Middle Ear Infection (Otitis Media)

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What is the anatomy of the ear?

The outer ear and middle ear are separated by the eardrum (tympanic membrane). The middle ear is open to the back of the nose through the eustachian tube. It is through the eustachian tube which the middle ear can exchange air and clear any fluid. The middle ear also contains the bones (ossicles) called the malleus, incus, and stapes. When sound travels into the ear canal (outer ear) and hits the eardrum, it is transmitted through the ossicles and into the inner ear.

What is otitis media (middle ear infection)?

Otitis media refers to inflammation of the middle ear. The inflammation is typically caused by an allergic reaction, a viral infection, or a bacterial infection. With the accumulation of pus and mucus along with swelling of the mucosa, the Eustachian tube is blocked, thus preventing proper ventilation of the middle ear.

Children are often at a higher risk of developing a middle ear infection than adults due to the shorter, more narrow, and more horizontal Eustachian tube position. The anatomy of the pediatric Eustachian tube pre-disposes the middle ear to more bacteria exposure. As your child continues to grow, the Eustachian tube becomes more vertical, which allows for less bacterial penetration into the middle ear and better drainage through the Eustachian tube.

In children, the risk factors for a middle ear infection include young age (3 months – 2 years), group childcare, cold, and allergy season, and tobacco exposure. In adults, the prevalence of middle ear infections is very low. However, some adult may continue to have frequent ear infections due to Eustachian tube dysfunction or due to concurrent sinonasal pathologies such as sinus infection and allergy.

Otitis media. Source: New England Journal of Medicine (left). Pediatric vs adult Eustachian tube. Source: Medline Plus (right).

What can be done to reduce and prevent middle ear infection?

Otitis media is a common infection of childhood, affecting about 62% of children by the age of one, 85% of children by the age of three, and nearly 100% of children by the age of five. While ear infections cannot be prevented entirely, the risk can be reduced with pneumococcal vaccination, proper hand-washing, control of nasal inflammation, strict avoidance of tobacco smoke exposure, and stopping bottle use after the age of one.

Why is it important to treat otitis media?

Otitis media is a common infection of childhood that is typically self-limiting even without treatment. However, cases of frequent recurrent infections or a chronic infection can lead to permanent hearing loss, speech delay, impairment of language development, and cholesteatoma. In some cases, a middle ear infection can progress to a more severe complication including mastoiditis (infection of the bone containing the ear) or spread to the brain (meningitis and epidural abscess). With vaccination and timely treatment, these complications are rare in the United States.

How is otitis media treated?

Most episodes of middle ear infection will likely subside without treatment. Control of nasal inflammation and congestion with decongestants and nasal saline can help expedite proper Eustachian tube drainage. Oral antibiotics can shorten the course of an acute ear infection with associated discomfort. In patients with recurrent acute otitis media or chronic otitis media, ear tubes placement is an option.

When is surgery indicated?

Ear tubes are typically indicated in patients who develop multiple recurrent ear infections or chronic infection with associated hearing loss or speech/language delay. Ear tubes can decrease the frequency of ear infections and the use of oral antibiotics. In most of these cases, ear tubes allow for treatment of a middle ear infection with topical drops. In cases where a second set of tubes is needed after the first set has fallen out, an adenoidectomy is often recommended at the same time to reduce the risk of recurrent ear infection. Learn more about ear tube placement and post-operative care after ear tubes.

When will my child outgrow the ear infections?

By the age of 7, most children will outgrow the ear infections. However, children with craniofacial abnormalities such as cleft palate may continue to be at risk for ear infections. A small number of patients will continue to have Eustachian tube dysfunction with persistent middle ear infections in adulthood. In these patients, a more long-term ear tube is usually recommended.

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