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The Middle Ear

The outer ear, the part you can see, collects sound waves; the middle ear passes these sound waves on to the inner ear. Key parts of the middle ear are the eardrum, three delicate bones (hammer, anvil, and stirrup) that conduct sound to the inner ear, and the auditory (Eustachian) tube, which, when healthy, keeps air pressure the same in the middle ear and the outer ear. The most common problems of the middle ear are infections and damage to the eardrum.

Acute Infection of the Middle Ear

Acute otitis media (AOM), a severe infection of short duration, is an inflammation of the cells lining the middle ear. Usually AOM is caused by a virus, but sometimes the infection is caused by bacteria. Infection often develops when viruses from a nose or throat infection travel up the Eustachian tube and enter the middle ear. The viruses cause inflammation that blocks the Eustachian tube. Secretions (fluids) then accumulate in the middle ear, allowing bacteria to grow.

Acute infections of the middle ear are very common during the first 2 years of life. Nearly 40% of all infants have at least one middle ear infection during the first 6 months of life. More than 80% of children will have at least one ear infection by the age of 3 years.

A number of things can increase your child's risk of a middle ear infection. It is also common for a child to develop repeat infections. This is most likely to occur if the child has his or her first middle ear infection before 6 months of age.

Factors that increase the risk of a middle ear infection:

  • Age <6 months at first ear infection

  • Male gender

  • Brother or sister with a history of ear infections

  • Bottle given in bed

  • Exposure to other children at home or in day care 

Signs of a Possible Middle Ear Infection

Rubbing or tugging on the ear is a common sign in young children. Older children may say they have a pain in their ear or that the ear feels blocked. Some children with a middle ear infection will have a fever and signs of an earache and will cry and become irritable. Some may experience a change in their sleep pattern or have a decrease in their appetite. However, these same signs may be present in children with other conditions.

Only your health care provider can determine whether or not your child has a middle ear infection that needs treatment. If your child develops any of the signs that suggest an ear infection, please call your health care provider as soon as possible.

Signs of a possible middle ear infection:

  • Rubbing or tugging on the ear

  • Earache

  • Ear feels blocked

  • Fever

  • Crying

  • Irritability

  • Change in sleep pattern

  • Decreased appetite 

Why it is Important to Treat AOM  

When caused by bacteria, acute middle ear infections that are not treated may lead to serious problems. Pus can collect in the middle ear and cause enough pressure to burst the eardrum. The infection may never completely clear up, leaving bacteria in the ear. Or it may clear up but leave the ear susceptible so that it becomes infected again. When a child continues to have ear infections, it often means that the medicines that have been used can no longer fight the bacteria, and other medicines may be needed.

Persistent middle ear infection is often the result of an acute middle ear infection that was not treated. With an untreated infection, pus or fluid is continually produced. The presence of this fluid may cause hearing loss because of damage to the eardrum and/or the small bones in the middle ear. Hearing problems can lead to speech and language problems for your child.

Infants and young children with repeat or continuing middle ear infections may have to have surgery. The surgeon will place a small tube (tympanostomy tube) through a hole made in the eardrum. This tube lets fluid flow out of the middle ear and lets air enter into it to help keep the middle ear dry. Your provider may recommend this procedure if your child has had four cases of acute middle ear infection during a one-year period.

Although these tubes may reduce the number of ear infections and their related problems, they raise the cost of treatment. The tubes must be put in place while your child is anesthetized (asleep), and a hole may be left in the eardrum if the tubes get loose. Special care of your child's ear is also needed to keep the tube from becoming blocked or from allowing water to enter the middle ear.


Acute middle ear infection can be treated if you see your health care provider as soon as possible after signs appear.

Antibiotics Your provider will most likely prescribe an antibiotic medicine for your child's ear infection because children who receive antibiotics get better faster than those who don't. Several antibiotic liquids can be used for infants and young children who can't swallow pills. Once your child starts taking the antibiotic, it will take a day or two before you notice an improvement. Even though your child may begin to look and feel better, you need to have your child finish all of the medicine to make sure the infection is completely gone. Antibiotics can cause mild side effects, such as diarrhea, loose bowel movements, nausea, or cramping. If you notice these or any other unusual side effects, do not skip a dose or stop giving the medicine to your child. Call your provider for instructions.

If your child does not start to feel better within 2 or 3 days, you should call your provider to see if a different antibiotic is needed.

Pain medicine If your child has an earache, your provider will probably prescribe a medicine you can buy without a prescription, such as Children's Advil® or Children's Tylenol®, to ease the pain.

Other medicines You may be tempted to give your child another medicine to help him or her sleep at night. Do not give your child any medicine unless your provider has told you to. Using other medicines may not be good for the treatment of this condition.

Making your child more comfortable There are a few things that can be done to make your child feel more comfortable. For example, ear pain is less bothersome when a child is sitting rather than lying down. Setting an electric heating pad on low and placing it against the ear can also provide some pain relief, but do not let your child sleep on the heating pad. Do not give your child a pacifier; sucking on a pacifier can change the pressure in the ear and increase discomfort.

What You Can Do

You have an important role in treating your child's middle ear infection and preventing more infections.

  • If your provider suggests it, have your child vaccinated for influenza and pneumonia (pneumococcal vaccine). Reducing the risk of these infections can also reduce the risk of acute middle ear infection.
  • Recognize the signs suggesting an acute middle ear infection and get medical treatment at once.
  • Give your child all the medicines exactly as prescribed and for as long as prescribed.
  • Do not give your child any other medicine unless your provider tells you to.
  • Call your provider if your child develops any serious side effects, or if there is no improvement within 2 to 3 days after the start of treatment.
  • Avoid smoking tobacco anywhere near your child, particularly in the car.
  • Observe your child. Depending on the age of your child and the physical findings after examination of your child's ear, your provider may decide not to prescribe a medicine for a short period of time (48 hours) to see if the ear infection clears on its own.

Please call Dr. Schwartz if you would like more information, if you would like to set up an appointment, or if your child or loved one is suffering with any of these symptoms: 702.647.2900.

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