Juan Garcia Arteaga, ENT Patient information
Dr. Juan García Arteaga
ENT specialist

Middle ear infection (otitis media)

A middle ear infection is inflammation behind the eardrum, very common in children. Learn about acute infection and glue ear, treatment and when to seek urgent help.

Written by Dr. Juan García Arteaga · Last reviewed:

A mother sitting on a bed at night holding her small child, who covers one ear, circled by a soft ring of light.

A middle ear infection, or otitis media, is inflammation of the middle ear, the air-filled space behind the eardrum. It is very common in young children. There are two main types: acute otitis media, with pain and infection, and glue ear, also called serous otitis or otitis media with effusion, in which fluid is left behind without infection.

What are the symptoms?

Acute otitis media:

  • Ear pain, often at night and after a cold.
  • A temperature, irritability and, in babies, crying and pulling at the ear.
  • Sometimes discharge from a burst eardrum. The pain usually eases then.

Glue ear:

  • Hearing less well: turning up the television or not responding when called.
  • A blocked feeling in the ear.
  • Usually no pain or fever, so it can go unnoticed.

Why does it happen?

The Eustachian tube links the ear to the nose and ventilates the middle ear. In children it is shorter and works less well during colds. Enlarged adenoids can also block it.

The risk is higher with:

  • Nursery or daycare.
  • Tobacco smoke.
  • Prolonged dummy use.
  • Bottle-feeding while the baby is lying flat.
  • Allergies.

How is it diagnosed?

We look at the eardrum with an otoscope. Sometimes we measure how it moves with tympanometry, a quick, painless test. If fluid lasts for months, we do a hearing test.

How is it treated?

Acute otitis media:

  • Pain relief with paracetamol or ibuprofen is the mainstay of treatment.
  • Antibiotics: not always needed. We mainly use them in these situations:
    • Children under 2 with infection in both ears.
    • Severe pain, or pain lasting more than 48 hours.
    • A high temperature.
    • Discharge from the ear.
    • Risk factors.
  • In mild cases in older children, we can watch for 48-72 hours and start antibiotics if there is no improvement.

Glue ear:

  • The fluid often clears by itself, so we watch it for about 3 months.
  • Cough and cold syrups, antihistamines and antibiotics have not been shown to help.
  • Autoinflation, which means blowing up a special balloon with your nose, may help some children a little while we wait. We explain it in exercises to unblock your ears.
  • If the fluid persists and your child hears poorly or has speech problems, we consider grommets (ventilation tubes) and, sometimes, removing the adenoids.

In adults, glue ear that does not clear needs a full examination of the nose and throat. In adults with persistent glue ear we also examine the nasopharynx, the area at the back of the nose, with a thin camera, to rule out anything blocking the Eustachian tube.

Advice

  • Do not allow smoking at home or in the car.
  • Breastfeeding and the routine vaccinations help prevent ear infections.
  • Do not bottle-feed a baby lying completely flat.
  • To clear the nose, we prefer continuous-mist seawater sprays. Avoid syringe rinses: in clinic we have seen them bring on middle ear infections, probably because they inflame the opening of the Eustachian tube at the back of the nose.
  • If your child has fluid in the ears, talk close to them, facing them and without background noise.
  • If they have grommets, follow dry ear care only if we advise it.

When should I seek urgent help?

Go to A&E, or call 112 (in Spain) or your local emergency number, if:

  • There is swelling, redness or pain behind the ear, or the ear sticks out forwards.
  • There is a high temperature that does not come down, marked drowsiness, a stiff neck or repeated vomiting.
  • The face droops or there is severe dizziness.
  • A baby under 6 months has a temperature and ear pain.

Frequently asked questions

Does every ear infection need antibiotics? No. Many mild infections clear by themselves. We decide according to age, severity and how things progress.

Does glue ear affect speech? It can if it lasts a long time and is in both ears, because the child hears less well. That is why we monitor it and check hearing.

Can my child bathe with an ear infection? If there is no discharge, yes. If the ear is discharging or the eardrum has a hole, keep it out of the water.

Are grommets a big operation? No. It is a short procedure, with a general anaesthetic in children. The tubes usually fall out by themselves after some months.

Do adults get middle ear infections too? Yes, although less often. It can be linked to Eustachian tube problems, allergies or colds. If the fluid does not clear, we also examine the nasopharynx.

References

  1. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999.
  2. López Martín D, Piñeiro Pérez R, Martínez Campos L, et al. Update of the consensus document on the aetiology, diagnosis and treatment of acute otitis media and sinusitis. An Pediatr (Engl Ed). 2023;98(5):362-372.
  3. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41.
  4. Webster KE, Mulvaney CA, Galbraith K, et al. Autoinflation for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2023;9:CD015253.
For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.

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