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Acute Middle Ear Infection in Children

(Acute Otitis Media)

by Udayan K. Shah, MD

Acute middle ear infection is a bacterial or viral infection of the middle ear, usually accompanying a cold.

  • Children with ear infections may have a fever and trouble sleeping and may cry, become irritable, and pull on their ears.

  • Doctors use a handheld light called an otoscope to check the eardrum for redness or bulging and to look for fluid behind the eardrum.

  • Acetaminophen or ibuprofen can relieve fever and pain, and antibiotics are usually used when children do not get better quickly or get worse.

Acute middle ear infection (also called acute otitis media—see also Otitis Media (Acute)) usually develops and resolves relatively quickly. Middle ear infections that recur or last for a long time are called chronic middle ear infections (see Chronic Middle Ear Infection in Children).

Causes

Acute middle ear infection is most often caused by the same viruses that cause the common cold. Acute infection may also be caused by bacteria that sometimes normally reside in the mouth and nose. Bacteria that affect newborns include Escherichia coli and Staphylococcus aureus. Bacteria that affect older infants and children include Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis. An infection initially caused by a virus sometimes leads to a bacterial infection.

Symptoms

Infants with acute middle ear infections have a fever and trouble sleeping. They cry or become irritable for no apparent reason. They may also have a runny nose, cough, vomiting, and diarrhea. The ear is painful, and hearing may be decreased. Infants and children who cannot communicate verbally may pull at their ears. Older children are usually able to tell parents that their ear hurts or that they cannot hear well.

Commonly, fluid accumulates behind the eardrum and remains after the acute infection has resolved. This disorder is called secretory otitis media (see Secretory Otitis Media in Children).

Complications

Rarely, acute middle ear infection leads to more serious complications. The eardrum may rupture, causing blood or fluid to drain from the ear. Also, nearby structures may become infected and cause symptoms:

  • Infection of the bone surrounding the ear (mastoiditis—see Mastoiditis) causes pain

  • Infection of the inner ear (labyrinthitis—see Purulent Labyrinthitis) causes dizziness and deafness

  • Infection of the tissues surrounding the brain (meningitis—see Introduction to Meningitis) or collections of pus in the brain (see Abscess of the Brain) cause headache, confusion, seizures, and other neurologic problems

If infections recur, abnormal skinlike tissue (a cholesteatoma) may grow in the middle ear and potentially through the eardrum. A cholesteatoma can damage the bones of the middle ear and cause hearing loss.

Did You Know...

  • Most acute middle ear infections resolve without use of antibiotics.

Diagnosis

Doctors diagnose acute middle ear infections by using a handheld light called an otoscope to look for bulging and redness of the eardrum and for fluid behind the eardrum. They may need to clean wax from the ear first so they can see more clearly. Doctors may use a rubber bulb and tube attached to the otoscope to squeeze air into the ear to see if the eardrum moves. If the eardrum does not move or moves only slightly, infection may be present.

Prevention

The pneumococcal conjugate vaccine, Haemophilus influenzae type b (Hib) vaccine, and influenza (flu) virus vaccine decrease the risk of acute middle ear infections. These vaccines are given to children according to a standard schedule (see Childhood Vaccination Schedule). Infants should not sleep with a bottle because drinking from a bottle while going to sleep tends to cause fluid to collect in the eustachian tubes. Fluid in the eustachian tubes traps secretions in the middle ear and prevents air from reaching the middle ear, both of which make infection more likely. Smoking should be eliminated from the household or minimized.

Did You Know...

  • Letting an infant sleep with a bottle can result in an acute middle ear infection.

Treatment

Acetaminophen or ibuprofen is effective for fever and pain.

Most acute middle ear infections resolve without antibiotics. Thus, many doctors use antibiotics only when children are very young or very ill or do not improve after a brief period of time or when there are signs that the infection is getting worse. Antibiotics, such as amoxicillin (with or without clavulanate) or trimethoprim plus sulfamethoxazole, may be used.

Preparations that contain decongestants (such as pseudoephedrine) or antihistamines (such as brompheniramine or chlorpheniramine) are not helpful for children.

If the eardrum is bulging and the child has severe or persistent pain, fever, vomiting, or diarrhea, a doctor may puncture the eardrum (called tympanic membrane perforation) to allow the infected fluid to drain. After this procedure, symptoms usually resolve quickly, hearing returns, and the eardrum heals on its own.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • ADVIL, MOTRIN IB
  • TYLENOL
  • AFRINOL, SUDAFED
  • No US brand name
  • CHLOR-TRIMETON
  • AMOXIL