Otitis Media – Symptoms, Causes, Types, and Management

An infection comprising the middle ear due to allergies, cold, or sore throat is known as otitis media. It is very common in children below 2 years of age due to the placement of the eustachian tube that connects the middle ear to the throat. The middle ear is an air-filled space that lies behind the eardrum (tympanic membrane) and houses the ossicles.

Symptoms of otitis media

The symptoms are acute in onset, intensifying with the severity of the disease, some of the most commonly observed symptoms are:

  • Otalgia (ear pain)
  • Fullness in the ear
  • Temporary hearing loss
  • Loss of balance
  • Tinnitus
  • Discharge that may be foul-smelling
  • Loss of appetite
  • Irritability
  • Fever
  • Vomiting

Causes of otitis media

The middle ear cavity is connected to the throat via a eustachian tube. The swelling in the tubes due to an ongoing infection can lead to the buildup of fluid in the middle ear which gets infected and cause otalgia and other related symptoms of otitis media. The tube can swell due to several reasons:

  • Allergies
  • Sinus infection
  • Cold and flu
  • Drinking while lying down
  • Adenoids and horizontal placement of eustachian tubes in children

Types of otitis media

A middle ear infection is further classified into subtypes, as mentioned below:

Acute otitis media (AOM)

The symptoms are acute in onset with mild signs of infection such as fever, irritability, loss of appetite, and pain.

Otitis media with effusion (OME)

OME often follows AOM, with additional symptoms of vertigo, tinnitus, and otorrhea.

Chronic suppurative otitis media (COM)

Persistent otitis media, that is not appropriately treated leads to pus formation and eventually perforation in the tympanic membrane.

Adhesive otitis media

The fragments of a perforated eardrum get sucked into the middle ear cavity and form adhesions with the ossicles or the walls in absence of any surgical intervention.

Types of otitis media

Otitis media in children

In children under 2 years of age, the eustachian tubes are narrow and lie horizontally, allowing entry of milk, food contents, saliva, and nasal secretions. This favors the entry of bacteria into the ear thus causing infections. Some other causes include swelling of adenoids, these lie close to the opening of eustachian tubes, leading to blockage of the tube and accumulation of infected fluid in the middle ear.

Risk factors

Not everyone gets otitis media, some individuals are more at risk to develop an infection, some of these are:

  • Children between the age limit of 6 months to 2 years
  • Children who use a pacifier
  • People who are exposed to air pollution, cigarette smoke, and other toxins
  • Being in the areas of the higher altitude
  • Recent cold or flu
  • Swimmers
  • Individuals with a malformed or cleft palate

Complications of otitis media

Most of the time, it is treated completely but incomplete treatment results in recurrent infections that lead to long-term complications.

  • Perforation of tympanic membrane
  • Spread of infection of mastoid air spaces
  • Impaired hearing
  • Impaired hearing in toddlers has an impact on speech causing delays
  • Paralysis if the facial nerve is involved
  • Meningitis
  • Cholesteatoma

How to prevent otitis media?

Risks of developing otitis media can be prevented by taking a few measures:

  • Breastfeeding the babies
  • Avoid pacifiers
  • Stay protected from common cold and flu
  • Hold the baby in an upright position, while feeding
  • Avoid passive smoking

Management of otitis media


Your doctor will take a detailed history of your symptoms to figure out the origin and cause of infection and formulate a final diagnosis before beginning with the treatment. Some investigations are:

  • An otoscope is used to visualize the tympanic membrane to find out the extent of the infection
  • Tympanometry is conducted to see if the eardrum is ruptured or not
  • Reflectometry is to determine the presence of fluid in the ear cavity
  • Hearing tests to rule out any other cause


The majority of the otitis media resolves without any antibiotic intervention. Some recurrent infections require antibiotic therapy for complete recovery. Different treatment modality is employed for different types of otitis media.

Medical treatment

Middle ear infections can be treated by treating the underlying cause. Some of the options are:

  • Antibiotic (oral) to treat the infection
  • Antibiotics (ear drops) to directly kill the bacteria if the tympanic membrane is perforated
  • Pain relievers for otalgia
  • Antihistamine for allergies
  • Nasal decongestants in children

Surgical treatment

For recurrent and persistent infections, surgical intervention is required:

  • Myringotomy is done to drain out the fluid from the cavity in otitis media with effusion. The tympanostomy tube is placed at the opening of the eardrum. The tube falls out itself within 6 months to 1 year.
  • Suctioning is done to remove the pus completely that fails to drain itself.
  • In children with recurrent ear infections, your doctor will suggest adenoid removal surgery to completely resolve the issue.

Home remedies

  • The ear is a sensitive organ and should be treated with caution. Avoid putting anything inside your ear in case of perforation
  • Warm or cold compresses can help with severe earache
  • Sleep with the affected ear facing upwards
  • Try to soothe your cough and cold by drinking herbal teas and warm liquids

When to consult a doctor?

If you begin to notice severity in your symptoms including bloody discharge, vomiting, fever, or unconsciousness consult your ENT specialist right away.


What is the best treatment for otitis media?

There is no specific treatment for middle ear infection, it is treated according to the severity of symptoms. Antibiotics are the mainstay treatment for recurrent infections.

What is the most common cause of middle ear infection?

The most common causative agents are H.Influenzae and S.Pneumoniae.

Can ear infections spread to other organs?

Yes, a middle ear infection can spread to the brain and inner ear.

Last medically reviewed on November 14, 2021.