Otitis Media (Middle Ear Infection)

Otitis media is an infection of the middle ear, the small air-filled space behind the eardrum that contains the tiny bones that carry sound. When germs infect this space it becomes inflamed and fluid can build up behind the eardrum, causing pain and a feeling of pressure or fullness.

It is one of the most common childhood infections, with a peak in babies and toddlers, partly because of the shape and angle of their developing ear passages. Adults can also get it. Most episodes are acute, meaning they come on quickly and settle within a few days.

Common symptoms include earache, a high temperature, reduced hearing, and a feeling of pressure or fullness in the ear. Sometimes fluid or pus drains from the ear if the eardrum develops a small perforation, which often relieves the pain.

In young children who cannot describe earache, signs may include pulling, rubbing or tugging at the ear, irritability, poor feeding, restlessness at night, not responding to quiet sounds, or general unwellness with a fever.

Middle ear infections usually follow a cold or other upper respiratory infection. Swelling and congestion can block the eustachian tube, the narrow channel connecting the middle ear to the back of the nose, allowing fluid and germs to collect behind the eardrum.

Both viruses and bacteria can be involved. Children are particularly prone because their eustachian tubes are shorter and more horizontal, making it easier for infection to reach the middle ear.

A clinician usually diagnoses a middle ear infection by asking about symptoms and looking inside the ear with a small lighted instrument called an otoscope. A red, bulging eardrum or fluid behind it supports the diagnosis.

Tests are not usually needed for a straightforward infection. If episodes are frequent, persistent, or fluid lingers and affects hearing, a clinician may arrange a hearing check or refer to an ear, nose and throat specialist for further assessment.

Most middle ear infections clear on their own within about three days, and the main aim is to keep the person comfortable while the body fights the infection. Over-the-counter pain relief such as paracetamol or ibuprofen, used according to the label, helps with earache and fever, along with plenty of fluids and rest. Children under 16 should not take aspirin.

Antibiotics are not needed for most cases and are generally reserved for infections that are severe, last longer than expected, affect both ears in very young children, or occur in people more likely to have complications. If discharge is present, gently wiping the outside of the ear is usually all that is needed; nothing should be pushed into the ear canal.

Seek medical advice if symptoms do not start improving after about three days, if there is fluid or pus coming from the ear, if there is new or worsening hearing loss, or if a child is very unwell, has a high fever, or is being sick.

Get urgent care if there is swelling, redness or tenderness of the bone behind the ear, severe pain followed by a sudden discharge, severe headache, drowsiness, a stiff neck, or swelling around the ear. These can indicate a complication that needs prompt attention.

It is not always possible to prevent otitis media, but some steps may reduce the risk, especially in children. These include keeping up with routine childhood vaccinations, avoiding exposure to tobacco smoke, and where possible feeding babies in a more upright position rather than flat on their back with a bottle.

The outlook is generally very good. Most children grow out of frequent ear infections as their ears develop, and individual episodes usually settle without lasting problems. Where infections are recurrent or fluid persists and affects hearing, an ear, nose and throat specialist can advise on further options.