Otitis Media

What is otitis media?

Otitis media is an infection of the middle ear (the space behind the eardrum), caused by bacteria or a virus. Middle ear infections often occur at the same time as a cold, allergies, nose and throat infection, or enlarged adenoids (glands at the top of the throat). Middle ear infections usually clear up without problems or long-term effects.

The ear structure and function

There are three main parts of the ear: outer, middle, and inner:

The Eustachian tube regulates air pressure within the middle ear, connecting it to the back of the nose and throat.

What are the symptoms of otitis media (middle ear infection)?

Ear infections can be painful. Trapped fluid puts pressure on the eardrum, causing it to bulge. Other symptoms include:

Who is most likely to get middle ear infections?

Middle ear infection is more common in children and is the most common childhood illness (other than a cold). Ear infections occur most often between age 3 months and 3 years, and are common until age 8 years. One-fourth of all children will have repeated ear infections; five to ten percent will develop a hole on the eardrum from fluid pressure. This hole usually heals in one week.

Children usually get more ear infections than adults. They usually get more colds and respiratory infections than adults, and the Eustachian tube is shorter and has less of a slope in children than in adults.

Other factors that can lead to middle ear infections include the following:

What are the causes of middle ear infection?

How is otitis media diagnosed?

When an ear infection is suspected, the doctor or nurse will examine the ear using an instrument called an otoscope. A healthy eardrum will be pinkish gray in color and translucent (clear). If infection is present, the eardrum may be inflamed, swollen, or red. The doctor may also check the fluid in the middle ear using a pneumatic otoscope, which blows a small amount of air at the eardrum. This should cause the eardrum to move back and forth. The eardrum will not move as easily if there is fluid inside the ear.

Another useful diagnostic tool is tympanometry, a test that uses sound and air pressure to check for fluid in the middle ear. (It cannot test hearing.) If needed, the doctor will order a hearing test (performed by an audiologist) for a patient who has persistent ear infections to help determine if there is any hearing loss, and how bad it is.

How is otitis media treated?

Many middle ear infections will get better on their own, while some ear infections need to be treated with an antibiotic. Your doctor will decide if your child needs to be treated with an antibiotic for an ear infection. Permanent damage to the ear or to the hearing is very rare. Treatments include the following:

After treatment

Ear recheck

Children should be scheduled for a return appointment 3 to 4 weeks after an ear infection. At that visit, the doctor will examine the eardrum to be certain that the infection is going away. Your doctor may also want to test the child's hearing. Follow-up exams are very important, especially if the infection has caused a hole in the eardrum.

Middle ear infections have few complications or long-term effects. It is especially important that children with middle ear infection have appropriate follow-up with their doctors.

Possible long-term effects of middle ear infection include:

Call your child's doctor immediately if:

Call your child's doctor during office hours if:

Preventing middle ear infections in adults and children

There are ways to help prevent ear infections in children and adults. Often, changing the environment at home is all that is necessary, but sometimes surgery is needed, too. If some of the following precautions apply to you or your child, follow them or talk to your doctor about them.

Questions to ask your doctor or your child's doctor



This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: