MSD Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Overview of Middle Ear Infections in Young Children

(Otitis Media)


Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Sep 2020| Content last modified Sep 2020
Click here for the Professional Version
Topic Resources

Middle ear infection is infection of the space immediately behind the eardrum.

A Look Inside the Ear

A Look Inside the Ear

Middle ear infections (otitis media) may occur in older children and adults (see Otitis Media (Acute)) but are extremely common among children between the ages of 3 months and 3 years. These infections often accompany the common cold. Young children are particularly susceptible to middle ear infections for several reasons:

  • Differences from adults in the size and length of their eustachian tubes

  • Increased susceptibility to infection in general

  • Increased exposure to infection

  • Use of a pacifier

Other important risk factors include

  • Exposure to cigarette smoke

  • Family history of frequent ear infections

The eustachian tube connects the middle ear with the nasal passages and helps balance air pressure in the middle ear with that in the environment. In older children and adults, the tube is relatively vertical, wide, and rigid, and secretions that pass into it from the nasal passages drain easily. In infants and younger children, the eustachian tube is more horizontal, narrower, less rigid, and shorter. Thus, the tube is thought to be more likely to become blocked by secretions and to collapse, trapping the secretions in or close to the middle ear and blocking air from reaching the middle ear. Also, the secretions may contain viruses or bacteria, which multiply and cause infection. Or viruses and bacteria can move back up the short eustachian tube of infants, causing middle ear infections.

The Eustachian Tube: Keeping Air Pressure Equal

The eustachian tube helps maintain equal air pressure on both sides of the eardrum by allowing outside air to enter the middle ear. If the eustachian tube is blocked, air cannot reach the middle ear, so the pressure there decreases. When air pressure is lower in the middle ear than in the ear canal, the eardrum bulges inward. The pressure difference can cause pain and can bruise or rupture the eardrum.

The Eustachian Tube: Keeping Air Pressure Equal

At about the age of 6 months, infants become more susceptible to infection because they lose protection from their mother’s antibodies, which they received through the placenta before birth. Breastfeeding seems to partially protect children from ear infections because breast milk contains the mother’s antibodies.

Also at about this age, children become more sociable and may acquire viral infections after touching other children and objects and then putting their fingers in their mouth and nose. These infections may in turn lead to middle ear infections. Attendance at child care centers increases the risk of exposure to the common cold and hence to middle ear infections.

Using a pacifier may impair the function of the eustachian tube and thus interferes with air reaching the middle ear.

All children have pain in the affected ear (see Earache). Infants with middle ear infection may simply be cranky or have difficulty sleeping. Young children often have fever, nausea, vomiting, and diarrhea.

Diagnosis of Middle Ear Infections

  • A doctor's examination

To detect a middle ear infection, doctors look in the ear with an otoscope and examine the eardrum for bulging and redness.

Treatment of Middle Ear Infections

  • Sometimes antibiotics

Acute middle ear infections and secretory otitis media (an accumulation of fluid behind the eardrum) usually go away without antibiotics. However, antibiotics are sometimes given to treat acute middle ear infections. Secretory otitis media that does not go away may need to be treated with a surgical procedure.

Chronic middle ear infections can come back frequently or last for a long time. Ear drops, antibiotics, and sometimes a surgical procedure are needed to treat these infections.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Test your knowledge

When to stop breastfeeding (wean the infant) depends on the needs and desires of both mother and baby. However, it is preferable for a mother to wait until the infant is at least how many months old before completely weaning? 
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID