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Middle Ear Infection

  • Cynthia M. Johnson, MA
Publication Type:


Middle Ear Infection

(Acute Otitis; Ear Infection, Middle; Otitis Media)


The middle ear is located behind the eardrum. An infection can enter this area and cause swelling and pain.

The Middle Ear.

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Most middle ear infections are caused by viruses. Others may be caused by 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.

Risk Factors

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 things that may raise the risk of a middle ear infection are:

  • A recent viral infection, such as a cold or flu
  • Recent sinusitis
  • Attending day care
  • Being exposed to secondhand tobacco smoke or smoke from sources like cooking or wood stoves
  • Formula feeding in babies
  • Health problems that cause abnormalities of the eustachian tubes, such as cleft palate or Down syndrome
  • A history of allergies, such as environmental or food allergies
  • Gastroesophageal reflux disease (GERD)
  • Babies whose mothers drank alcohol while pregnant
  • Pacifier use


A middle ear infection may cause:

  • Ear pain (babies may tug or rub at the ear or face)
  • Fever
  • Irritability
  • Hearing problems
  • Lack of hunger, problems feeding
  • Problems sleeping
  • Drainage from the ear
  • Balance problems


The doctor will ask about symptoms and past health. A physical exam will be done. It will focus on the ear.

A scope will be used to look at the ear. The doctor may also check to see if there is fluid in the ear. This can be done with a scope that blows air or with tympanometry, which uses air pressure. This is usually enough to make the diagnosis.


Some infections will pass on their own in 2 to 3 days and antibiotics may not be needed. Infections that are severe, last longer than expected, or are in babies 6 months of age and under may need more treatment. Options are:


The risk of a middle ear infection may be lowered by:

  • The flu and pneumococcal vaccines
  • Avoiding exposure to smoke
  • Breastfeeding babies for at least the first 6 months of life


Medicines may be used to help manage symptoms. Options are:

  • Over the counter pain relievers
  • Antibiotics to treat severe infections caused by bacteria




  • Acute otitis media (AOM). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-otitis-media-aom-in-children.
  • Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at: http://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx.


  • David L. Horn, MD, FACP
Last Updated:

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.