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Ear infection, middle ear


Disease: Ear infection, middle ear Ear infection, middle ear
Category: Ear, nose, larynx diseases

Disease Definition:

One of the common illnesses of early childhood is the otitis media (middle ear infection).


Usually, children stop having ear infections by the age of 4 or 5. Most ear infections clear up on their own within a few days, despite the fact that they make children uncomfortable and worry the parents.


Adults usually don’t get middle ear infections, and the treatments for adult ear infections are similar to those for children. However, in some very rare cases, surgery may be necessary.

Work Group:

Symptoms, Causes


In case a child is too young to say that his/her ear hurts, an ear infection in a child will be quite hard to detect. Children who have ear infections might:


  • Be unusually irritable
  • Complain of pain in their ears
  • Fail to respond to sounds
  • Cry more than usual
  • Have headaches
  • Tug or pull at their ears
  • Have trouble sleeping
  • Develop a fever of 38 C (100 F) or higher
  • Develop a clear fluid that drains from the ears.


To check for an infection, parents shouldn’t stick anything in their child’s ear.


Some of the signs and symptoms of adults who have a middle ear infection are:


  • Dizziness
  • Earache
  • Temporary loss of hearing
  • A feeling of blockage in the ear
  • Fever of 38 C (100 F) or higher.


Although ear infections could make an adult or a child uncomfortable, but they aren’t an emergency. However, a person should call a doctor in case the signs and symptoms linger for more than a day. In the case of children younger than 2 years, parents should watch for sleeplessness and irritability after an upper respiratory infection, such as a cold.


A doctor or a pediatrician should be called in case a discharge of blood or pus is seen from the ear, which could mean that the child’s eardrum has ruptured. This rupture of the eardrum could relieve the child’s pain, and he/she can go to a doctor for treatment even after a day or two, despite the fact that is seems like an emergency.


A parent should also call a doctor in case their child has been diagnosed with an ear infection but his/her signs and symptoms don’t improve within three days or become worse.


Usually, a cold or some other viral infection causes ear infections, in which case fluid builds up behind the eardrum and the middle ear lining becomes swollen from the viral infection.


Another possible cause of ear infection is the blockage or swelling in the narrow passageways that connect the middle ear to the nose (Eustachian tubes). When the eustachian tubes become blocked during a cold, fluid gets trapped in the middle ear, causing ear infection and pain.


Kids are more likely to develop ear infections than are adults, because their eustachian tubes are narrower and shorter than those of adults.


Swelling of the adenoids, which are tissues located in the upper throat near the eustachian tubes, is yet another cause of ear infections. These adenoids contain cells that normally fight infection. However, when they get infected or enlarged, the eustachian tubes get blocked. This infection could also spread to the eustachian tubes.


Children are more likely to develop illnesses such as colds and ear infections because their immune systems are not fully developed yet.



After about three days, most ear infections clear on their own. However, when ear infections last long or recur they could lead to: \

Ruptured eardrum:

Pus and fluid could press against the eardrum during ear infections, which could be quite painful. Rarely, this pressure could rupture the eardrum, in which case a discharge of blood and pus will be seen from the affected ear, a situation which could be alarming. However, this rupture relieves the pain and the eardrum heals on its own. In some cases, surgical repair may be necessary, when the eardrum ruptures repeatedly and doesn’t heal.

Short-term hearing loss:

Hearing could be affected temporarily due to fluid buildup, because it is more difficult for the eardrum and the tiny bones in the middle ear to send sound vibrations through fluid.


This is a type of sinus infection that could affect the space in the bone of the skull behind the ear. This infection can occur when the ear infection is not treated.
In some very rare cases, infections can move from the ear to other parts of the head.

Long-term hearing loss:

In most cases, the fluid disappears on its own in a few weeks. However, sometimes, it could remain in the middle ear for months, damaging the eardrum and bones in the middle ear. In the past, it was thought that persistent middle ear fluid contributes to speech or developmental delays in children. This theory is no more believed.


In most cases of ear infection, antibiotics or other treatments are not needed. Depending on the child’s age, medical history and type of ear infection, the best method of treatment will be advised.



In most cases, doctors will wait and see if the infection clears up on its own before prescribing antibiotics. The wait-and-see approach is advised for the first 72 hours especially for children who:


  • Are otherwise healthy
  • Are older than 6 months
  • Have mild signs and symptoms or an uncertain diagnosis.


Antibiotics don’t help an infection caused by a virus, in addition, most ear infections clear on their own in just a few days. Almost 80% of children with a middle ear infection recover without antibiotics. Adults’ ear infections also could clear on their own.


In order to help with the pain from the infection, some over-the-counter pain relievers will be recommended, such as ibuprofen or acetaminophen.


Prescription eardrops containing numbing medication could also be an option in case the child doesn’t have drainage from the ear or ear tubes. Although these drops will not cure the infection, but they could relieve the pain. The bottle containing the drops should be placed in warm water in order to make it warmer, and then the child should be laid on a flat surface with the infected ear facing up. Additionally, these drops shouldn’t be given when the child is on someone’s lap or in someone’s arms.



Antibiotic treatment is recommended for:


  • Children and adults who have had two or more ear infections in the past 30 days.
  • Children younger than 6 months


Although some doctors believe that people who have otitis media with effusion (OME) should be given antibiotics, but it is not universally agreed that antibiotics are necessary or that they will work in preventing an ear infection for people with OME.


Despite the fact that the first choice of antibiotic of many doctors is amoxicillin, but some other antibiotics could also be effective in case a person is allergic to amoxicillin.


The patient should start feeling better in a few days in case the medication is effective. However, they should take the antibiotic for the full length of the prescription because if they stop the medication too soon, the infection could come back.


It is worth mentioning that the overuse of antibiotics contributes to strains of the bacteria that resist these medications, and that antibiotics will not be able to treat an infection caused by a virus. Some of the side effects of medications include diarrhea, vomiting and allergic reactions.



Surgery may be suggested in case the recurrent ear infections don’t respond to antibiotics or if the child’s ear is affecting his or her hearing. However, in the case of adults, surgery is not a common treatment.


Myringotomy and the insertion of tubes in the child’s ears is the most common surgery for ear infections. In this procedure, a small drainage tube is inserted through the child’s eardrum, helping drain the fluid and equalize the pressure between the middle ear and outer ear.


Immediately after this procedure, the child’s hearing should improve. As the child grows the tubes will come out on their own and the drainage holes will heal within a year. But meanwhile, in order to keep water out of the child’s ears, he/she should wear special earplugs in the pool and bathtub.


In some cases, children continue having ear infections even after the surgery, which leads to another set of tubes. Removing the child’s adenoids may be recommended in case the ear infections continue after the age of 4.


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Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Talal Sabouni


Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

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