to release the pus. The eardrum usually heals within a week. Prophylactic antibiotic therapy has not been shown to decrease the frequency of ear infections in those children with recurrent AOM.
Although treatment may cure an ear infection, the ear can become re-infected.
How is chronic middle ear infection or inflammation treated?
Treatment for chronic middle ear infection or inflammation may include:
- Initially, antibiotics may resolve the ear infection.
- If a tympanic membrane perforation also is present, topical antibiotic drops may be used.
- If eardrum or ossicle scarring has occurred, that will not be reversed with antibiotics alone.
- Surgery often is indicated to repair the tympanic membrane (eardrum) and remove the infected tissue and scar from the middle ear and the mastoid bone.
- Long-term prophylactic antibiotics are not recommended.
IMAGESSee a medical illustration of the ear plus our entire medical gallery of human anatomy and physiology See Images
What are the goals of chronic otitis media surgery?
The goals of surgery include the following:
- First, remove all of the infected tissue so that it can be "safe" from recurrent infections.
- Then recreate a middle ear space with an intact eardrum.
- Finally, the hearing is to be restored.
- This may seem strange that hearing is the last priority, but if the first two priorities are not met, anything that is done to improve hearing will ultimately fail.
- If hearing is restored, but the infection returns, the hearing will be lost again.
- Likewise, if hearing is restored, but the middle ear space is not recreated, the eardrum will re-stick to the middle ear or the ossicles.
Are there any home remedies for acute middle ear infection?
There are several suggested home remedies for the treatment of ear infections, including:
- Humidified air
- Homeopathic treatments
- Naturopathic ear drops
However, there are limited studies suggesting the benefits of these measures over accepted and recommended treatments.
- Both oral and topical analgesics are effective in controlling the pain associated with ear infections, but the use of decongestants or antihistamines has not been demonstrated to improve symptoms or speed the resolution of acute otitis media.
What limitations are there on a child with middle ear infection or inflammation?
Otitis media is not contagious (although the initial cold that caused it may be).
A child with otitis media can travel by airplane, but if the Eustachian tube is not working well, the pressure change as the plane descends may cause the child pain. It is best not to fly (or swim) with a draining ear.
You should always consult your doctor if you have specific concerns.
Can otitis media (middle ear infection or inflammation) be prevented?
Currently, the best way to prevent acute otitis media is to assure a child is vaccinated. Ensuring that your child receives an annual flu vaccine and is up to date with his/her pneumococcal vaccine is the best way to prevent the most common causes of middle ear infections (otitis media).
In addition, both early and sustained breastfeeding (for at least 6 months) and avoidance of tobacco smoke exposure be related to fewer ear infections. Recent studies suggest that Xylitol-based gum or lozenges may have a preventive impact on acute otitis media. Unfortunately, it cannot be used in young children and must be used 3-5 times a day during the cold and flu season to be effective.
Donaldson, J.D., MD. "Acute Otitis Media." Medscape. Updated: Sep 25, 2019.
Lieberthal A et al. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics. March 2013. 131:3.e964-e999.
Natal, B.L., MD. "Emergent Management of Acute Otitis Media." Medscape. Updated: Jun 17, 2019.
Rennie, C.E. "Pneumatic Otoscope Examination." Medscape. Updated: Feb 05, 2016.
Top Ear Infection Related Articles
Ear Infection SlideshowLearn about the causes and symptoms of ear infections and how they are diagnosed and treated. Read about treatments such as ear tubes and antibiotics, which could prevent future ear infections.
Babies QuizTake the Babies Quiz to learn what milestones and developments you can expect from your baby’s first year.
Baby's 1st Yr SlideshowWhat developmental milestones can you expect to see during baby's first year? Find out when babies learn to smile, laugh, crawl, and talk.
Bacterial Infections 101Get more information on bacterial skin infections, which bacteria cause food poisoning, sexually transmitted bacteria, and more. Explore the most common bacterial infections.
Kids' Illnesses SlideshowIs your child at risk for these childhood diseases? Know when to call the doctor for conditions such as measles, mumps, ringworm, pink eye, strep throat, cough, ear aches, and more.
Dental Care for BabiesGetting in the habit of cleaning your baby's gums after each feeding will help prevent future oral health problems, like bleeding gums and cavities. Also, it's important to be able to recognize the symptoms of teething. The symptoms include increased drooling, tender gums, rash on the cheeks, ear pulling, and placing objects in the mouth and biting down on them. Treat teething pain by massaging your child's gums, allowing your child to suck on a chilled teething ring or cold, wet cloth, or applying an over-the-counter teething ointment to numb the gums.
