Middle Ear Infection
(Acute Otitis; Ear Infection, Middle; Otitis Media)
by Rosalyn Carson-DeWitt, MD
The middle ear is located behind the eardrum. An infection can enter this area and cause swelling and pain.
Most middle ear infections are caused by viruses. Others may be caused by a bacteria.
Most ear infections develop after a cold or flu. A tube called the eustachian tube runs from the middle ear to the back of the throat. A cold or flu virus can pass from the throat, through the tubes, and up to the ears.
Middle ear infections are more common in infants and toddlers because their eustachian tubes are shorter. They occur more often during the winter months. Other factors that may increase your chance of a middle ear infection include:
A middle ear infection may cause:
The doctor will ask about symptoms and past health. A physical exam will be done. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument called an otoscope.
The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.
Other tests may include:
The doctor may choose to wait and see. Most ear infections will pass on their own within 2 to 3 days. Medicines is often not needed. Infections that are severe, last longer than expected, or are in children aged 6 months and under, may need more treatment.
Medicines may be used to help manage symptoms. Options include:
Antibiotics are not often needed. They are used for severe infections caused by bacteria. Mild infections caused by bacteria can pass on its own without antibiotics. Using antibiotics when not needed can actually make you more ill than letting the infection pass on its own.
Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
Note: Decongestants and antihistamines are not recommended to treat ear infections.
A myringotomy may be done to drain fluid from the inner ear. A tiny cut is made in the eardrum to drain fluid and pus. An ear tube may also be placed to let fluids continue to drain.
Habits that may help decrease the risk of middle ear infection:
American Academy of Otolaryngology—Head and Neck Surgery
National Institute on Deafness and Other Communication Disorders (NIDCD)
Caring for Kids—Canadian Paediatric Society
Acute otitis media (AOM). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-otitis-media-aom-in-children. Accessed January 29, 2021.
Hurst DS, Amin K, Seveus L, Venge P. Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope. 1999;109(3):471-477.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
...(Click grey area to select URL)
Accessed January 29, 2021.
3/18/2014 DynaMed Systematic Literature Surveillance https://www.dynamed.com/condition/acute-otitis-media-aom-in-children: van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder AG. A trial of treatment for acute otorrhea in children with tympanostomy tubes. N Engl J Med. 2014;370(8):723-733
Last reviewed January 2021 by EBSCO Medical Review Board Shawna Grubb, RN
Last Updated: 1/29/2021
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
To send comments or feedback to our Editorial Team regarding the content please email us at firstname.lastname@example.org. Our Health Library Support team will respond to your email request within 2 business days.