Middle ear infections, sometimes called otitis media, are infections in the air-filled space located behind the eardrum.
Though these infections are especially common in children, adults can be affected too. Most infections clear up on their own, but in some cases, your doctor may prescribe antibiotics.
In this article, I’ll describe the different types of middle ear infections and the symptoms of these infections in both children and adults.
I’ll also cover the process of diagnosis and treatment options available.
Finally, I’ll describe how best to prevent middle ear infections and when you should reach out to your healthcare provider for care.
What is a Middle Ear Infection?
A middle ear infection is an infection or inflammation of the area behind your eardrum.
This prevents fluid from draining from the middle ear, causing many of the common symptoms of a middle ear infection.
You can also have an inner ear or outer ear infection (also called swimmer’s ear), but middle ear infections are the most common type of ear infection.
There are several conditions that can cause a middle ear infection, including:
- A common cold or flu
- Sore throat
- Respiratory infection
Eustachian tubes and adenoids can affect middle ear infections, too.
The eustachian tubes are a pair of narrow tubes that form a passage between your middle ear and the upper part of the throat.
These tubes (one located near each ear) work to regulate air pressure, refresh air, and drain secretions from the middle ear. Swollen eustachian tubes can cause fluids to build up in the middle ear, causing an infection.
Children’s eustachian tubes are narrower than those of adults, which is one reason why they’re more likely to get ear infections.
Adenoids, two small pads of tissues located in the back of the upper part of the throat near the eustachian tubes, can also block the tubes when swollen, causing a middle ear infection.
Children have larger adenoids than adults, which is why they’re more likely to get middle ear infections.
Middle Ear Infection in Adults
A middle ear infection in an adult can be a sign of a more serious problem, which is why it’s important to see your healthcare provider for treatment.
If you experience chronic ear infections, talk to your primary care provider, an otolaryngologist (ear, nose, and throat specialist), or an otologist (ear subspecialist).
Middle ear infections in adults can occur for the same reasons as middle ear infections in children: infection caused by bacteria or virus, or allergies.
As an adult, you’re also more at risk for a middle ear infection if you:
- Smoke, or are in close regular contact with someone who smokes
- Have seasonal allergies
- Have a common cold or other upper respiratory infection
Types of Middle Ear Infections
Not every middle ear infection is the same.
There are several ways a middle ear infection can present:
Acute Otitis Media
Acute otitis media refers to a middle ear infection that comes on quickly.
It can cause redness, swelling, fever, and pain, and often results in fluid and pus that gets trapped under the eardrum. In some cases, you may also experience temporary hearing impairment.
Chronic Otitis Media
Chronic otitis media refers to a middle ear infection that does not go away, or happens multiple times over the course of several months or years.
It can cause fluid to drain from the ear canal, and in some cases may be accompanied by tympanic membrane perforation (or a perforated eardrum) and hearing loss.
Otitis Media with Effusion
In some cases, fluid buildup (also called effusion) and mucus can persist in the middle ear even after the infection is cleared.
This can happen because of a dysfunction or noninfectious blockage of the eustachian tubes.
Otitis media with effusion, sometimes called serous otitis media, can feel like your ear is full and persist for several months, possibly affecting your hearing.
Chronic Otitis Media with Effusion
Chronic otitis media with effusion refers to fluid that remains in the middle ear for a long period of time, or builds up persistently even though there is no bacterial or viral infection present.
Similarly to otitis media with effusion, it can affect your hearing.
Chronic Suppurative Otitis Media
An ear infection that does not go away after treatment is referred to as chronic suppurative otitis media.
In some cases, it can lead to a hole in the eardrum or pus that drains from the ear.
Middle Ear Infection Symptoms
The symptoms of a middle ear infection can differ in children versus adults.
The most common symptoms of a middle ear infection in children are:
- Fever of 100° F (37.8° C) or higher (especially in infants and younger children)
- Ear pain, especially when lying down
- Difficulty falling or staying asleep
- More crying and irritability than usual
- Fluid drainage from the ear
- Pulling or tugging at an ear or ears
- Trouble eating or drinking
- Difficulty hearing or responding to sounds (even quiet ones)
- Loss of balance or clumsiness
- Lack of energy
The symptoms of a middle ear infection in adults are:
- Earache or pain in one or both ears
- Drainage from the ear
- Muffled hearing
- Sore throat
- Impaired balance
If you or your child experience a high fever, severe pain behind your ear, or paralysis in your face, talk to your healthcare provider as soon as possible.
Most providers will diagnose a middle ear infection by examining your outer ear and eardrum with lighted tools, such as an otoscope or an otomicroscope.
Your doctor may also want to use a pneumatic otoscope to blow a puff of air into your ear to see how well your eardrum moves in response. If your eardrum doesn’t move well, this can be a sign that there is fluid blocking your middle ear.
In some cases, your doctor may also perform a test called tympanometry, which can identify pressure changes in the middle ear. Finally, your doctor might want to do a hearing test with a tuning fork or audiogram.
Middle Ear Infection Treatment Options
Many middle ear infections go away on their own within a few days, but in some cases—especially if you experience recurring middle ear infections—your doctor or pediatrician may prescribe an antibiotic to help clear the infection.
In determining the right treatment options for you or your child, your healthcare provider will consider several things, including:
- The type and severity of the ear infection
- The frequency of ear infections
- How long you or your child has had the current infection
- Age and other risk factors
- Whether or not hearing has been affected
Depending on these factors, your middle ear infection may be treated with:
- Antibiotics: Your doctor may prescribe antibiotics to be taken orally or by ear drops.
- Pain medication: Talk to your doctor about recommended medication to alleviate your pain. Your provider may recommend over-the-counter (OTC) options like acetaminophen (Tylenol) or ibuprofen (Advil).
- Decongestants, antihistamines, or nasal steroids: These can help reduce swelling in the mucous membranes and open up the eustachian tubes.
- Anesthetic drops: These drops can help relieve pain in the eardrum if there is no hole or tear in it.
- Tympanostomy tube: If you have chronic otitis media with effusion, your provider may suggest placing a small tube in your ear to keep fluid from building up and to help relieve pressure in the middle ear. These tubes usually fall out on their own within six months to one year.
Preventing middle ear infections isn’t always possible, especially those caused by bacterial or viral infections.
To help prevent middle ear infections in your child, you can:
- Breastfeed your infant: Breastfeeding infants for at least six months can help prevent early episodes of middle ear infections. If you bottle feed your baby, hold the baby at an angle instead of feeding the baby while laying down.
- Prevent exposure to secondhand smoke: Reduce or eliminate your child’s exposure to secondhand smoke.
- Wash hands well and often: Ensuring both parents and children are washing their hands well and often can help prevent the spread of germs, some of which can cause ear infections.
- Keep your child’s vaccinations up to date: This can help prevent ear infections.
If you notice persistent symptoms that don’t resolve on their own, call a healthcare professional or pediatrician immediately.
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Frequently Asked Questions
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Acute Otitis Media. (2021). https://www.ncbi.nlm.nih.gov/books/NBK470332/
A Study of Correlation Between Tympanic Membrane Perforation Size With Hearing Loss in Patients With Inactive Mucosal Chronic Otitis Media. (2021). https://pubmed.ncbi.nlm.nih.gov/33044337/
Chronic Suppurative Otitis Media. (2013). https://www.aafp.org/afp/2013/1115/p694.html
Middle Ear Infections (Otitis Media). (2017). https://kidshealth.org/en/parents/otitis-media.html
What can parents do about middle ear infections? (2013). https://www.ncbi.nlm.nih.gov/books/NBK279380/