Detecting Hearing Loss in ChildrenThere are many degrees of hearing, from normal hearing to deafness. Many states mandate the testing of newborns before leaving the hospital. The risk factors for hearing loss in children include
- a family history of hearing loss,
- frequent ear infections,
- diagnosis of a learning disability,
- syndromes associated with hearing loss,
- speech delay, and
- infectious diseases that cause hearing loss.
- the child not responding to his or her name,
- the child asking for words to be repeated, and
- the child not paying attention to what is being said.
Ear Infection QuizIs it possible to prevent ear infections? Take the Ear Infection (Otitis Media) Quiz to learn the risks, causes, symptoms and treatments for the common ear infection.
Illustrations of the EarThere are three sections of the ear, according to the anatomy textbooks. They are the outer ear, the middle ear, and the inner ear. See a picture of Ear Anatomy and learn more about the health topic.
Ear TubesWhen a child has repeated middle ear infections or fluid build-up in the ears, which causes problems with speech or hearing, surgery to place tubes inside the ear is often recommended. The surgery is called myringotomy. Preparing your child for this procedure will help comfort them, and knowing what to expect before, during, and after surgery is important as well.
How Do You Clear Blocked Eustachian Tubes?Learn what medical treatments can help ease your blocked eustachian tube symptoms and speed up your recovery for blocked eustachian tubes. Ear infections are common and usually go away on their own after a few days, even without medical treatment. Learn about causes and treatment.
Inner Ear InfectionAn inner ear infection or otitis interna is caused by viruses or bacteria and can occur in both adults and children. An inner ear infection can cause symptoms and signs, for example, a severe ear, dizziness, vertigo, nausea and vomiting, and vertigo. An inner ear infection also may cause inflammation of the inner ear or labyrinthitis. Inner ear infections are not contagious; however, the bacteria and viruses that cause the infection can be transmitted to other people. Good hygiene practices will help decrease the chances of the infection spreading to others. Inner ear infection symptoms and signs like ear pain and nausea may be relieved with home remedies or over-the-counter (OTC) medication. Some inner ear infections will need to be treated and cured with antibiotics or prescription pain or antinausea medication.
Liver BiopsyLiver biopsy is a procedure used to remove a small piece of liver tissue for examination for signs of disease or damage to the liver. Preparation for liver biopsy includes discontinuing certain medications. The techniques used to perform liver biopsy include percutaneous liver biopsy, transvenous liver biopsy, and laparoscopic liver biopsy. Recovery from liver biopsy are generally one to two days. Certain risks are associated with liver biopsy.
Sore throat (throat pain) usually is described as pain or discomfort in the throat area. A sore throat may be caused by bacterial infections, viral infections, toxins, irritants, trauma, or injury to the throat area. Common symptoms of a sore throat include a fever, cough, runny nose, hoarseness, earaches, sneezing, and body aches. Home remedies for a sore throat include warm soothing liquids and throat lozenges. OTC remedies for a sore throat include OTC pain relievers such as ibuprofen or acetaminophen. Antibiotics may be necessary for some cases of sore throat.
Strep Throat QuizTake the Strep (Streptococcal) Throat Infection Quiz to learn about causes, symptoms, treatments, prevention methods, diagnosis, and complications of this common infectious disease.
Swollen Lymph Nodes (Lymphadenopathy)Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly, but may include fever, night sweats, toothache, sore throat, or weight loss. Causes of swollen lymph nodes also vary, but may include cancer, the common cold, mono, chickenox, HIV, and herpes. The treatment of swollen lymph nodes depends upon the cause.
Upper Respiratory Infection (URI)An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barr. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infections are based upon the cause. Generally, viral infections are treated symptomatically with over-the-counter (OTC) medication and home remedies.
What Can Trigger Vertigo?Vertigo is the sensation of spinning or rocking, even when someone is at rest. Vertigo may be caused by a problem in the brain or spinal cord or a problem within in the inner ear. Head injuries, certain medications, and female gender are associated with a higher risk of vertigo. Medical history, a physical exam, and sometimes an MRI or CT scan are required to diagnose vertigo. The treatment of vertigo may include medication, special exercises to reposition loose crystals in the inner ear, or exercises designed to help the patient re-establish a sense of equilibrium. Controlling risk factors for stroke (blood pressure, weight, cholesterol, and blood glucose) may decrease the risk of developing vertigo.