Middle Ear Infection

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a middle ear infection?

A middle ear infection, also called otitis media or simply ear infection, is a common, often painful type of ear infection that occurs behind the eardrum. (Outer ear infection and inner ear infection are two other types.) Bacteria and viruses cause middle ear infections. A middle ear infection can interfere with the normal process of hearing and result in ear pain, hearing impairment, and other symptoms.

People of all ages can get a middle ear infection, but it is more common in infants and young children up until the age 3.

In the ear, the Eustachian tubes are responsible for equalizing air pressure in the middle ear and allowing mucus to drain from the middle ear to the throat. Sometimes, however, the tube can become blocked by congestion, which causes fluid from the middle ear to build up. Bacteria or viruses can enter the middle ear through the Eustachian tubes, leading to infection.

Treatment for a middle ear infection varies depending on the cause (bacterium or virus). Treatment may include oral medications, ear drops, or surgical procedures in severe cases.

Complications of a middle ear infection can be serious in some cases and result in permanent hearing loss, brain abscess, meningitis, and other problems.

Seek prompt medical care for symptoms of a middle ear infection, such as ear pain and drainage, or if a middle ear infection is not getting better.

Seek immediate medical care (call 911) for seizures, lethargy, or a change in alertness.

What are the different types of middle ear infections?

There are two types of middle ear infections: acute otitis media (AOM) and otitis media with effusion (OME).

  • Acute otitis media usually follows a viral upper respiratory tract infection, such as a cold or flu. This middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing fever, ear pain, and hearing loss.

  • Chronic otitis media is an ongoing middle ear infection that can occur after acute otitis media or because of a poorly healed ruptured eardrum. Fluid and mucus continue to accumulate in the middle ear after an initial infection subsides. Symptoms include a feeling of fullness in the ear and hearing loss.

What are the symptoms of a middle ear infection?

Symptoms of a middle ear infection can vary and differ depending on the specific type of infection. Young children cannot clearly communicate symptoms, including pain. They may cry and tug on their ears.

Common symptoms of a middle ear infection include:

  • A feeling of fullness in the ear

  • Chills

  • Drainage of pus and blood from the ear canal followed by relief from pain, which indicates a ruptured eardrum

  • Ear pain

  • Fever

  • Hearing loss

  • Irritability, fussiness, poor feeding, and poor sleeping in infants and young children

  • Loss of balance

  • Tugging or rubbing at the ear in infants and young children

Serious symptoms that might indicate a life-threatening condition

In some cases, a middle ear infection can result in serious, even life-threatening complications, such as meningitis or a brain abscess.

Seek immediate medical care (call 911) for any of these symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions 
  • Neck stiffness
  • Purple-reddish rash of tiny spots

When to see a doctor for middle ear infection symptoms

Seek medical care if you or your child has:

  • Fever, higher than 101°F 
  • Symptoms of middle ear infection that are getting worse or lasting more than 2 or 3 days
  • Ear drainage, pus or other fluid coming from the ear
  • Hearing loss

What causes a middle ear infection?

Normally, fluid in the middle ear drains through the Eustachian tube to the throat. The Eustachian tube helps to equalize the pressure between the outer ear and the middle ear like when ears 'pop' during air travel. Fluid can build up in the middle ear, behind the eardrum, when the Eustachian tube becomes blocked or swollen. Bacteria and viruses grow and multiply easily when fluid in the middle ear does not drain normally.

Conditions that cause swelling or blockage of the Eustachian tube include:

What are the risk factors for developing a middle ear infection?

Middle ear infections can occur in any age group or population, although they most commonly occur in infants and young children. Several factors increase the risk of developing a middle ear infection including:

  • Exposure to other children (child daycare setting)

  • Family history of middle ear infections

  • Living in a cold climate

  • Not being breastfed as an infant

  • Perforated eardrum

  • Recent illnesses, especially an upper respiratory infection or sinusitis

  • Smoking and secondhand smoke

  • Traveling to a different climate or altitude

  • Use of an oral pacifier

How do you prevent a middle ear infection?

In some cases, bacterial ear infections in infants and toddlers may be prevented by vaccination with the pneumococcal vaccine, as recommended by your healthcare provider.

You may also be able to lower your risk of developing middle ear infections by protecting yourself and your child from colds, flu, and upper respiratory infections. Ways to reduce the risk of middle ear infections include:

  • Avoiding contact with a person who has an upper respiratory infection

  • Avoiding touching your eyes, nose, ears and mouth, which can transmit an infectious virus from the hands into the body

  • Breastfeeding infants, which transfers protective antibodies from the mother to the baby

  • Covering your mouth and nose with your elbow or a tissue when sneezing or coughing

  • Eating a well-balanced diet that includes fruits and vegetables

  • Getting enough rest

  • Not smoking, and avoiding secondhand smoke

  • Using appropriate antibacterial cleaners to clean hands and surfaces

  • Washing hands frequently with soap and water for at least 20 seconds, especially during and after contact with a person who is sick

What are the diet and nutrition tips for middle ear infection?

