A Guide to Middle Ear Infections (Otitis Media): Causes, Symptoms and Treatment

Sep 29, 2023

Article by Hearing Partners, contributed by Jennifer Lee, Senior Clinical Audiologist at Hearing Partners

The middle ear, which is located behind the eardrum, plays a crucial role in transmitting sound from the outer to the inner ear. This part of the ear is susceptible to an infection, otherwise known as otitis media.

Otitis media results in redness, swelling and the accumulation of fluid behind the eardrum. This infection can manifest as either acute or chronic. Although anyone can develop a middle ear infection, infants between the ages of 6 and 15 months are at the highest risk.

In this article, we’ll provide an overview of the various types of otitis media, along with the common symptoms and causes of this condition. Additionally, we’ll explore the diagnostic and treatment options available for this condition. Finally, we’ll discuss the potential complications associated with otitis media and some measures to prevent this condition from occurring.

Causes of Otitis Media

In this section, we’ll delve into the underlying causes of otitis media, shedding light on the factors that contribute to the development of this ear condition. The 2 most common causes of otitis media are infected eustachian tubes and infected adenoids.

Infected eustachian tubes

Infected eustachian tubes

The eustachian tubes are narrow tubes that extend from the middle ear to the back of the throat, behind the nasal passages. The end of the tube, which is found at the throat, is capable of opening and closing. This motion helps to regulate air pressure and drain fluid from the middle ear.

With a severe upper respiratory tract infection, the Eustachian tubes may become swollen and blocked. For adults, inflammation of these tubes can lead to fluid accumulation in the middle ear. Otitis media occurs when this fluid becomes infected and bacteria multiply in the fluid.

As children have narrower and flatter eustachian tubes, it becomes more difficult for fluid to drain from the middle ear. As such, it becomes more vulnerable to blockages and subsequently infections.

Infected adenoids

Adenoids are 2 small tissue pads located high in the back of the nose. As they’re found near the opening of the eustachian tubes, swollen adenoids can potentially obstruct the tubes, causing a middle ear infection.

Children typically have larger adenoids compared to adults. Thus, they’re more likely to experience a middle ear infection caused by infected adenoids than adults.

Types of Otitis Media

These are the main types of middle ear infections: acute or chronic otitis media, or otitis media with effusion. Learn about their differences below.

Acute otitis media

This type of otitis media occurs suddenly and will result in inflammation and redness. The accumulation of fluid and mucus inside the ear will lead to symptoms such as fever and pain in the ear.

Otitis media with effusion

With this type of middle ear infection, mucus and fluid, also known as effusion, build up within the middle ear even after the initial infection has subsided. This can lead to fullness in the ear and potentially impact hearing, though it may also manifest without noticeable symptoms.

Chronic suppurative otitis media

Chronic middle ear infections can arise from recurring infections within the middle ear. They can also occur due to a perforation of the eardrum, which is typically the result of prior trauma or infection. This type of otitis media can result in hearing loss and unpleasant-smelling discharge from the ear.

Symptoms of Otitis Media

Symptoms of a middle ear infection can vary between children and adults as children may have difficulty effectively communicating their discomfort.

  • Crying more than usual
  • Difficulty sleeping
  • Ear discharge
  • Fever
  • Headache
  • Slight hearing loss or unresponsiveness to soft sounds
  • Irritability
  • Loss of appetite
  • Loss of balance
  • Pulling on, tugging on or rubbing their ear
  • Ear discharge
  • Ear pain
  • Fever
  • Slight hearing loss
  • Lethargy
  • Diagnosing Otitis Media

    To determine if you have an ear infection, your Ear, Nose and Throat (ENT) doctor will assess your symptoms, conduct a physical examination for symptoms of a cold and perform an ear examination. During the ear examination, an instrument called an otoscope will be used to inspect your eardrum. If your eardrum appears inflamed, swollen or red, it may indicate the presence of an ear infection.

    Aside from a physical examination and ear examination, your hearing care professional may recommend other tests including the following:

    • Tympanometry: Air pressure is used to check for fluid in your middle ear.
    • Acoustic reflectometry: Sound waves are used to check for fluid in your middle ear.
    • Tympanocentesis: Fluid will be extracted from your middle ear and tested for the presence of viruses and bacteria.
    • Hearing test: Individuals who experience persistent or recurrent ear infections, as well as those who often experience accumulation of fluid in the middle ear, are at a higher risk for developing hearing loss. Thus, you may also be required to undergo a hearing test.
    Diagnosing Otitis Media
    Diagnosing Otitis Media

    Aside from a physical examination and ear examination, your hearing care professional may recommend other tests including the following:

    • Tympanometry: Air pressure is used to check for fluid in your middle ear.
    • Acoustic reflectometry: Sound waves are used to check for fluid in your middle ear.
    • Tympanocentesis: Fluid will be extracted from your middle ear and tested for the presence of viruses and bacteria.
    • Hearing test: Individuals who experience persistent or recurrent ear infections, as well as those who often experience accumulation of fluid in the middle ear, are at a higher risk for developing hearing loss. Thus, you may also be required to undergo a hearing test.

    Speak to an audiologist today

    If you notice signs or symptoms of an ear infection, book an appointment today to get your ear checked by our audiologists.

    Treatment for Otitis Media

    The appropriate course of action will depend on various factors including your age, the nature and severity of the infection, and the duration for which the fluid has been accumulating in your middle ear.

    Typically, the majority of ear infections resolve naturally within 3 to 5 days and don’t require treatment. However, there are instances when treatment becomes necessary. In such cases, your hearing care professional may recommend the following depending on your condition.

    Pain management

    Your hearing care professional may recommend over-the-counter medications like acetaminophen or ibuprofen to alleviate discomfort and lower your fever. Additionally, they may provide a prescription for ear drops to help with the pain.


