Middle Ear Infection: What It Is, Causes, Symptoms & Treatments

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Many people have experienced the pain and thumping that accompany a middle ear infection, and they’re especially common in children.

Learn more about these common infections, their causes, symptoms and treatments, and how long they typically last.

What is a middle ear infection?

When bacteria or a virus enters the open area behind the eardrum, an infection of the middle ear can occur. This condition is also known as acute otitis media, according to the Mayo Clinic.

Middle ear infection in children is much more common than in adults, in part because of how this part of the ear is designed. It contains eustachian tubes that connect the middle ear to the back of the nasal passages. They drain and properly pressurize your ear.

In children, these tubes are narrower and more parallel to the ground than in adults, making it harder for fluid to drain out and easier for bacteria and viruses to get trapped and thrive.

JAMA Pediatrics notes that about half of all children will have at least one middle ear infection by their second birthday.

“Ear infections are extremely common in children,” Dr. Aileen Wertz, an ear, nose and throat specialist at Geisinger Otolaryngology in Pennsylvania, told Balance by Geisinger. “They’re like any infection you get in your nose or throat. And we all know how common runny noses and coughs are in kids.”

Middle ear infection causes

Several factors can cause eustachian tubes to get blocked, making it easier for an infection to develop, according to Penn Medicine. They include:

  • Colds
  • Sinus infections
  • Allergies
  • Infected or overgrown adenoids (lymph tissue in the throat)
  • Tobacco smoke
  • Altitude or climate changes
  • Living in a cold climate
  • Recent middle ear infection
  • Family history of ear infections
  • A birth defect that causes eustachian tube dysfunction
  • Any recent illness that lowers resistance to infection

In addition, middle ear infections in children may also be caused by:

  • Teething and pacifier use
  • Not being breastfed
  • Exposure at daycare
  • Milk from a sippy cup getting into the ear

Middle ear infection symptoms

A middle ear infection can have some of the same symptoms in children and adults:

  • Ear pain
  • Difficulty hearing
  • Fluid drainage from the ear

“The drainage we look for with ear infections is very different from ear wax,” Wertz said. “It’s a clearer liquid, more like what you see with nasal discharge.”

Children may also experience the following symptoms:

  • Fussiness
  • Difficulty responding to sounds
  • Fever of 100 degrees Fahrenheit or higher
  • Poor appetite
  • Headaches
  • Tugging on their ear
  • Poor balance
  • Excessive crying
  • Difficulty sleeping
  • Extra ear pain when lying down

Middle ear infection treatment

There are three main ways to care for middle ear infections.

At home self-care

Treating a middle ear infection often starts with a watch-and-wait strategy to see if it’s mild enough to clear up on its own, according to OSF HealthCare and the Mayo Clinic. They offer some strategies on treating middle ear infections at home:

  • Hot and cold compresses applied to the outer ear
  • Pain medications like ibuprofen or acetaminophen

If symptoms persist beyond 48 hours, or your child’s temperature exceeds 102.2 F, contact your doctor immediately for additional treatment options. The Mayo Clinic says untreated middle ear infections can have serious consequences, including eardrum tears, more permanent hearing loss, speech or developmental delays in young children, and the risk of the infection spreading to other parts of the body.

Middle ear infection antibiotics

“Infections in the middle ear, behind the eardrum, usually occur with colds or seasonal allergies … it usually takes oral antibiotics to clear them up,” Wertz said.

Nemours KidsHealth noted that a 10-day supply of antibiotics is often prescribed, although a five-to-seven-day prescription may be given for children age 6 and older who have a mild to moderate infection. Sometimes antibiotic ear drops are prescribed as well.

Middle ear tubes

For some children and adults, middle ear infections don’t clear up even with antibiotics. Other people may experience recurring ear infections. In both cases, a drain tube may be placed into the ear.

“The most common treatment for chronic ear infections is to place a tube in the eardrum to provide ventilation to the middle ear and prevent fluid buildup,” Wertz said.

John Hopkins notes that these ear tubes are temporary and typically fall out on their own in six to 12 months.

Living with a middle ear infection

How long does a middle ear infection last?

The good news is that middle ear infections are short-lived, typically lasting two to three days, according to Nemours. The best self-care strategies are over-the-counter pain medications and lots of TLC.

“The biggest thing we are trying to do is manage pain and discomfort,” Dr. Kristine Ray, a Peoria, Ill., pediatrician, explained to OSF HealthCare.


Geisinger.org: Think your child has an ear infection?

Johns Hopkins Medicine: Middle-Ear Infection in Adults

JAMA Pediatrics: Acute Otitis Media

Mayo Clinic: Ear infection (middle ear)

Nemours KidsHealth: Middle Ear Infections (Otitis Media)

OSF HealthCare: Ear infections: When to treat at home and when to call a doctor

Penn Medicine: Ear Infection (Middle Ear)

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