Otitis media is an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.
Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.
It's estimated that around one in every four children experience at least one middle ear infection by the time they're 10 years old.
Symptoms of a middle ear infection
In most cases, the symptoms of a middle ear infection (otitis media) develop quickly and resolve in a few days. This is known as acute otitis media. The main symptoms include:
• earache
• a high temperature (fever)
• being sick
• a lack of energy
• slight hearing loss – if the middle ear becomes filled with fluid, hearing loss may be a sign of glue ear, also known as otitis media with effusion
In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves.
Signs in young children
As babies are unable to communicate the source of their discomfort, it can be difficult to tell what's wrong with them. Signs that a young child might have an ear infection include:
• pulling, tugging or rubbing their ear
• irritability, poor feeding or restlessness at night
• coughing or a runny nose
• diarrhoea
• unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness
• loss of balance
When to seek medical advice
Most cases of otitis media pass within a few days, so there's usually no need to see your GP.
However, see your GP if you or your child have:
• symptoms showing no sign of improvement after two or three days
• a lot of pain
• a discharge of pus or fluid from the ear – some people develop a persistent and painless ear discharge that lasts for many months, known as chronic suppurative otitis media
• an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely
Read more about diagnosing middle ear infections
How middle ear infections are treated
Most ear infections clear up within three to five days and don't need any specific treatment. If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature.
Make sure any painkillers you give to your child are appropriate for their age. Read more about giving your child painkillers.
Antibiotics aren't routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.
Read more about treating middle ear infections
What causes middle ear infections?
Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked.
This mean mucus can't drain away properly, making it easier for an infection to spread into the middle ear.
An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections. Read more about removing adenoids.
Younger children are particularly vulnerable to middle ear infections as:
• the Eustachian tube is smaller in children than in adults
• a child's adenoids are relatively much larger than an adults
Certain conditions can also increase the risk of middle ear infections, including:
• having a cleft palate – a type of birth defect where a child has a split in the roof of their mouth
• having Down's syndrome – a genetic condition that typically causes some level of learning disability and a characteristic range of physical features
Can middle ear infections be prevented?
It's not possible to prevent middle ear infections, but there are some things you can do that may reduce your child's risk of developing the condition. These include:
• make sure your child is up-to-date with their routine vaccinations – particularly the pneumococcal vaccine and the DTaP/IPV/Hib (5-in-1) vaccine
• avoid exposing your child to smoky environments (passive smoking)
• don't give your child a dummy once they're older than six to 12 months old
• don't feed your child while they're lying flat on their back
• if possible, feed your baby with breast milk rather than formula milk
Avoiding contact with other children who are unwell may also help reduce your child's chances of catching an infection that could lead to a middle ear infection.
Further problems
Complications of middle ear infections are fairly rare, but can be serious if they do occur.
Most complications are the result of the infection spreading to another part of the ear or head, including:
• the bones behind the ear (mastoiditis)
• the inner ear (labyrinthitis)
• the protective membranes surrounding the brain and spinal cord (meningitis)
If complications do develop, they often need to be treated immediately with antibiotics in hospital.
