Overview
Otitis media, commonly called a middle ear infection, occurs when fluid builds up and becomes infected behind the eardrum, most often in young children following a cold or respiratory infection.
Disease Summary
- Category
- Infectious Disease
- Cause
- Bacteria or viruses infecting the middle ear, often following a cold or upper respiratory infection
- Transmission
- Not directly contagious itself, though the underlying viral or bacterial infections that lead to it can spread between people
- Body System
- Ears
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Symptoms often develop shortly after a cold or upper respiratory infection.
Ear Pain
Pain in the ear, or in young children, tugging or rubbing at the ear, is the most common symptom.
Fever
A mild to moderate fever often accompanies a middle ear infection.
Irritability
Young children may become unusually fussy, especially when lying down.
Difficulty Sleeping
Ear pain often worsens when lying down, disrupting sleep.
Danger Signs
Seek prompt medical attention if any of the following develop.
High Fever
A high or persistent fever may indicate a more serious infection.
Fluid or Pus Draining from the Ear
May indicate a ruptured eardrum and needs medical evaluation.
Severe Headache or Neck Stiffness
Can indicate a rare but serious complication spreading beyond the ear.
Swelling Behind the Ear
May indicate mastoiditis, an infection of the bone behind the ear that needs prompt treatment.
Diagnosis
Clinical Assessment
Diagnosis is based on symptoms and a physical examination of the ear.
Otoscopy
A healthcare provider uses an otoscope to look at the eardrum for redness, bulging, or fluid.
Tympanometry
Measures how the eardrum moves in response to air pressure, helping confirm fluid in the middle ear.
Laboratory Tests
Otoscopic Examination
Direct visual examination of the eardrum for signs of infection, such as redness or bulging.
Tympanometry
Measures eardrum movement to detect fluid behind it.
Tympanocentesis (in select cases)
Fluid is sampled to identify the specific bacteria in severe or recurrent cases.
Treatment
Pain Relief and Observation
For many children, especially those with mild symptoms, pain relief and a short observation period is a reasonable first step.
Antibiotics
Used for more severe infections, younger children, or when symptoms don’t improve with observation alone.
Prevention
Stay up to date on vaccinations
Vaccines against certain bacteria and viruses can reduce the risk of ear infections.
Avoid secondhand smoke
Exposure to tobacco smoke increases the risk of ear infections in children.
Breastfeed when possible
Breastfeeding has been associated with a lower risk of ear infections in infants.
Practice good hand hygiene
Frequent handwashing helps reduce the spread of colds and respiratory infections that can lead to ear infections.
Risk Factors
High Risk
These factors substantially increase the likelihood of developing an ear infection.
- Age between 6 months and 2 years
- Attending group childcare
- Recent cold or upper respiratory infection
Increased Risk
These factors are associated with a moderately higher risk of ear infections.
- Exposure to secondhand smoke
- Bottle-feeding while lying down
- Family history of frequent ear infections
Additional Contributing Factors
Other factors linked with an increased likelihood of ear infections.
- Seasonal changes, particularly fall and winter
- Cleft palate or other structural differences
- Use of a pacifier beyond infancy
Complications
Hearing Loss
Fluid buildup or repeated infections can temporarily or, rarely, permanently affect hearing.
Ruptured Eardrum
Pressure from fluid buildup can cause the eardrum to tear, though it usually heals on its own.
Spread of Infection
Rarely, infection can spread to nearby structures, such as the bone behind the ear or, very rarely, the brain.
When to Seek Medical Care
High Fever
A high or persistent fever needs medical evaluation.
Fluid or Pus Draining from the Ear
May indicate a ruptured eardrum and should be assessed by a healthcare provider.
Symptoms Lasting More Than 48 to 72 Hours
Symptoms that don’t improve after a couple of days may need antibiotic treatment.
Swelling Behind the Ear
May indicate a more serious infection and needs prompt medical attention.
Prognosis
Usually Resolves Within a Few Days
Most ear infections improve within a couple of days, with or without antibiotics.
Excellent with Appropriate Treatment
The vast majority of children recover fully without lasting effects.
Possible Recurrence
Some children experience repeated ear infections, which may need further evaluation.
Differential Diagnosis
Otitis Media with Effusion
Fluid remains in the middle ear without an active infection or the usual symptoms.
Swimmer's Ear (Otitis Externa)
An infection of the outer ear canal rather than the middle ear, often linked to water exposure.
Teething
Can cause fussiness and ear-rubbing in infants that may be mistaken for an ear infection.
Foreign Body in the Ear
An object lodged in the ear canal can cause pain and discomfort similar to an infection.
References
Centers for Disease Control and Prevention (CDC)
CDC guidance on the types, symptoms, and treatment of ear infections.
Mayo Clinic
Patient-focused guidance on diagnosing and treating middle ear infections.
NCBI Bookshelf (StatPearls)
Clinical reference on the causes, evaluation, and management of acute otitis media.
Frequently Asked Questions
Are ear infections contagious?
Ear infections themselves are not contagious, but the colds and respiratory infections that often lead to them can spread to others.
Do all ear infections need antibiotics?
No. Many ear infections improve on their own, and a healthcare provider may recommend a short observation period before starting antibiotics.
How can I tell if my baby has an ear infection?
Signs include tugging or rubbing the ear, fussiness, difficulty sleeping, and fever, though only a healthcare provider can confirm the diagnosis.
Can ear infections affect hearing?
Fluid buildup can cause temporary hearing changes, and frequent infections should be evaluated to prevent any lasting impact on hearing or speech development.