Otitis Media: Symptoms, Causes, & Prevention

What is Otitis Media?

Otitis media is an infection or inflammation of the middle ear, the space behind the eardrum. This part of the ear contains small bones that help carry sound from the outer ear to the inner ear. Otitis media is especially common in children but can also affect adults.

Symptoms of Otitis Media

Otitis media is an infection in the middle ear that can affect both children and adults. Symptoms of otitis media usually appear shortly after a cold or respiratory infection. The condition can cause pain, hearing issues, and other signs depending on the age of the person affected.

Common Otitis Media Symptoms in Adults and Older Children

• Ear pain or a sharp ache in one or both ears
• Trouble hearing clearly or muffled hearing
• A feeling of fullness or pressure inside the ear
• Fluid drainage from the ear (yellow, white or brown)
• Difficulty sleeping or restlessness
• Reduced appetite
• A general feeling of being unwell

Otitis Media Symptoms in Children and Infants

Small children and infants may not be able to explain what they are feeling. In such cases, look for these signs of otitis media infection:

• Tugging or pulling at the ears
• Crying more than usual or being extra irritable
• Difficulty sleeping or frequent waking
• Refusing to eat or drink during feeds
• Mouth breathing or louder snoring than usual

A child with inflamed middle ear tissues may also show symptoms of enlarged or infected adenoids. Swollen adenoids can block the eustachian tubes, making ear infections more likely.

When Should You See a Doctor for Otitis Media?

Otitis media is a common ear infection in the middle ear that may sometimes go away on its own. However, there are times when medical attention is necessary to avoid complications.

You should see a doctor right away if:

• You or your child has severe ear pain.
• Your child develops a stiff neck or cannot move their neck properly.
• You or your child has a high fever (above 40°C or 104°F).
• Your child seems very unwell, drowsy, or extremely irritable.
• Your child walks unsteadily or appears dizzy.
• There is fluid, pus, or blood coming out of the ear.
• There are signs of facial weakness, such as an uneven smile or drooping on one side of the face.

Contact a doctor normally if:

• Your symptoms last more than three days, even after taking antibiotics to treat otitis media.
• Fever returns or continues after 48 hours of starting antibiotic medication.
• Hearing problems, pressure, or a blocked feeling in the ear continue for more than a few days.
• There are recurring infections or signs of chronic suppurative otitis media or otitis media with effusion.

What Causes Otitis Media?

Otitis media is usually caused by bacteria or viruses that affect the middle ear. It often follows a cold, sinus infection, or other upper respiratory illness. Here are the common causes of otitis media:

• Upper respiratory infections; Colds and throat infections can cause the eustachian tubes to swell or become blocked. This leads to a build-up of fluid behind the eardrum, resulting in an ear infection in the middle ear.
• Bacterial infections: Bacteria such as Streptococcus pneumoniae and Haemophilus influenzae are common causes of acute otitis media, especially in children.
• Viral infections: Viruses like the flu or common cold virus can trigger inflammation of the middle ear, especially in infants and young children.
• Poor eustachian tube function: The eustachian tube helps drain fluid from the middle ear. If it becomes blocked or swollen, it can cause fluid to stay trapped, increasing the risk of otitis media with effusion or chronic suppurative otitis media.
• Allergies: Nasal allergies can lead to swelling and blockage of the nasal passages and eustachian tubes, contributing to fluid build-up and middle ear infection.
• Enlarged adenoids: Enlarged adenoids can press against the eustachian tubes, making it difficult for fluid to drain properly, which may cause otitis media in children.
• Second-hand smoke and pollution: Exposure to cigarette smoke or air pollutants can irritate the airways and increase the risk of otitis media, especially in infants and young children.
• Bottle feeding while lying down: Feeding infants while they are lying flat may allow milk to enter the eustachian tube, which can increase the risk of infant otitis media.

Types of Otitis Media

Below are the main types of otitis media:

Acute Otitis Media (AOM)

This is the most common type of ear infection in the middle ear, especially in children. It develops quickly and is usually caused by a viral or bacterial infection. The middle ear becomes inflamed and filled with fluid, leading to ear pain, fever, hearing difficulties, and general discomfort. Acute otitis media in infants may also present with irritability, feeding problems, or trouble sleeping.

Otitis Media with Effusion (OME)

OME occurs when fluid remains trapped in the middle ear after an infection has cleared or even in the absence of active infection. There may be no obvious symptoms, but some people may feel fullness in the ear, mild hearing loss, or a sensation of blocked ears. This is also called serous otitis media or fluid in the ear and can happen in both children and adults. Bilateral otitis media with effusion affects both ears.

Chronic Suppurative Otitis Media (CSOM)

This is a long-term otitis media infection that causes a tear or hole in the eardrum (known as otitis media perforation) and persistent ear discharge. It is usually the result of untreated or poorly treated acute otitis media. Chronic suppurative otitis media can lead to hearing loss, and in severe cases, more serious complications if not managed properly.

