Middle ear infection (otitis media)

 Introduction 

Otitis media is an infection of the middle ear that is particularly common in young children. 
Although anyone can develop a middle ear infection, 75% of cases occur in children under 10. Infants between 6 and 15 months old are most commonly affected.
It's estimated that around one in every four children will have had at least one middle ear infection by the time they are 10 years old.

Signs and symptoms of a middle ear infection

Signs that a young child might have an ear infection include:

• pulling, tugging, or rubbing their ear
• a high temperature (fever)
• irritability
• poor feeding
• restlessness at night
• a lack of response to quiet sounds

Older children and adults may have earache, be sick and experience slight hearing loss.
Read more about the symptoms of middle ear infections.

When to seek medical advice

Most cases of otitis media pass within a few days, so there's usually no need to see your General Practictioner.
However, you should take your child to see a General Practictioner if their symptoms show no sign of improvement after two or three days, they seem to be in a lot of pain, or you notice a discharge of pus or fluid from their ear.
You should also contact your General Practictioner if your child has an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make them more vulnerable to complications.

How middle ear infections are treated

Most ear infections clear up within three to five days and don't need any specific treatment. If necessary, paracetamol or ibuprofen (appropriate for the child's age) should be used to relieve pain and a high temperature.
Antibiotics are not routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.
Read more about treating middle ear infections.

What causes middle ear infections?

The middle ear is located directly behind the eardrum. It contains three tiny bones that transmit sound vibrations from the eardrum to the hearing organ in the inner ear.
Most middle ear infections occur when a viral or bacterial infection such as a cold causes mucus to build up in the middle ear, which then becomes infected.
Younger children are particularly vulnerable to this type of infection because the tube that allows fresh air into the middle ear (the Eustachian tube) is smaller than it is in adults.
Read more about the causes of middle ear infections.

Can middle ear infections be prevented?

It's not possible to prevent middle ear infections, but there are some things you can do that may reduce your child's risk of developing the condition. These include:

• make sure your child is up-to-date with their routine vaccinations – particularly the pneumococcal vaccine and the DTaP/IPV/Hib (5-in-1) vaccine
• avoid exposing your child to smoky environments (passive smoking)
• don't give your child a dummy once they are older than 6 to 12 months old
• don't feed your child while they are lying flat on their back
• if possible, feed your baby with breast milk rather than formula milk

Avoiding contact with other children who are unwell may also help reduce your child's chances of catching an infection that could lead to a middle ear infection.

Further problems

Complications of middle ear infections are fairly rare, but can be serious if they do occur.
Most complications are the result of the infection spreading to another part of the ear or head, including the bones behind the ear (mastoiditis), the inner ear (labyrinthitis), or the protective membranes surrounding the brain and spinal cord (meningitis).
If complications do develop, these often need to be treated immediately with antibiotics in hospital.