Otitis media, known as a middle ear infection, is a common condition that causes ear pain and other symptoms, such as hearing difficulties or dizziness. Sometimes, this type of ear infection is acute, arising as a complication of a cold or another upper respiratory infection. Other times, these middle ear infections can recur and even become chronic, or fluid within the middle ear doesn’t go away.

Children are diagnosed with otitis media more often than adults; the condition is most likely to occur between 6 months and 2 years of age. It’s estimated that up to 85% of babies experience otitis media during their first 12 months of life, and up to 99% experience otitis media during their first 24 months. Though it happens less frequently, older children and adults can also develop middle ear infections. Only between 3% and 15% of all diagnosed otitis media infections occur in adults.

Otitis media typically occurs during cold-weather months, when respiratory infections are also commonly diagnosed. Males are more likely to be diagnosed than females, and the condition runs in some families.

Although many middle ear infections go away on their own, treatments for the condition are available. Most people with otitis media recover without any long-term complications.

Otitis media is the medical name for a middle ear infection that arises due to inflammation. This leads to fluid buildup within the middle ear, causing ear pain. Otitis media typically occurs in one ear, although both can be affected.

The middle ear houses the eardrum, which vibrates in response to sound; it’s part of the process that enables people to hear. Just behind the eardrum is one end of the Eustachian tube, a structure that connects the middle ear to the back of the throat.

Fluids in the middle ear travel through the Eustachian tube toward the throat, where they are swallowed. If the Eustachian tube becomes swollen, inflamed, or blocked, fluid is unable to drain out of the middle ear, leading to fluid buildup. Any bacteria present in the middle ear then become trapped in the fluid, leading to infection.

The pressure of fluid caught in the middle ear may cause the eardrum to swell or rupture. When the eardrum ruptures, fluid from the middle ear leaks out through the hole created in the eardrum. The hole typically heals within a few days. However, if a patient has chronic otitis media, the hole may not heal for long periods of time.

It’s important to note that some children with chronic middle ear infections may experience short-term hearing loss because fluid may remain behind the eardrum for weeks or months after treatment.

Otitis media is often caused by bacteria or viruses.

Viruses that commonly cause otitis media include:

• The common cold
• Flu (influenza)
• Respiratory syncytial virus (RSV)
• Some coronaviruses
• Adenoviruses
• Human metapneumovirus
• Picornaviruses

Bacteria that commonly cause otitis media include:

• Streptococcus pneumoniae
• Haemophilus influenzae (NTHi)
• Moraxella catarrhalis

Other common factors that cause otitis media include:

• Allergies
• Exposure to cigarette smoke
• Drinking while lying horizontally
• Sudden changes in elevation that cause the ears to clog, such as during an airplane takeoff and landing

People with a middle ear infection experience the following symptoms:

• Ear pain
• Muffled hearing
• Perceived ringing in the ears
• Difficulty sleeping
• Decrease in appetite
• Dizziness
• Irritability
• Fatigue
• Fever
• A cloudy or yellowish fluid that dribbles out of one ear (if an eardrum ruptures)
• Fussiness (in babies)
• Vomiting or diarrhea (in babies)
• Tugging at the ears (in babies or nonverbal toddlers)

These factors may put babies and children at increased risk of otitis media:

• Being male
• Being born prematurely (before 37 weeks’ gestation)
• Exposure to secondhand smoke
• Using a pacifier
• Having large adenoids, which may cause mouth breathing or nighttime snoring
• Having a personal or family history of otitis media
• Having a cleft palate
• Having Down syndrome

Pediatricians see middle ear infections frequently in babies and young children. It’s possible to get a diagnosis after the doctors learn about a patient’s medical history, then examine the patient. Diagnostic tests are rarely needed because doctors can diagnose patients after an examination.

Be sure to tell the doctor about your child’s symptoms—when they began fussing because of ear pain, whether a cloudy fluid drained out of their ear, if they’ve had trouble sleeping, or if it seems that their hearing has been worse than usual. Also let the doctor know if your child has a personal history or family history of ear infections.

During a physical exam, a doctor will use a tool called an otoscope to look into your child’s ear. Your child will likely be diagnosed with otitis media if the eardrum appears swollen, bulging, or ruptured or if the doctor sees fluid buildup in the middle ear.

In some cases, doctors offer diagnostic tests to confirm the presence of otitis media, such as:

• Tympanocentesis, during which the doctor uses a thin needle to collect a small sample of fluid from behind the eardrum, which is sent to a lab for analysis.
• Tympanometry, which uses a probe in the ear to deliver a burst of air and measure the response. This test checks for fluid in the middle ear; the eardrum cannot vibrate properly if fluid is present.
• Acoustic reflectometry, during which a probe is placed in the ear to see if a muscle in the middle ear is functioning properly. When a person hears a loud sound, the muscle reflexively tightens; this does not occur if the person has otitis media.

Different treatments are available for patients with otitis media.

Over-the-counter pain relief. If a virus causes it, the middle ear infection should resolve within a few days. To relieve pain, a doctor may recommend over-the-counter acetaminophen or ibuprofen, along with over-the-counter eardrops, to help ease the pain. Placing warm compresses on the ear may also be soothing. A cold compress may ease pain and help reduce inflammation or swelling.

Older children or adults with otitis media may take decongestants or allergy medication to limit the amount of fluid in the Eustachian tubes. This may help to clear the infection more effectively.

Antibiotics. If otitis media is caused by bacteria, doctors may prescribe antibiotics. The antibiotics may be an oral medication or eardrops. Over-the-counter medications plus warm or cool compresses to ease pain may also be recommended.

If a child has chronic otitis media, a doctor may prescribe a low daily dose of antibiotics to prevent new ear infections.

Ear Tube Surgery. When an ear infection doesn’t respond to antibiotics or a child has recurrent ear infections, doctors may suggest ear tube surgery. This involves a surgical procedure called a myringotomy that places a small drainage tube in the ear. During the procedure, doctors create a small opening in the eardrum, allowing air to flow into the middle ear and fluid to drain out of it.

Ear tube surgery is commonly offered when children have three ear infections in six months or four ear infections in a 12-month period, with fluid present behind the eardrum of at least one ear. Also, ear tube surgery is offered if fluid gets stuck behind the eardrum for three months or longer. The procedure reduces the frequency of ear infections and helps to improve a child’s hearing. Eventually, the drainage tubes fall out on their own; if they don’t, doctors can remove them.

Some children with chronic otitis media who have large adenoids may need surgery to have the adenoids removed.

Most people with otitis media make a full recovery. Various treatment options are available to ensure people go on to live normal, healthy lives.

“At Yale, the pediatric otolaryngologists [surgeons specializing in disorders of the ears, nose, and throat of children] work closely with a team of pediatric audiologists [specialists that perform hearing tests],” says Yale Medicine pediatric otolaryngologist Kiley Trott, MD. “We offer coordinated visits so that families can undergo hearing assessments and then immediately proceed to a consultation with a pediatric otolaryngologist. This streamlines testing and treatment so that we can provide timely management.”