Risk Factors

Several factors can increase the chances of developing otitis media. These include age, environmental exposures, and certain medical conditions. Here are the common risk factors for otitis media:

• Age: Children between 6 months and 2 years are more likely to develop otitis media. This is because their eustachian tubes are shorter and more horizontal, making it easier for germs to reach the middle ear.
• Group childcare: Children who attend daycare or school are exposed to more colds and infections, increasing their risk of developing ear infections in the middle ear.
• Bottle feeding: Babies who are bottle-fed, especially while lying down, are more likely to get ear infections than those who are breastfed.
• Seasonal changes: Otitis media is more common during autumn and winter when colds and respiratory infections are widespread. Seasonal allergies can also contribute to ear infections due to nasal congestion.
• Exposure to tobacco smoke or air pollution: Poor air quality, especially second-hand smoke, can irritate the respiratory system and raise the risk of inflammation in the middle ear.
• Cleft palate: Children with a cleft palate may have structural differences that affect how the eustachian tube drains, making them more prone to otitis media infection.
• Family history: Children with parents or siblings who had frequent ear infections may be more likely to develop acute otitis media or otitis media with effusion.
• Low immunity: Children and adults with weakened immune systems may be more vulnerable to otitis media due to their reduced ability to fight off infections.

Complications of Otitis Media

Most cases of otitis media get better without lasting problems. However, repeated or untreated infections may lead to complications, especially in children. Here are the common complications of otitis media:

• Hearing loss: Temporary hearing issues such as muffled sounds are common during an ear infection in the middle ear. Repeated or untreated otitis media infection may cause long-term hearing loss.
• Speech and language delays: Children with chronic otitis media or fluid build-up (otitis media with effusion) may have difficulty hearing, which can affect their speech and language development.
• Torn or perforated eardrum: In some cases, a build-up of pressure from acute otitis media can lead to a small tear in the eardrum. This usually heals on its own, but in rare cases, surgery may be needed.
• Spread of infection: If left untreated, the infection can spread to nearby areas such as the bone behind the ear (mastoiditis) or, in rare cases, to the brain and spinal cord lining, causing meningitis.
• Chronic suppurative otitis media: A long-lasting ear infection with ongoing discharge may develop if fluid remains trapped in the middle ear for a long time. This may require further medical attention.
• Balance issues: Inflammation of the middle ear can affect the inner ear, which may lead to dizziness or problems with balance.
• Cholesteatoma: Repeated infections may result in abnormal skin growth inside the middle ear, known as a cholesteatoma. This condition can damage nearby structures and may require surgery.

Prevention

While it is not always possible to prevent otitis media, certain steps can lower the risk of developing this ear infection in the middle ear:

• Limit exposure to colds and infections: Teach children proper hand hygiene. Avoid sharing cups, spoons, or forks. Try to keep children home when they are unwell to reduce the spread of infections that may lead to otitis media.
• Avoid second-hand smoke: Children exposed to cigarette smoke have a higher risk of developing an otitis media infection. Ensure your home and car are smoke-free.
• Breastfeed infants for at least six months: Breastfeeding helps build a baby’s immune system and can reduce the chances of infant otitis media, especially during the first year of life.
• Hold babies upright during bottle-feeding: Feeding a baby in a lying-down position can increase the risk of fluid entering the eustachian tube, which may lead to acute otitis media. Always hold your baby upright during feeds and avoid placing bottles in the crib.
• Stay up to date with vaccinations: Flu vaccines and pneumococcal vaccines can help prevent infections that may lead to otitis media with effusion or acute otitis media. Ask your child’s doctor which vaccines are recommended.
• Limit time in large group childcare settings: Children in group childcare have more exposure to colds and viruses. Choosing smaller daycare groups or keeping sick children at home may lower the risk of chronic suppurative otitis media.

Questions to Ask Your Doctor

If you or your child is undergoing treatment for otitis media, it helps to be well-prepared before your appointment. Asking the right questions allows you to better understand the treatment process, possible outcomes, and what to expect during recovery. Here are some important questions to consider asking your ENT specialist:

• What type of middle ear infection is this? Is it acute otitis media, chronic otitis media, or otitis media with effusion?
• How severe is the infection, and what are the recommended otitis media treatment options?
• Will antibiotics be necessary? If so, which antibiotics for middle ear infection are commonly prescribed, and for how long?
• Are ear drops for otitis media enough, or will oral medication be required?
• If the symptoms are mild, is a wait-and-watch approach advisable, especially for acute otitis media with effusion?
• What are the signs that the infection may be worsening or not responding to treatment?
• Is there a build-up of fluid in the middle ear? If yes, is it a case of middle ear effusion or serous otitis media?
• When is otitis media surgery needed? Will procedures like myringotomy, insertion of grommets, or a tympanoplasty be required?
• Are there any risks of complications of otitis media, such as hearing loss or damage to the eardrum?
• What symptoms should prompt urgent medical attention?
• How can we prevent future episodes of otitis media infection? Are there steps for preventing otitis media at home or through vaccination?
• Could allergies or sinus problems be contributing to the repeated infections?
• Is the ear canal inflamed or blocked, possibly due to adhesive otitis media or secretory otitis media?
• Will a hearing test be required now or during follow-up?
• What follow-up care is necessary after treatment? Will future appointments be needed to monitor progress?
• Does my child need to avoid swimming, flying, or other activities during treatment?
• Are there any alternative meds for otitis media in case of drug allergies, such as to amoxicillin?