Otitis media

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 21, 2016
StartDiseasesOtitis media

An ear infection also called otitis media is a viral infection or bacterial infection that happens in the middle ear. The middle ear is a space that is filled with air and has little vibrating bones. It is located behind the eardrum.


Definition & Facts

An ear infection can cause a great amount of pain because of fluid buildup and inflammation. For those that get ear infections more often, there are some longer term problems that can occur such as persistent buildup of fluids in the middle ear. These issues with ear infections can lead to hearing loss and other serious issues.

Symptoms & Complaints

Symptoms of ear infections are often different for children and adults. The symptoms for children include:

The symptoms that are most often seen in adults include:

  • Pain in the ear
  • Having difficulty hearing as normal
  • Fluid draining from the ear

Some of these signs could point to a variety of illnesses, so if any of these symptoms are seen it is best to consult a doctor.


The cause of an ear infection is a virus or bacteria within the middle ear. The infection often comes as a result of another illness, such as allergies, flu, or a common cold. These illnesses cause congestion and swelling of the throat, Eustachian tubes, and nasal passages.

The Eustachian tubes are two narrow tubes that goes from the middle ear on each side to the high point in the back of the throat, just behind the nasal passages. The Eustachian tubes at the back of the throat will open and close in order to bring fresh air into the middle ear, regulate the pressure of the air in the middle ear, and drain secretions that are normally in the middle ear.

If someone has an illness or allergies, the Eustachian tubes can become inflamed or clogged with mucus. This blockage can allow fluid to build up in the middle ear, leading to the infection of the ear.

Children are more susceptible to ear infections partially because their Eustachian tubes are more horizontal and are more narrow. Both of these factors make it easier for the tubes to become clogged and more difficult for the tubes to drain.

The adenoids can also play a part in an ear infection. Adenoids are two little pieces of tissue way up in the back of the nose near the Eustachian tubes. They play a part in the activity of the immune system. This role makes them more susceptible to becoming inflamed and infected.

Because of the adenoids' proximity to the Eustachian tubes, if the adenoids become inflamed or swollen, they may block the Eustachian tubes, causing an ear infection. Children are more likely than adults to have an ear infection due to enlarged adenoids.

Diagnosis & Tests

A doctor will often be able to determine whether or not a patient has an ear infection by looking in the ears and throat. They will use an otoscope, which is a lighted instrument, to look inside of the ears as well as inside of the mouth at the throat.

When the doctor looks in the ears, the otoscope allows them to determine how much fluid is in the middle ear behind the eardrum. A little puff of air is blown into the ear which the doctor is looking. Typically, the little puff of air will make the eardrum move. If there is excess fluid behind the eardrum, it will not be able to move or will move very little.

If the doctor has any doubt that the patient has an ear infection, there are other tests that may be performed including:

  • A tympanometry which will measure the amount of movement of the eardrum.
  • Acoustic reflectometry measures how much sound coming from a device will be reflected back from the eardrum. Most of the time the eardrum will absorb the majority of the sound, but when there is excess fluid from an ear infection, more sound will be reflected.
  • Rarely a tympanocentesis will be done. This is done by piercing the eardrum with a tiny tube that is used to then drain the fluid from the middle ear. This is often only done if treatments for the infection have not worked. The fluid may then be tested to determine what type of infection is in it. The doctor may then be able to prescribe a better medication for the infection.

Treatment & Therapy

Most of the time an ear infection will go away without any kind of treatment. In cases that are severe or the pain is bad, especially for younger children and babies, medication will be given. Antibiotics are used to treat bacterial infections. It is important that the antibiotic is used until it is gone, even if the infection seems to have gone away. The pain from the ear infection can be lessened by using putting a warm, wet washcloth over the ear or by taking pain reliever medication that is appropriate for the patient's age.

If a child has recurring ear infections, the doctor may suggest having tubes put in their ears. This is done by putting a small hole in the eardrum and then putting a tiny tube into the hole. This will help to allow air into the middle ear for ventilation and prevent excess fluid from building up. Most of the tubes that are put in will fall out on their own after about six months to one year. Other tubes are meant to stay in longer and may need to be surgically removed.

Prevention & Prophylaxis

There are a few things that can be done to try and prevent ear infections, including:

  • Try to prevent flu, cold, and other illnesses that cause ear infections. Teach children to wash hands frequently and thoroughly and not to share things that are put in the mouth.
  • Breastfeed babies for as long as possible. Antibodies in breastmilk help to prevent ear infections.
  • For babies that are bottle fed, they should be propped up during feedings. Do not have them laying flat while drinking.