There is no specific diet for ear health or ear infections. However, a diet rich in nutrients with a variety of grains, fresh fruits, and vegetables is good for the immune system and overall health. Your body also needs protein. Healthy sources of protein include dairy, ancient grains like quinoa, and lean cuts of meat.

Consider adding probiotics to your diet to help boost your immune system. You can find probiotics in yogurt, kefir (a fermented dairy drink), aged cheese that contain live cultures, and other fermented foods including tempeh and miso.

For bottle-feeding infants, position them during feeding so their head is higher than the stomach. This will help prevent fluid from draining back into the Eustachian tubes.

Ask your healthcare provider for guidance before making significant changes to your diet. Consult with your child’s pediatrician before making any feeding changes.

How do doctors diagnose a middle ear infection?

To diagnose an ear infection, a doctor will look at the outer ear(s) and examine the eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the doctor to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

A doctor may also perform these tests to check function and hearing:

  • Tympanometry to measure how well the eardrum and middle ear are functioning and to detect changes in pressure in the middle ear. Because this test requires a person to remain still and quiet, it can be difficult to perform on younger children.

  • Hearing test to check for hearing in loss in one or both ears. The most common hearing test is pure tone audiometry, which identifies the faintest tones a person can hear. A person sits in a quiet room wearing earphones to hear a series of sounds in one ear at a time. A person who has frequent ear infections may have a hearing test.

How do you treat a middle ear infection?

Middle ear infection treatment addresses the infection, minimizes ear pain, and reduces the possibility of complications, such as hearing loss.

Healthcare providers may prescribe antibiotics if they suspect the infection is bacterial. However, there is great controversy surrounding the use of antibiotics in young children, since outcomes are not better than supportive treatments, such as ear drops for pain relief. Many healthcare professionals are concerned about overprescribing antibiotics, which can lead to the development of antibiotic-resistant bacteria.

Treatment of a middle ear infection may include:

  • Acetaminophen (Tylenol) for fever and ear pain

  • Antibiotic medications for ear infections caused by bacteria. Antibiotics may be given orally (pills or liquid) or as ear drops. Antibiotics do not kill viruses and are not prescribed for middle ear infections caused by a virus.

  • Corticosteroids to reduce ear inflammation and pain

  • Decongestants to relieve ear congestion caused by inflammation or infection

  • Follow-up medical care, as recommended, during and after a middle ear infection to reevaluate the ear and assess the risk of developing complications, such as hearing loss and chronic otitis media

  • Drinking extra fluids and getting extra rest and sleep

  • Surgery, in some cases, to insert tubes in the ears to drain excess ear fluid, remove infected tissue, or repair a damaged eardrum. A doctor may recommend tonsillectomy for recurrent otitis media due to swollen tonsils.

If your child has a middle ear infection, do not use aspirin or products that contain aspirin because of the risk of developing a rare but life-threatening condition called Reye syndrome. Reye syndrome has been linked to taking aspirin during a viral illness, such as a viral middle ear infection or flu.

Home remedies for middle ear infection 

There are several self-care strategies to bring soothing relief from symptoms of middle ear infection. In addition to drinking plenty of fluids and getting extra rest, try:

  • Over-the-counter pain reliever and fever reducer. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) reduce fever and can ease ear pain. Ask with your child’s doctor for the appropriate dose for your child.

  • Over-the-counter decongestants. Nose drops, nasal sprays, or oral decongestants can reduce swelling and help open passages. 

  • Warm or cold compresses. Rest with a warm compress (heating pad set on low or a warm damp washcloth) or ice pack over the ear. Alternate warm and cold compresses if that provides relief.

  • Sleep positions to help drain ear fluid. Sleeping with your head raised on extra pillows. Also, if you rest on your side, lay on the opposite side of your infected ear to keep your infected ear up off the pillow.

What are the potential complications of middle ear infections?

Complications of a middle ear infection can be serious, even life-threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you.

Complications of a middle ear infection include:

  • Bell’s palsy (swollen or inflamed nerve that controls facial muscles)

  • Brain abscess

  • Chronic otitis media (ongoing middle ear infection)

  • Enlarged adenoids (enlarged lymphoid tissue in the back of the nose)

  • Loss of hearing, even deafness

  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)

  • Ruptured eardrum

It’s important to seek medical care early on, when a child is unwell or symptoms for middle ear infection worsen or last more than a few days. A doctor can check for infection and together you can discuss the most appropriate treatment plan. If, despite treatment, symptoms do not improve or you notice hearing loss, contact the doctor’s office.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 23
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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