- Otitis media is a middle ear infection that can cause ear pain, fever, discharge, and hearing changes.
- In children, signs can include pulling at the ear, fussiness, crying more than usual, and trouble sleeping.
- Treatment may include pain relievers and sometimes antibiotics, although mild cases may improve with watchful waiting and home care.
Otitis media, also called a middle ear infection, is an inflammation of the middle ear that usually happens when viruses or bacteria are present, often after a cold or sinus infection. It can also develop due to trauma or allergies.
Because the ear is inflamed, symptoms may include ear pain, yellow or whitish discharge from the ear canal, fever, and irritability, and their intensity can vary from person to person.
If these signs and symptoms are present, it is important to see a pediatrician for children or an otolaryngologist (ENT specialist) for adults, so the diagnosis can be confirmed and the best treatment started. Treatment may include medications to relieve symptoms or antibiotics.
Ear infection symptoms
The main symptoms of otitis media (middle ear infection) are:
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Discharge or fluid buildup in the ear.
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Reduced hearing.
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Ear pain.
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Fever.
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Irritability.
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Redness.
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Eardrum perforation, in some cases, with pus present.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), signs of ear infection in children can include tugging or pulling at the ear, fussiness, and trouble sleeping. In these cases, it is important to consult a pediatrician.
Confirming a diagnosis
The diagnosis is made based on the person’s signs and symptoms and a physical exam, which includes looking inside the ear with a device called an otoscope. This allows the provider to spot any changes in the ear and choose the most appropriate treatment to reduce inflammation and ease symptoms.
When to see a doctor
Schedule an appointment with your primary care provider, pediatrician, or an ear, nose, and throat (ENT) specialist if you have symptoms that may indicate otitis media, especially when they are severe or accompanied by fever.
Main types
Otitis media can also be divided into different types according to the symptoms present, how long they last, and how often they happen:
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Acute otitis media: this is the most common form, with a rapid onset of signs and symptoms, such as ear pain and fever, caused by an acute middle ear infection
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Recurrent acute otitis media: this is acute otitis media that happens repeatedly, with more than 3 episodes in 6 months or 4 episodes in 12 months, usually due to the same microorganism growing again or new infections
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Serous otitis media: also called otitis media with effusion, this is the presence of fluid in the middle ear that can remain for several weeks to months without causing signs or symptoms of infection
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Chronic suppurative otitis media: this is characterized by persistent or recurrent purulent discharge together with perforation of the tympanic membrane
To distinguish between these types, the doctor usually performs a clinical evaluation that includes a physical exam, looking inside the ear with an otoscope, and assessing the person’s signs and symptoms.
Possible causes
Otitis media usually happens as a result of the flu, a cold, or a sinus infection, and is mainly caused by viruses and bacteria. The main viruses associated with otitis media are influenza (flu) virus, respiratory syncytial virus (RSV), and rhinovirus, while the most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
However, this type of ear infection can also be triggered by other situations, such as allergy, reflux, fungal infection, or anatomical changes in the ear, although these causes are less common.
Treatment options
Treatment for otitis media may vary depending on the symptoms, severity, age, and exam findings. A healthcare provider may recommend pain relievers such as acetaminophen or ibuprofen to help relieve ear pain and fever.
According to the CDC, some middle ear infections need antibiotic treatment, but many can get better without antibiotics. In some mild cases, a healthcare provider may recommend watchful waiting for 2 to 3 days before starting antibiotics.
If antibiotics are needed, amoxicillin is commonly used as a first-line treatment. Antibiotics are more likely to be recommended for severe symptoms or when symptoms do not improve.
Decongestants and antihistamines are not routinely recommended for otitis media. In some cases, referral to an ENT specialist or procedures such as ear tube placement may be considered, depending on the type and severity of the condition.
Home remedies
Some home measures may help speed recovery and relieve symptoms. However, they should never replace medical treatment.
During treatment for an ear infection, it may be helpful to:
- Drink plenty of fluids and stay hydrated throughout the day
- Rest and avoid strenuous exercise or exhausting activities
- Eat a healthy, balanced diet that includes fruits, vegetables, grains, and seeds, as these foods provide omega-3 fats and other nutrients that support recovery from inflammation
- Apply a warm compress to the outer ear to help relieve pain
In addition, never put any product into the ear unless it has been recommended by a healthcare provider, as this may worsen inflammation and delay recovery.