Otitis Media, Pediatric

An ear, with close-ups of a normal ear and an ear filled with fluid.

Otitis media occurs when there is inflammation and fluid in the middle ear with signs and symptoms of an acute infection. The middle ear is a part of the ear that contains bones for hearing as well as air that helps send sounds to the brain. When infected fluid builds up in this space, it causes pressure and results in an ear infection. The eustachian tube connects the middle ear to the back of the nose (nasopharynx). It normally allows air into the middle ear and drains fluid from the middle ear. If the eustachian tube becomes blocked, fluid can build up and become infected.

What are the causes?

This condition is caused by a blockage in the eustachian tube. This can be caused by mucus or by swelling of the tube. Problems that can cause a blockage include:

Colds and other upper respiratory infections.
Allergies.
Enlarged adenoids. The adenoids are areas of soft tissue located high in the back of the throat, behind the nose and the roof of the mouth. They are part of the body's defense system (immune system).
A swelling or mass in the nasopharynx.
Damage to the ear caused by pressure changes (barotrauma).

What increases the risk?

This condition is more likely to develop in children who are younger than 7 years old. Before age 7, the ear is shaped in a way that can cause fluid to collect in the middle ear, making it easier for bacteria or viruses to grow. Children of this age also have not yet developed the same resistance to viruses and bacteria as older children and adults.

Your child may also be more likely to develop this condition if he or she:

Has repeated ear and sinus infections.
Has a family history of repeated ear and sinus infections.
Has an immune system disorder.
Has gastroesophageal reflux.
Has an opening in the roof of his or her mouth (cleft palate).
Attends day care.
Was not breastfed.
Is exposed to tobacco smoke.
Takes a bottle while lying down.
Uses a pacifier.

What are the signs or symptoms?

Symptoms of this condition include:

Ear pain.
A fever.
Ringing in the ear.
Decreased hearing.
A headache.
Fluid leaking from the ear, if a hole has developed in the eardrum.
Agitation and restlessness.

Children too young to speak may show other signs, such as:

Tugging, rubbing, or holding the ear.
Crying more than usual.
Irritability.
Decreased appetite.
Sleep interruption.

How is this diagnosed?

A health care provider checks a person's ear using an otoscope. A close-up of the ear and otoscope is also shown.

This condition is diagnosed with a physical exam. During the exam, your child's health care provider will use an instrument called an otoscope to look in your child's ear. He or she will also ask about your child's symptoms.

Your child may have tests, including:

A pneumatic otoscopy. This is a test to check the movement of the eardrum. It is done by squeezing a small amount of air into the ear.
A tympanogram. This test uses air pressure in the ear canal to check how well the eardrum is working.

How is this treated?

This condition can go away on its own. If your child needs treatment, the exact treatment will depend on your child's age and symptoms. Treatment may include:

Waiting 48–72 hours to see if your child's symptoms get better.
Medicines to relieve pain. These medicines may be given by mouth or directly in the ear.
Antibiotic medicines. These may be prescribed if your child's condition is caused by bacteria.
A minor surgery to insert small tubes (tympanostomy tubes) into your child's eardrums. This surgery may be recommended if your child has many ear infections within several months. The tubes help drain fluid and prevent infection.

Follow these instructions at home:

Give over-the-counter and prescription medicines only as told by your child's health care provider.
If your child was prescribed an antibiotic medicine, give it as told by your child's health care provider. Do not stop giving the antibiotic even if your child starts to feel better.
Keep all follow-up visits. This is important.

How is this prevented?

To reduce your child's risk of getting this condition again:

Keep your child's vaccinations up to date.
If your baby is younger than 6 months, feed him or her with breast milk only, if possible. Continue to breastfeed exclusively until your baby is at least 6 months old.
Avoid exposing your child to tobacco smoke.
Avoid giving your baby a bottle while he or she is lying down. Feed your baby in an upright position.

Contact a health care provider if:

Your child's hearing seems to be reduced.
Your child's symptoms do not get better, or they get worse, after 2–3 days.

Get help right away if:

Your child who is younger than 3 months has a temperature of 100.4°F (38°C) or higher.
Your child has a headache.
Your child has neck pain or a stiff neck.
Your child seems to have very little energy.
Your child has excessive diarrhea or vomiting.
The bone behind your child's ear (mastoid bone) is tender.
The muscles of your child's face do not seem to move (paralysis).

Summary

Otitis media is redness, soreness, and swelling of the middle ear. It causes symptoms such as pain, fever, irritability, and decreased hearing.
This condition can go away on its own, but sometimes your child may need treatment.
The exact treatment will depend on your child's age and symptoms. It may include medicines to treat pain and infection, or surgery in severe cases.
To prevent this condition, keep your child's vaccinations up to date. For children under 6 months of age, breastfeed exclusively if possible.