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Eye & EarICD-10: H66About 80% of children will have at least one ear infection by age 3

Otitis Media

Also known as: Middle Ear Infection, Ear Infection

Otitis media is an infection or inflammation of the middle ear, most common in children between 6 months and 3 years of age. It occurs when fluid accumulates behind the eardrum, often following an upper respiratory infection, and bacteria or viruses infect the fluid. While usually not serious, recurrent infections can lead to hearing problems and may require surgical intervention.

Symptoms

Ear pain (otalgia), often worse when lying down
Tugging or pulling at the ear (in young children)
Fever
Irritability and fussiness in infants
Difficulty sleeping
Hearing difficulties or muffled hearing
Fluid drainage from the ear if the eardrum ruptures
Loss of appetite

Causes

  • Bacterial infection (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)
  • Viral upper respiratory infection leading to Eustachian tube dysfunction
  • Eustachian tube swelling and blockage trapping fluid in the middle ear

Risk Factors

  • Age 6 months to 3 years
  • Group child care settings
  • Bottle-feeding while lying down
  • Exposure to secondhand smoke
  • Seasonal allergies or frequent upper respiratory infections
  • Pacifier use

Diagnosis

  • Otoscopic examination showing a bulging, red, or immobile tympanic membrane
  • Pneumatic otoscopy to assess eardrum mobility
  • Tympanometry to measure middle ear pressure and fluid
  • Audiometry if hearing loss is suspected

Treatment

  • Watchful waiting for 48–72 hours in mild cases (per AAP guidelines)
  • Antibiotics (amoxicillin first-line) for persistent or severe cases
  • Pain management with acetaminophen or ibuprofen
  • Tympanostomy tubes for recurrent or chronic otitis media with effusion
  • Warm compress on the affected ear for comfort

Prevention

  • Stay up to date on pneumococcal and flu vaccines
  • Breastfeed infants for at least 6 months if possible
  • Avoid exposing children to secondhand smoke
  • Practice good hand hygiene to prevent colds
  • Avoid bottle-feeding while the infant is lying flat

When to See a Doctor

  • Ear pain lasting more than a day or severe in intensity
  • Fluid, pus, or blood draining from the ear
  • Symptoms in an infant under 6 months
  • Hearing changes or symptoms not improving after 48 hours of antibiotics

Frequently Asked Questions

Related Conditions

Pharyngitis

Infectious

Sinusitis

Respiratory

Hearing Loss

Eye & Ear

Meniere's Disease

Eye & Ear

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

Content reviewed against peer-reviewed medical literature and clinical guidelines. Read our editorial standards.