Middle Ear Infection

What is middle ear infection?

Middle ear infection is the inflammatory condition caused by bacteria in the rare part of the eardrum. Middle ear infection is medically termed as otitis and most common in children below 3 years of age. Inflammation occurs due to fluid accumulated at the ear canal. (1,2)

Middle ear infection Anatomy

Figure 1 – Normal Ear Vs Infected Middle ear (pus, inflammation noted)

Symptoms of middle ear infection

Middle ear is most common in children, but adults can also get infected. Sign and symptoms of middle ear infection is fast developing after bacterial invasion in the middle ear.

In Children

  1. Pain in ear and become severe in lying down posture
  2. Ear tugging or ear pulling at backward direction
  3. Sleep disturbance
  4. Irritable mood and often more crying that the normal
  5. Hearing difficulty
  6. Intricacy in sound respond
  7. Body balancing difficulty
  8. Fever, often body temperature is 100 0F or more
  9. Pus or fluid leakage from the ear canal
  10. Headache
  11. Anorexia

The above mentioned all the symptoms may not present in adults, but ear pain, shrinking of hearing power and pus release from ear canal are usual. (1,2,3)

Causes of middle ear infection

The infection is more common in children due to their immune system is not developed properly. The middle ear infection often has prior infection in the respiratory tract, including cold, flu or allergy. There is close anatomical connection between nasal passages, throat and eustachian tubes. Any bacterial lodging in this chain of anatomical structure caused congestion fluid accumulation provide the favorable condition to multiply the bacteria and the infection become spread at the rare portion of the ear drum. (1,2)

Middle ear infection & Eustachian Tubes

In middle ear infection eustachian tubes play a major role. The narrow tube like structure of eustachian tubes, each tube extent behind the middle ear and connect at the back of the throat. Nasal passage is located at the front of the eustachian tubes. The tubes open up and close due to:

  • Adjusting the air pressure in the middle ear
  • Maintain temperature of the air
  • Run down regular secretions from the middle ear

Throat infection or other related upper respiratory tract infection causing mucous accumulation, swelling and narrowing of the eustachian tubes. These restrict the regular secretion from the middle ear and infection is multiplied and extent to middle ear.

Children are more susceptible towards ear infection due to following factors trigger the fluid clogging in the middle ear.

  • Diameter of the eustachian tubes are narrower
  • Eustachian tubes sited horizontally

Middle ear infection & Adenoids

Adenoids are two tiny tissue pads located behind the nose and may provide contributory functioning to increase susceptibility towards infection by acting on immune system. In addition, the anatomical location of adenoids is present at the entrance of the eustachian tubes and any inflammatory condition of this tissue trigger the blockage of the nasal passage and also influence middle ear infection. Children have larger sized adenoids and considered as a contributory factor for development of middle ear infection more prevalence in them. (1,2)

Types of middle ear infection

There are three types of middle ear infection, they are as follows:

Otitis media with effusion

In this condition, middle ear effusion or fluid buildup takes place without bacterial or vital interference. This condition is persistent problem associated after bacterial or viral infection has resolved. The reason of the condition may associated with non-infectious obstruction or functional disorder in the eustachian tubes.

Chronic otitis media with effusion

This condition occurs when leftover fluid present in the middle ear and persist to repeat the fluid accumulation without bacterial or viral infection. This condition elicits recurrence of the ear infections and continuing condition may negatively influence hearing.

Chronic suppurative otitis media

This is a continual ear infection that often consequences of the tearing or damage of the eardrum. (1,2)

Risk factors for middle ear infection


Children having age between 6 months to 2 years are more vulnerable to middle ear infections, due to anatomically narrow sized and shape of the eustachian tubes and also under developed immune systems.

Child care

Child care is important factor in development of ear infection. It has been observed that more exposure to cold weather, outside roaming, excessive water contact prompt ear infection.

Infant feeding

Feeding habits also influence ear infection, which includes bottle feeding in lying down posture often tend to increase ear infection in infants compare with breast feed infants.

Climatic alteration

Ear infection prevalence is increased during monsoon and winter. In these climates, infectious agent for colds and flu become more prevalent. Individuals having pollen allergy history are more susceptible in middle ear infection.

Poor air quality

Air pollution or exposure to tobacco smoke can enhance the risk of ear infection. (2)

Diagnosis of Middle Ear Infection

  • Examination of the eardrum with an otoscope to identify the sign of the ear infection like blockage or filling of the middle ear.
  • Tympanometry is another ear infection test to check fluid accumulation of the middle ear.
  • Hearing test for check the audibility of the affected individuals.
  • Rare cases culture of the accumulated fluid in the ear drum is conducted for severe infection. (2,3)

Treatment of Middle Ear Infection

Usually middle ear infection is subsided by their own way without any treatment within one to two weeks. Within this period close monitoring is required.

Treatment aim in middle ear infection is to eliminate the cause of the infection, so that no further associated complication can progress.

  • Non-steroidal anti-inflammatory drugs, such as ibuprofen, acetaminophen prescribe to control the pain and inflammation caused by middle ear infection.
  • Antibiotic medications are given to subside the infecting agent in case of severe infection.
  • Warm compression is given to manage the pain symptoms.
  • Doctor may recommend to drain out fluid from the middle ear canal yearly once or twice in recurrent of middle ear infection. (2,3)

Middle ear infection pus drianage surgery incision tympanic membraneMiddle ear infection pus drianage surgery incision tympanic membrane

Figure 2 – Surgical Drainage of pus from middle ear

Source – Adam, Inc


  1. Debra Sullivan, (2015); Middle Ear Infection (Otitis); Retrieve from: http://www.healthline.com/health/otitis#Overview1
  2. Mayo Clinic Staff; Ear infection (middle ear) (2016); Retrieve from: http://www.mayoclinic.org/diseases-conditions/ear-infections/home/ovc-20199482
  3. Middle ear infection (otitis media), (2016); Retrieve from: http://www.nhs.uk/conditions/Otitis-media/Pages/Introduction.aspx

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