Middle Ear Infection

Otitis media is a middle ear infection that happens when the air-filled space behind the eardrum becomes infected and fills with fluid. The condition is widespread during early childhood, affecting 80% of all children under 3 years old at least once.

There are several types of otitis media, including:

  • Acute otitis media: an infection that occurs quickly when infected fluid becomes trapped behind your child’s eardrum
  • Chronic otitis media with effusion: the presence of fluid behind your child’s eardrum, which stays for a long time or comes back repeatedly. The liquid is not infected and may not cause symptoms. Your doctor can see the fluid with an instrument that allows them to view behind your child’s eardrum.
  • Otitis media with effusion: swelling and fluid buildup behind your child’s eardrum that does not include infection

Bacteria or a virus in the middle ear can cause otitis media. Fluid may accumulate more easily in children's ears because their eustachian tubes are shorter and more horizontal, making it more difficult for fluid to drain well. Exposure to secondhand smoke and attending daycare can also make children more prone to ear infections.

Symptoms, Diagnosis and Outlook

The main signs of an ear infection are pain and hearing loss. Other symptoms include:

  • Rubbing or tugging on ears
  • Increased irritability
  • Difficulty sleeping or ear pain at night
  • Ear drainage
  • Hearing loss
  • Poor balance
  • Poor feeding

Otitis media is usually diagnosed by your child’s pediatrician or by an otolaryngologist, a doctor with specialized training in ear, nose and throat care.

Testing for otitis media may include:

  • Examination with a pneumatic otoscope that gently puffs air against your child’s eardrum to measure its movement
  • Tympanometry to measure how well your child’s eardrum moves
  • Acoustic reflectometry to measure how much sound is reflected from your child’s eardrum to gauge the amount of trapped fluid
  • Assessment of your child’s hearing, speech and language comprehension 

Most middle ear infections will get better with time and medication. Untreated, prolonged otitis media can cause infections in other areas, impact speech and language development and lead to permanent hearing loss.

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