Middle Ear Infection

(Acute Otitis; Ear Infection, Middle; Otitis Media)


With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.
The Middle Ear
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In most cases, middle ear infections are caused by viruses. In other cases, specific bacteria may be the cause.

Risk Factors

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


A middle ear infection may cause:


The doctor will ask about symptoms and medical history. 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:



Some doctors may take a wait and see approach. In some cases, the doctor may prescribe an antibiotic (oral or ear drops) for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective in decreasing unnecessary antibiotic use. Since viruses cause most ear infections, antibiotics won't make those infections go away faster. Most middle ear infections, including those caused by bacteria, tend to improve on their own in 2-3 days.
Other medications may include:
  • Pain relievers
  • Fever reducers
  • Anesthetic ear drops
Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
Decongestants and antihistamines are not recommended to treat ear infections.


Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus. This is usually followed by the placement of a ventilation or tympanostomy tube.


To help reduce the chance of a middle ear 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: Updated July 28, 2015. Accessed August 4, 2015.

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: Updated March 2013. Accessed August 4, 2015.

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12/16/2011 DynaMed's Systematic Literature Surveillance Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011;11:CD007095.

3/18/2014 DynaMed's 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

3/31/2014 DynaMed's Systematic Literature Surveillance Vernacchio L, Corwin MJ, Vezina RM, et al. Xylitol syrup for the prevention of acute otitis media. Pediatrics. 2014;133(2):289-295.

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