Middle ear infections (otitis media)

A middle ear infection is inflammation in the part of your ear that's behind your eardrum. Middle ear infections can affect anyone but are most common in kids, especially during cold and flu season.

Medically, middle ear infections are known as "otitis media." When there is fluid build-up as well, it's known as otitis media with effusion. Fluid in the ears can cause temporary hearing loss. Pain in the affected ear and a fever are the most common symptoms. Younger children may tug on their ears.

Understanding the ear and where infections can occur

Our ear is comprised of three parts: the outer ear, the middle ear and the inner ear.

The outer ear consists of the pinna (the body part we think of when we think of our ears), the ear canal, and it ends at our eardrum, also referred to as the tympanic membrane.

The middle ear is filled with air and is open to the Eustachian tube. It also houses three tiny hearing bones known as ossicles.

The inner ear is where the cochlea (our hearing organ), and semicircular canals (our balance organ) are located.

Eustachian tubes help drain the ear of fluid and keep the pressure stable. A middle ear infection is caused mainly due to malfunctioning Eustachian tubes or sudden changes in barometric pressure. When the air in the middle ear is unable to equalize, fluid may build up, which can cause bacterial growth.

Why do they affect kids more often?

Middle ear infections are predominant in children because their ear anatomy and immune systems are less developed. Specifically, a child’s Eustachian tube is shorter and straighter than an adult's, and so does not drain as easily. Data shows that ear infections are very common among Canadian infants and toddlers. While most kids will just have one or two in their childhood, some may have chronic and recurrent ear infections. In these kids, they may endure long periods of hearing loss, possibly affecting speech development. 

How is a middle ear infection diagnosed?

A pediatrician will look into the ear using a device known as an otoscope for signs of infection and inflammation. In some cases, a tympanometry test may be given using a tympanometer, which measures the pressure and movement of the ear drum. A standard hearing test also may be given.

Hearing healthcare professionals at hearing clinics have the tools and capabilities to perform these tests to assist your doctor in their diagnosis.

What are the symptoms?

Ear pain and earache typically occur in both middle and outer ear infections causing great discomfort in both adults and children. Signs that your child may have an ear infection include:

• tugging at the ear (common in babies)
• fever
• discharge from the ear
• inability to fall or stay asleep
• irritability
• crying more than normally
• not reacting to or seeking out where sounds or voices are coming from (due to loss of hearing)

How to make your child more comfortable

Tips to keep your child more comfortable during their ear infection include:

• keeping your child upright or their head elevated and keeping them hydrated—the act of swallowing and sitting upright will help the fluid drain
• placing a warm compress on their affected ear
• giving acetaminophen (or a medicine recommended by your doctor) to help relieve pain and fever

What is the treatment for ear infections?

Otitis media treatment may require antibiotic ear drops, but most commonly requires antibiotics given by mouth. Symptoms will likely go away in about two to three days, but it is important to complete the entire course of antibiotics to prevent recurring infections.

Chronic ear infections

In cases of chronic or recurrent ear infection, a doctor known as an otolaryngologist (ear, nose and throat specialist) may recommend a surgery called myringotomy. Myringotomy is better known as ear tube surgery, although not all myringotomies require tubes to stay in the ear. During a myringotomy, a tiny incision is made on the tympanic membrane, and excess fluid is suctioned out. Sometimes, a tube is inserted into the tympanic membrane to keep the incision open and allow for further draining and better pressure equalization.

It can be especially scary to think of your child undergoing a surgical procedure, however, the surgery is commonplace, is conducted as an outpatient procedure, and your child can resume regular activities the following day.

Preventing ear infections

While it is not always possible to stop ear infections, there are ways to reduce the chances of developing them.

To prevent otitis media:

• avoid smoking
• feed your baby in an upright position
• avoid giving your baby a pacifier
• wash your and your child’s hands frequently
• keep up to date on your and your child’s immunizations

If you suspect you or your child may be suffering from hearing loss or middle ear infection, it is important to speak with your doctor right away along with a hearing healthcare professional. Acting quickly is the best way to mitigate the impact hearing loss can have on developing children and the quality of life in adults.

What is swimmer's ear? Is it the same?

No, a middle ear infection (otitis media) differs from swimmer's ear (otitis externa), which is an outer ear infection. Swimmer's ear occurs in the ear canal rather than the middle ear. It usually happens when fluid becomes trapped in the ear canal, creating bacterial growth. If there is enough discharge in the ear canal, hearing can also be affected, since sound is unable to travel unobstructed through the ear canal to the eardrum.

Swimmer's ear is treated with ear drops to kill the bacteria and reduce swelling. Once treated, it can take 7-10 days to clear. Outer ear infections are usually diagnosed by a doctor by simply looking into your ear canal with an otoscope along with evaluating your symptoms. To prevent swimmer's ear, keep your and your child’s ears as dry as possible. This means drying ears thoroughly with the use of a towel and/or hairdryer after bathing or swimming or using swim plugs or ear bands to keep water completely out of your and your child’s ear canals.