by Carson-DeWitt R
(Acute Otitis; Ear Infection, Middle; Otitis Media)


The middle ear is located behind the eardrum. An infection can enter this area and cause swelling and pain.

The Middle Ear
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Most middle ear infections are caused by viruses. Others may be caused by a bacteria.

Most ear infections develop after a cold or flu. A tube called the eustachian tube runs from the middle ear to the back of the throat. A cold or flu virus can pass from the throat, through the tubes, and up to the ears.

Risk Factors

Middle ear infections are more common in infants and toddlers because their eustachian tubes are shorter. They occur more often during the winter months. Other factors that may increase your chance of a middle ear infection include:

  • Recent viral infection, such as a cold or flu
  • Recent sinusitis
  • Attendance at day care
  • Exposure to secondhand smoke, usually cigarette smoke, but also from cooking and wood-heating
  • Babies who are formula-fed
  • Medical conditions that cause abnormalities of the eustachian tubes, such as cleft palate or Down syndrome
  • History of allergies, such as environmental or food allergies
  • Gastroesophageal reflux disease (GERD)
  • Babies whose mothers drank alcohol while pregnant
  • Pacifier use


A middle ear infection may cause:

  • Ear pain (babies may tug or rub at the ear or face)
  • Fever
  • Irritability
  • Hearing loss (may be only temporary, due to fluid accumulation)
  • Decreased appetite, difficulty feeding
  • Disturbed sleep
  • Drainage from ear
  • Difficulty with balance


The doctor will ask about symptoms and past health. A physical exam will be done. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument called an otoscope.

The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.

Other tests may include:

  • Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
  • Hearing test—may be done if you have had many ear infections
  • Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria


The doctor may choose to wait and see. Most ear infections will pass on their own within 2 to 3 days. Medicines is often not needed. Infections that are severe, last longer than expected, or are in children aged 6 months and under, may need more treatment.


Medicines may be used to help manage symptoms. Options include:

  • Pain relievers
  • Fever reducers
  • Anesthetic ear drops—pain relievers

Antibiotics are not often needed. They are used for severe infections caused by bacteria. Mild infections caused by bacteria can pass on its own without antibiotics. Using antibiotics when not needed can actually make you more ill than letting the infection pass on its own.

Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.

Note: Decongestants and antihistamines are not recommended to treat ear infections.


A myringotomy may be done to drain fluid from the inner ear. A tiny cut is made in the eardrum to drain fluid and pus. An ear tube may also be placed to let fluids continue to drain.


Habits that may help decrease the risk of middle ear infection:

  • Avoid exposure to smoke.
  • Breastfeed your baby for at least the first 6 months of life.
  • Try to avoid giving your baby a pacifier.
  • If you bottle-feed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
  • Get tested for allergies if you or your child have chronic nasal congestion. Keep allergy symptoms well controlled.
  • Treat related conditions, such as GERD.
  • Practice good hand washing hygiene.
  • Make sure your child's vaccinations are up to date.
  • Consider getting a flu vaccine. Pneumococcal vaccine may prevent some ear infections, but the overall effect on ear infections is not known. If your child has a history of ear infections, talk to the doctor about long-term antibiotic use.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum and prevent fluid buildup and infection.


American Academy of Otolaryngology—Head and Neck Surgery 

National Institute on Deafness and Other Communication Disorders (NIDCD) 


Caring for Kids—Canadian Paediatric Society 

Health Canada 


Acute otitis media (AOM). EBSCO DynaMed website. Available at: Accessed January 29, 2021.

Hurst DS, Amin K, Seveus L, Venge P. Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope. 1999;109(3):471-477.

Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at: Accessed January 29, 2021.

3/18/2014 DynaMed Systematic Literature Surveillance van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder AG. A trial of treatment for acute otorrhea in children with tympanostomy tubes. N Engl J Med. 2014;370(8):723-733

Revision Information

  • Reviewer: EBSCO Medical Review Board Shawna Grubb, RN
  • Review Date: 01/2021
  • Update Date: 01/29/2021