KidsMD Health Topics

Otitis Media

  • Overview

    Otitis media is inflammation centered in your child's middle ear. It often occurs after a cold, sore throat, or respiratory infection.

    • More than 80 percent of children have at least one episode of otitis media by the time they are 3 years old.
    • Nearly half of these children have three or more episodes by the time they are 3 years old.
    • Otitis media can also affect adults, although it's primarily a condition that occurs in children.
    • Otitis media is the most common diagnosis for children in the US.
    • About 30 million visits to the pediatrician each year are due to otitis media.
    • Otitis media occurs most often in children younger than 7 years old and even more frequently in children between the ages of 6 months and 3 years old.
    • Otitis media is more common in boys than girls.
    • Otitis media occurs more often in the winter and early spring.

    How Boston Children's Hospital treats otitis media

    Our physicians and researchers have extensive expertise treating otitis media, particularly as a recurrent condition. Your child will be seen through our General Pediatric Otolaryngology Program.

    Jonathan Finkelstein, MD, MPH, pediatrician at Children's

    Boston Children's Hospital 
    300 Longwood Avenue
    Boston MA 02115

  • In-Depth

    What causes otitis media?

    Middle ear infections are usually a result of a malfunction of the eustachian tube, a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a build up of fluid behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media.

    The eustachian tube may not work properly if:

    • The child has a cold or allergy, which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids).
    • The eustachian tube has a malformation which causes a build up of fluid.

    What are the different types of otitis media?

    Different types include the following:

    • Acute Otitis Media (AOM). The middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing your child to have a fever, ear pain, and hearing loss.
    • Otitis Media with Effusion (OME). Fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. Your child may experience a feeling of fullness in the ear and hearing loss.
  • Tests

    While any child may develop an ear infection, some factors increase your child's risk of developing ear infections.

    What are the symptoms of otitis media?

    The following are the most common symptoms of otitis media. However, each child may experience symptoms differently. Symptoms may include:

    • unusual irritability
    • difficulty sleeping or staying asleep
    • tugging or pulling at one or both ears
    • fever
    • fluid draining from ear(s)
    • loss of balance
    • hearing difficulties
    • ear pain
    • nausea and vomiting
    • diarrhea
    • decreased appetite
    • congestion

    The symptoms of otitis media may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

    In addition to taking a complete medical history and physical examination, your child's physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

    Tympanometry is a test that can be performed in most physicians' offices to help determine how the middle ear is functioning. It doesn't determine if your child is hearing or not, but helps to detect any changes in pressure in the middle ear. Your doctor also might perform a hearing test, if your child has frequent ear infections.

  • How will my child's otitis media be treated?

    Specific treatment for otitis media will be determined by your child's physician. Treatment may include:

    • antibiotic medication by mouth or ear drops
    • medication (for pain)

    If fluid remains in the ear(s) for longer than three months, your child's physician may suggest that small tubes be placed in the ear(s). This surgical procedure, called myringotomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. Your child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months.

    Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called nasopharynx) if they are infected. Removal of the adenoids has shown to help some children with otitis media.

    Treatment will depend upon the type of otitis media. Consult your child's physician regarding treatment options.

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