Middle ear infection is a bacterial or viral infection that may cause earache, temporary hearing loss, and fluid discharge. Show
Middle ear infections occur mainly in early childhood, although older children and adults also get these kinds of infection. It is estimated that one in four children will develop an acute ear infection before they turn 5 years of age. Children should always be taken to a doctor if they have earache. What is middle ear infection?The ear is made up of three different sections: the outer ear, the middle ear, and the inner ear. These parts all work together so you can hear and process sounds. The outer and middle ear are separated by the eardrum – a very thin piece of skin that vibrates when hit by sound waves.  This page deals with middle ear infection (otitis media), which is the infection / inflammation of the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. This space can become blocked and filled with mucus (a slippery fluid secretion), which can become infected, causing inflammation. There are two types of middle ear infection:
Sometimes gel-like fluid will remain in the middle ear after an ear infection, causing "glue ear", a relatively common condition that is often undetected among New Zealand pre-schoolers. Glue ear can adversely affect hearing and may take several weeks to resolve. Outer ear infection (otitis externa) is characteristically different to middle ear infection. This is a skin infection in the outer ear canal, which may start as an itch and develop into infection causing inflammation. Sometimes referred to as swimmer’s ear, this kind of infection can normally be treated effectively with ear drops from your doctor or pharmacist. CausesA middle ear infection often begins as a common cold, influenza (flu), sinusitis, or strep throat infection. The nose and throat are connected to the ear by the eustachian tubes. Bacteria or a virus enter the nose or throat and travel up the eustachian tubes to the middle ear. The accumulation of fluid in a blocked eustachian tube may increase the pressure within the middle ear causing pain. Sometimes the pressure can cause part of the eardrum to tear (rupture). Although the eardrum will repair itself, frequent rupture (which can occur with chronic ear infection) may result in the development of scar tissue on the eardrum and hearing loss. Middle ear infections are common in children because their eustachian tubes are narrow and easily blocked. Risk factorsFactors that increase the likelihood of developing ear infections include:
Symptoms and diagnosisTypical signs and symptoms of middle ear infection include:
Specific signs that your baby may have an ear infection include crying or grizzling more than usual, they keep touching their ear, and/or they have a discharge from the ear. An older child may show some of these signs or complain of having a sore ear. Children with a suspected ear infection, or who have difficulty hearing, should see a doctor. Children with evidence of damage to the inside of the ear, hearing loss, or language learning delay are likely to be referred to an ear, nose, and throat (ENT) specialist (otolaryngologist). To diagnose ear infection, a doctor will likely use an otoscope, which is a specialised instrument, with a light and magnifying glass, to look inside the ear to detect fluid behind the eardrum. A pneumatic otoscope is a special type of otoscope that allows the doctor to gently puff air against the eardrum. The puff of air should cause the eardrum to move. If the middle ear is filled with fluid, there will be little or no movement of the eardrum. Note: earache is a common symptom of middle ear infection, but not all earaches are caused by a middle ear infection. A build-up of ear wax in the outer ear, or changes in altitude or air pressure, are examples of other causes of blockage or earache. TreatmentEar infections usually clear up on their own, so treatment may begin with managing pain and close monitoring of the condition. However, ear infection in infants and severe cases of ear infection may require treatment with antibiotic medication. Self-treatment (after having seen a doctor) may help to relieve symptoms, including:
You should never use cotton buds to clean your ears or your baby’s ears, or put anything into the ear that has not been prescribed by a doctor, as the eardrum is delicate and can be easily damaged. PreventionThe risk of middle ear infections in babies can be reduced by keeping rooms warm and dry, ensuring a smoke-free environment, and breast feeding for as long as possible (preferably longer than six months). If bottle-fed, babies should be held in an upright position while being fed. Showing older children how to blow their nose properly can also help prevent ear infection. Children's vaccinations should be kept up to date. Taking steps to avoid catching a cold or flu will also reduce the risk of developing a middle ear infection. This can be achieved by washing hands frequently, not sharing eating and drinking utensils, covering the mouth when coughing or sneezing (using a disposable tissue or covering your mouth with the crook of your arm), and getting a seasonal flu vaccination. The use of a nasal decongestant during a cold, influenza, or sinusitis, may also help to prevent an ear infection. Further informationMinistry of HealthHealthline 0800 611 116 Royal New Zealand Plunket SocietyPlunketLine 0800 933 922 ReferencesGribben B, et al. (2012). The incidence of acute otitis media in New Zealand children under five years of age in the primary care setting. J Prim Health Care. 2012;4(3):205-12. Reviewed: February 2021 Go to our Medical Library Index Page to find information on other medical conditions. The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. How do I know if my middle ear is infected?Symptoms. Ear pain, especially when lying down.. Tugging or pulling at an ear.. Trouble sleeping.. Crying more than usual.. Fussiness.. Trouble hearing or responding to sounds.. Loss of balance.. Fever of 100 F (38 C) or higher.. How does a middle ear infection feel?The symptoms of an ear infection may include pain, tenderness, and hearing changes. Older adults may also experience balance problems and vertigo. Since an ear infection in adults can lead to serious health issues, it is important to see a doctor for treatment.
Can a middle ear infection heal on its own?Most middle ear infections (otitis media) clear up within three to five days and don't need any specific treatment. You can relieve any pain and a high temperature using over the counter painkillers such as paracetamol and ibuprofen.
How can a doctor tell if you have a middle ear infection?An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum.
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Signs of middle ear infection in adults
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