Otitis media is an infection or inflammation in the middle ear—the small, air-filled space behind your eardrum that contains tiny bones responsible for transmitting sound. When this area becomes infected, it often causes fluid to build up, leading to discomfort, hearing issues, and other symptoms.

How the middle ear works:

The middle ear is connected to the back of the throat by the Eustachian tube, which normally helps equalize pressure and drain fluid. When this tube becomes blocked or swollen (often due to a cold or respiratory infection), fluid can accumulate and become infected.

Types of otitis media:

• Acute otitis media (AOM): A sudden, short-term infection with symptoms like ear pain, fever, and fluid behind the eardrum. This is the most common type
• Otitis media with effusion (OME): Also called "glue ear," this occurs when fluid remains in the middle ear after an infection clears, or without infection. It may not cause pain but can affect hearing
• Chronic otitis media with effusion: Persistent fluid in the middle ear lasting more than 3 months, often leading to hearing problems
• Chronic suppurative otitis media: Long-term infection with persistent ear discharge and possible eardrum perforation

Understanding the signs and seeking timely medical advice can help you manage this condition effectively and prevent complications.

You or your child might have otitis media if you notice any of the following symptoms:

Common symptoms in children and adults:

• Ear pain or discomfort: Often sharp or throbbing, may worsen when lying down
• Fever or high temperature: Usually 38°C (100.4°F) or higher
• Fluid or discharge from the ear: May indicate eardrum perforation (see below)
• Muffled or reduced hearing: Sounds may seem distant or unclear due to fluid behind the eardrum
• Feeling of fullness or pressure: A sensation that the ear is blocked or "stuffed up"
• Balance problems or dizziness: The middle ear plays a role in balance

Additional symptoms in young children:

• Pulling, tugging, or rubbing the ear
• Irritability, crying, or fussiness (especially at night)
• Difficulty sleeping or lying down
• Loss of appetite or difficulty feeding
• Appearing not to hear or respond to sounds
• Loss of balance or clumsiness

If you suspect a middle ear infection, don't delay seeking advice from your GP, especially for young children or if symptoms are severe.

Middle ear infections are typically triggered by bacteria or viruses that enter the middle ear, often following a cold, flu, or other upper respiratory illness.

Primary causes:

• Bacterial infections: Common bacteria include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
• Viral infections: Respiratory viruses (including cold and flu viruses) can cause inflammation and fluid buildup
• Eustachian tube dysfunction: When the tube connecting the middle ear to the throat becomes blocked or swollen, fluid cannot drain properly

How infection develops:

1. A cold or respiratory infection causes inflammation in the nose, throat, and Eustachian tubes
2. The Eustachian tube becomes swollen or blocked, preventing normal drainage
3. Fluid accumulates in the middle ear, creating a warm, moist environment
4. Bacteria or viruses multiply in this trapped fluid, causing infection

Additional risk factors:

• Age: Children aged 6 months to 2 years are at highest risk
• Childcare attendance: Increased exposure to colds and respiratory infections
• Bottle feeding while lying down: Can allow formula to enter the Eustachian tubes
• Pacifier use: May increase middle ear infections in children over 6 months
• Seasonal factors: More common in autumn and winter when colds are prevalent
• Exposure to secondhand smoke: Irritates the Eustachian tubes and increases infection risk
• Allergies: Can cause Eustachian tube inflammation and congestion
• Family history: Genetic factors may make some people more prone to ear infections
• Cleft palate or Down syndrome: These conditions can affect Eustachian tube function

While adults can also develop middle ear infections, they're less common. When they do occur in adults, they may indicate underlying issues like allergies, chronic sinusitis, or Eustachian tube dysfunction.

The good news is that most middle ear infections clear up on their own within a few days to a week as your immune system fights off the infection. However, medical guidance is important to ensure proper care and prevent complications.

What your GP may recommend:

1. Watchful waiting (observation):

Your GP may recommend monitoring symptoms for 2-3 days before prescribing antibiotics, as many cases resolve without medication. This approach is common when:

• The child is over 6 months old
• Symptoms are mild to moderate
• There's no severe pain or high fever
• The infection affects only one ear

2. Pain and fever management:

• Over-the-counter pain relief: Paracetamol or ibuprofen (for children over 3 months, following age-appropriate dosing)
• Warm compress: A warm, damp cloth held against the ear can provide comfort
• Keeping upright: Sitting or sleeping with head elevated may reduce pressure

3. Antibiotics:

Your GP may prescribe antibiotics if:

• Symptoms are severe or worsening
• The child is under 6 months old
• There's discharge from the ear
• Both ears are infected
• The child has other health conditions
• Symptoms haven't improved after 2-3 days of observation

If antibiotics are prescribed, it's essential to complete the full course, even if symptoms improve quickly.

4. Additional treatments for persistent cases:

• Decongestants or antihistamines: May help if allergies or congestion are contributing factors
• Grommets (ventilation tubes): For chronic or recurrent infections, tiny tubes may be surgically inserted to help drain fluid and equalize pressure
• Adenoidectomy: Removing enlarged adenoids may help in cases of frequent infections

Home care during recovery:

• Ensure plenty of rest and fluids
• Keep ears dry—avoid swimming until fully healed
• Don't insert anything into the ear canal
• If the eardrum has perforated, keep water out of the ear during bathing
• Follow up with your GP if symptoms don't improve or worsen

For care home residents:

Older adults may not always communicate ear pain clearly, especially those with cognitive impairment. Watch for signs like increased confusion, agitation, or balance problems. If hearing seems reduced or the resident seems unwell, arrange a GP assessment promptly.

While it's not always possible to prevent middle ear infections, several strategies can reduce the risk, especially in children:

For children in childcare:

• Choose smaller group settings when possible to reduce exposure to infections
• Ensure the facility follows good hygiene practices
• Keep sick children home to prevent spreading illness

During cold and flu season:

• Encourage frequent handwashing
• Avoid sharing utensils, cups, or toys with sick individuals
• Clean and disinfect frequently touched surfaces
• Consider annual flu vaccination for the whole family

For adults prone to ear infections:

• Treat allergies and sinus conditions promptly
• Practice nasal irrigation during colds to keep passages clear
• Avoid smoking and secondhand smoke exposure
• Stay up to date with vaccinations

At Clear Ear Cheer, we're passionate about helping you maintain healthy ears for you and your family. We understand that ear health is crucial for communication, learning, quality of life, and overall wellbeing.

Our dedication includes:

• Providing clear, reliable, evidence-based information about ear conditions
• Supporting campaigns for better ear care access across the UK
• Educating families about prevention and early intervention
• Offering professional ear health assessments and care services
• Working alongside healthcare professionals to ensure comprehensive care

While middle ear infections require medical diagnosis and treatment from your GP, we're here to support you with education, prevention advice, and ongoing ear health maintenance.

Important reminder:

Otitis media is different from earwax build-up or outer ear infections. It requires medical evaluation and cannot be treated with over-the-counter earwax removal products or drops. Always consult your GP if you suspect a middle ear infection.

We work to ensure that everyone in our community—from young children to care home residents—has access to the information and services they need for optimal ear health.