    Antibiotics aren’t usually prescribed for middle ear infections. However, if your symptoms are severe and persistent, your hearing care professional may administer this medication.

    Antihistamines or nasal decongestants

    To alleviate symptoms associated with upper respiratory infections, such as a runny or congested nose, antihistamines or nasal decongestants may be administered.


    Tympanostomy is a brief surgical procedure that lasts approximately 10 minutes. During this time, your ear, nose, and throat (ENT) specialist will create a tiny hole in your eardrum to facilitate drainage. Next, a small metal or plastic tube will be inserted into the hole previously created.

    Once the tubes are in place, they’ll facilitate air circulation and allow fluid to drain from your middle ear. The tubes will typically remain in place for 6 to 18 months. After which, they may either naturally fall out or be removed through surgery. The tiny hole in the eardrum will heal and close once the tubes have been removed.

    Tympanostomy is commonly recommended for children experiencing recurring ear infections, infections that don’t respond to antibiotics, or instances of hearing loss due to fluid accumulation.

    Complications of Otitis Media

    Complications arising from middle ear infections are relatively uncommon. However, if they do occur, they can be serious. Some complications include:

    Hearing loss

    Temporary mild hearing loss often accompanies an ear infection and typically improves once the infection subsides. However, recurrent ear infections or a buildup of fluid in the middle ear can result in more severe hearing loss.

    Delayed speech and language development

    Temporary or permanent hearing loss in infants and toddlers (due to ear infections) can cause delays in the development of their speech, social abilities, and developmental skills.

    Spread of the infection

    Infections that don’t respond to treatment or are left untreated can potentially spread to nearby tissues. An infection that spreads to the mastoid, the bony projection situated behind the ear, is known as mastoiditis. Mastoiditis can lead to bone damage and the development of cysts filled with pus. 

    On rare occasions, severe middle ear infections can affect other tissues within the skull, such as the brain or the membranes encompassing the brain. This condition is known as meningitis.

    Torn eardrum

    Middle ear infections can result in a perforated eardrum, albeit rare. They typically heal within 72 hours, though certain cases may require surgical intervention.

    Preventing Otitis Media

    Preventing middle ear infections may not be possible, but there are certain measures you can take to reduce the likelihood of this condition. They include:

    Preventing common colds and other illnesses

    Teaching your children the right habits can help prevent common colds and other illnesses. For example, you can teach them to wash their hands frequently, cough or sneeze with their mouth covered, and avoid sharing utensils with other children.

    You can also limit your children’s time in childcare, and keep them at home when they’re ill. Furthermore, adults and children can get vaccinated against colds regularly.

    Avoiding secondhand smoke

    Staying away from smoke, including secondhand smoke, can help reduce your chances of developing otitis media.

    Breastfeeding your baby

    The antibodies present in breast milk can protect your baby from ear infections including otitis media. Thus, we recommend breastfeeding your baby for at least 6 months where possible.

    Holding your baby in an upright position when bottle-feeding

    Bottle-feeding your baby while they’re lying on their back increases the chance of regurgitation and the risk of otitis media. Hence, it’s best to only feed your child while they’re in an upright position.

    Taking the necessary vaccinations

    Taking the right vaccinations, such as flu and pneumococcal vaccinations, can potentially reduce the chances of an ear infection. However, do consult your doctor before proceeding with any of these vaccinations.

    FAQs About Otitis Media

    What are the risk factors for ear infections?

    These are the common risk factors for an ear infection:

    • Age: Children between 6 months and 2 years old are more likely to develop otitis media due to the size of their eustachian tubes.
    • Family history: Individuals with a family history of ear infections are more likely to get an ear infection.
    • Weak immune system: Individuals with a weak immune system, especially young children, are more susceptible to otitis media.
    • Improper feeding habits: Feeding a baby while they’re lying down can more easily result in otitis media.
    • Poor air quality: Being exposed to tobacco smoke or polluted air can increase the likelihood of developing an ear infection.
    • Group childcare: Children in group childcare have a higher likelihood of contracting colds and otitis media compared to those who stay at home. This is because children in group childcare are exposed to more viruses and bacteria.
    • Cleft palate: Children with cleft palates have different bone structures and muscles. Due to these differences, their eustachian tube may drain fluid less easily than others, resulting in otitis media.
    • Swimming in a pool with poor water quality: Swimming increases the chances of water entering your nose. If water from the swimming pool enters the Eustachian tube from the nasal passages, bacteria can breed in the middle ear, leading to otitis media.

    Can an ear infection go away on its own?

    Yes, most ear infections can go away on their own. Hence, many hearing care professionals may advise you to wait for a couple of days before they prescribe any treatment or medication. They may, however, prescribe pain relief medication if you experience ear pain.

    If your ear infection doesn’t go away on its own, your hearing care professional will recommend the best course of action for you depending on your age, symptoms and condition.

    When should I see a doctor for a middle ear infection?

    In most cases, a middle ear infection should go away on its own. However, if your child is below the age of 6 months old, or if you notice any of the following, you may wish to visit a doctor:

    • Symptoms lasting more than 1 – 3 months
    • High fever
    • Severe ear pain
    • Weakness in the face
    • Discharge from the ear
    • (For children) Inability to eat or sleep after a cold

    It’s important to visit a doctor as quickly as possible if you have an underlying health condition, such as cystic fibrosis or congenital heart disease, which could increase the chances of complications.

    Can I swim with a middle ear infection?

    Yes, you can swim even with otitis media if you don’t have a perforation in your eardrum or drainage from your ear.

    Suspect you might have hearing loss?

    Your ears play an important role in your daily life and should not be neglected.

    Speak to our hearing care professionals regarding your concerns today.

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