Disease, Condition & InjuryEars, nose & throatHead & neck conditions

Middle ear infection

(Acute Otitis; Ear Infection, Middle; Otitis Media)

Middle ear infection – Definition

With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.

Middle ear infection – Causes

Bacteria and viruses cause this condition, such as:

  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Moraxella (Branhamella) catarrhalis
  • Streptococcus pyogenes (less common)

Middle ear infection – Risk Factors

These factors increase your chance of developing middle ear infection:

  • Recent viral infection (eg, cold)
  • Recent sinusitis
  • Age: babies and toddlers
  • Season: winter
  • Attendance at day care
  • Babies who are formula-fed
  • Medical conditions that cause abnormalities of the eustachian tubes, such as:
    • Cleft palate
    • Down syndrome
  • History of allergies (environmental allergies, food [milk] allergies)
  • Gastroesophageal reflux disease (GERD)
  • Babies whose mothers drank alcohol while pregnant
  • Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating
  • Tell your doctor if you have any of these risk factors.

Middle ear infection – Symptoms

Symptoms include:

  • Ear pain (babies may tug or rub at the ear or face)
  • Fever
  • Irritability
  • Hearing loss (may be only temporary, due to fluid accumulation)
  • Decreased appetite, difficulty feeding
  • Disturbed sleep
  • Drainage from ear
  • Difficulty with balance

Middle ear infection – Diagnosis

The doctor will ask about symptoms and medical history, and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.

The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.

Other tests may include:

  • Tympanocentesis — used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
  • Tympanometry — measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
  • Hearing test — may be done if you have had many ear infections

Middle ear infection – Treatment

Treatments include:


Antibiotics are commonly used to treat ear infections. Examples include:

  • Amoxicillin (Amoxil, Polymox)
  • Clavulanate (Augmentin)
  • Cephalosporins ( cefprozil, cefdinir, cefpodoxime, ceftriaxone)
  • Sulfa drugs (eg, Septra, Bactrim, Pediazole)

Since bacteria develop a resistance to antibiotics, doctors may take a “wait and see” approach. In some cases, your doctor may prescribe an antibiotic for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective.

While antibiotics may be effective, it is also important to keep in mind these medicines can cause a number of side effects. Nausea, stomach pain, and diarrhea are common. Also, a person may have an allergic reaction to the antibiotic. It is important to discuss the risks and benefits of taking antibiotics with your doctor.

A virus causes some ear infections. This type will not go away faster with antibiotics. Most middle ear infections (including bacterial ones) tend to improve on their own in 2-3 days.

Over-the-Counter Pain Relievers

Pain relievers can help reduce pain, fever, and irritability. These include:

  • Acetaminophen
  • Ibuprofen
  • Aspirin

Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye’s syndrome. Ask your doctor which other medicines are safe for your child.

Decongestants and antihistamines are not recommended to treat an ear infection.

Ear Drops

In children, ear drops that have a local anaesthetic (eg, ametocaine, benzocaine, or lidocaine) can help decrease pain, especially when the drops are used with oral pain relievers. If there is a chance that the eardrum has ruptured, do not use ear drops.


Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus.

If you are diagnosed with an ear infection, follow your doctor’s instructions.

Middle ear infection – Prevention

To reduce the chance of getting an ear infection:

  • Avoid exposure to smoke.
  • Breastfeed your baby for at least the first six months.
  • Try to avoid giving your baby a pacifier.
  • If you bottle-feed, keep your baby’s head propped up as much as possible. Don’t leave a bottle in the crib with your baby.
  • Get tested for allergies.
  • Treat related conditions, such as GERD.
  • Practice good hand washing.
  • Make sure your child’s vaccinations are up to date. The pneumococcal vaccine can prevent middle ear infections.
  • Consider getting a flu vaccine.
  • If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
  • Xylitol is a natural sugar that is used as a sweetener in gum, candy, and other types of food. Eating food with xylitol on a regular basis may help to reduce your risk of ear infections.

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