What Is It?

Otitis media is an inflammation and infection of the middle ear (the membrane-lined chamber behind the eardrum). It often is related to an inflammation or infection of the throat or Eustachian tube (the passageway that connects the middle ear to the back of the throat).

Under normal circumstances, the Eustachian tube helps to equalize pressure between the throat and the middle ear. However, when the opening of the Eustachian tube is inflamed or obstructed (usually because of allergies or a throat infection), the normal ventilation of the middle ear is disrupted, leading to pressure changes and an accumulation of fluid inside the middle ear. Bacteria travel up the Eustachian tube from the throat and multiply in this accumulated fluid, resulting in a middle ear infection. Most ear infections are caused by viruses rather than bacteria.

Otitis media is currently the most common illness in children in the United States and the second most common illness in the general population (adults and children combined). Before age 3, approximately 85 percent of children will have at least one episode of this infection, and 50 percent will have at least two. After age 6, episodes of otitis media become much less frequent, possibly because of the child’s maturing immune system and normal growth-related changes in the ear and throat.

Inside the middle ear, three ossicles (tiny bones) normally conduct sound vibrations from the eardrum to the inner ear, where they are converted into the nerve impulses for “sound.” In patients with otitis media, however, inflammation and infection interfere with this normal mechanism for sound conduction, causing decreased hearing. Infection-related pressure changes and fluid accumulation also produce significant ear pain. Other symptoms may include fever; general body discomfort; rubbing or pulling of the ears (in children); and vomiting and diarrhea (in infants).

Because otitis media is often related to a throat infection, symptoms of otitis media may begin a few days after a sore throat, with or without nasal symptoms (stuffiness, runny nose).

Your doctor will ask about ear pain, discharge from the ear and fever. He or she will examine the ears with an otoscope — an instrument with a lighted, cone-shaped end piece for inspecting the eardrum and ear canal. Your doctor will look for redness and bulging of the eardrum and to see if the eardrum moves. (Eardrums will not move if they are too stiff or if there is fluid behind them.) A pneumatic otoscope (an otoscope that can blow a tiny puff of air) may be used to check for fluid accumulation.

With proper medical treatment, symptoms of otitis media usually improve within 24 to 48 hours, but the middle ear’s accumulated fluid may persist for six weeks or longer (in some cases).

You may be able to decrease the risk of otitis media by doing the following:

• Avoid rooms contaminated with secondhand smoke, because environmental cigarette smoke may increase a child’s risk of ear infections. Secondhand smoke alters the function of the Eustachian tube and the protective mucosal properties of the nasopharynx.
• Breast-feed your child, because breast-feeding seems to offer some protection against otitis media.
• Have your child immunized with the Pneumococcal and Haemophilus vaccines.

If you yourself smoke cigarettes, try to quit, or at least avoid smoking near your child.

Treatment involves keeping the Eustachian tube open to allow proper drainage with a decongestant, use of an antibiotic if bacterial infection is probable, and pain control. After the acute infection, fluid may persist with diminished hearing. A different program of decongestants and another course of antibiotics may be advised.

In children with reduced hearing because of otitis that does not resolve, the insertion of ear tubes (a myringotomy) may be considered. This is a surgical procedure in which an otolaryngologist (doctor who specializes in illnesses of the ears, nose and throat) inserts a small plastic tube into the eardrum to ventilate the middle ear. Myringotomy is performed under anesthesia and can usually be done as an outpatient procedure.

Call your doctor if you or your older child complains of an earache or has trouble hearing. If your child is a baby, call your doctor promptly if he or she has a fever, is unusually irritable or can’t sleep, frequently rubs or pulls his or her ears, has vomiting or diarrhea, or does not respond normally to sounds (doesn’t startle when a door slams or pots clang).

In most patients with otitis media, accumulated ear fluid completely clears within six weeks. If fluid persists and remains untreated, it may produce hearing difficulties that may affect the speech and language development of younger children.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.