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Topic Overview
What is an ear infection?
Ear infections include a broad range of diseases that can affect any of the ear structures. A middle ear infection (otitis media) is an inflammation or infection of the middle ear and is the focus of this topic. This condition is most common in young children, because their eustachian tubes (the tubes that connect the throat and the middle ear) are shorter, more horizontal, and more easily blocked than those in older children and adults. A middle ear infection frequently occurs along with or after a cold or other upper respiratory infection.
The space in the middle ear, behind the eardrum, is normally filled with air. Any accumulation of fluid in the middle ear space is called an effusion. This fluid provides an environment that allows infection to develop.
There are three types of ear infections. An infection involving the outer parts of the ear, such as "swimmer's ear," is called otitis externa. An infection involving the hearing parts of the inner ear is called otitis interna. For more information on outer ear infections, see the topic Ear Canal Problems (Swimmer's Ear). For more information on inner ear infections, see the topic Labyrinthitis. This topic deals with otitis media, or infection of the middle ear.
There are two main classifications of otitis media.
Acute otitis media is an inflammation of the lining of the middle ear space that can result in
the accumulation of fluid in the space and infection. Otitis media is associated with a rapid
onset of symptoms, including ear pain and fever.
Otitis media with effusion is a buildup of
fluid in the middle ear behind the eardrum without symptoms of infection.
What causes middle ear infection?
A middle ear infection is caused by bacteria or viruses. Often, during a cold or other condition where the eustachian tubes become blocked, the fluid that builds up provides an environment where bacteria or viruses can multiply and cause infection.
Fluid buildup (otitis media with effusion), also called glue ear, commonly follows an ear infection, although fluid can build up without an infection. Fluid that accumulates in the middle ear and is unable to drain due to blocked eustachian tubes is called effusion.
What are the symptoms of middle ear infection?
The main symptoms of a middle ear infection are fever and earache, which may be severe. Perforation of the eardrum can occur and you may notice thick, yellow drainage from the ear, though not like earwax. Irritability, difficulty sleeping, and loss of hearing are also possible.
Fluid buildup without infection is usually characterized by a feeling of stuffiness in the ears. Children with this condition may not hear well, though hearing usually returns to normal after the fluid behind the eardrum clears. Some children will not have any symptoms with this condition.
How is a middle ear infection diagnosed?
Middle ear infections can usually be diagnosed based on medical history, physical exam, and an ear exam using a pneumatic otoscope.
A health professional can conduct a hearing test if hearing loss is suspected or if the child has had fluid in one or both ears for 3 months.
Other tests include tympanometry, hearing tests, tympanocentesis, reflectometry, and blood tests.
How is a middle ear infection treated?
For both middle ear infection and fluid buildup without infection, treating the symptoms at home may be all that is needed. Analgesics such as acetaminophen can help to relieve ear pain. However, do not give aspirin to anyone under the age of 20 because its use in this age group has been linked to Reye's syndrome.
Up to 80% of ear infections get better without treatment.1 However, to prevent complications, most doctors choose to use antibiotics to treat all ear infections in children age 2 and younger and in children with medical conditions such as cleft palate or recurrent infections that put them at risk for complications.
Antibiotics are often prescribed to treat middle ear infections. Some doctors prescribe antibiotics to treat all ear infections, while others ask parents of otherwise healthy children older than 2 years to watch their child for a couple of days. If the child begins to feel better within a couple of days, antibiotics may not be necessary. If a child has not improved, antibiotics can then be started, and the infection usually clears.
Worldwide, medical experts are rethinking the treatment of ear infections, because the vast majority of ear infections resolve on their own and because of the growing number of bacteria that are developing resistance to antibiotics.
In the United States, where antibiotics were once the standard treatment for ear infections, some doctors are now taking more of a wait-and-see approach. In some European countries, antibiotics are not prescribed routinely for simple ear infections. This precaution has led to significantly fewer strains of antibiotic-resistant bacteria than are seen elsewhere.2 Many doctors feel that efforts to reduce antibiotic resistance outweigh the uncertain risk of a child possibly developing a complication.
Most experts recommend tubes for young children with fluid buildup (otitis media with effusion) that has persisted for 3 months who also have related hearing loss. The tubes, surgically inserted through their eardrums, drain fluid in the middle ear and improve hearing. The decision to insert tubes for other reasons, including the treatment of recurrent ear infections, is less clear-cut.
Can frequent ear infections lead to hearing loss?
Repeated ear infections or persistent fluid behind the eardrum rarely causes permanent hearing loss but often causes temporary hearing loss. Hearing loss is of greatest concern for young children because normal hearing is critical in the development of basic speech and language skills.
