Middle ear infection is a common condition, especially in children. In fact, five out of six children will have at least one ear infection by the time they turn three years old4.


Middle ear infections are a very common occurrence in children and are one of the most frequent reasons children need to visit the doctor. Whilst ear infections can often cause distressing symptoms, they very rarely lead to serious complications. They are a common cause of fever and a painful ear.

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Causes and Risk Factors

The middle ear is the area behind the eardrum and this air-filled cavity communicates with the back of the throat via a small ventilation tube known as the Eustachian tube. When the Eustachian tube becomes blocked (e.g., due to upper respiratory tract infections or allergies), the pressure in the middle ear drops. Fluid and mucous builds up in the cavity (known as a “glue ear”) and this fluid can become infected causing “otititis media” or or middle ear infection.2

The following are risk factors that may increase the likelihood of developing a middle ear infection:

  • Age (children under the age of five are more likely to get middle ear infections)
  • Family history of ear infections
  • Being male (boys are more likely to get ear infections than girls)
  • Exposure to cigarette smoke
  • Attending daycare
  • Bottle feeding instead of breastfeeding
  • Seasonal allergies or other respiratory infections
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The following are common symptoms of middle ear infection:

  • Ear pain
  • Fever
  • Upper respiratory symptoms such as as a runny nose or sore throat
  • A discharge from the ear (this occurs if a hole forms in the eardrum, allowing fluid from the middle ear to drain outwards via the ear canal.)
  • Headache
  • Loss of appetite
  • Sleep disturbance
  • Lethargy
  • Hearing difficulties

If you or your child is experiencing any of these symptoms, it is important to see a doctor for a proper diagnosis.3

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To diagnose middle ear infection, a doctor will use an otoscope to look inside the ear and check for signs of infection or fluid build-up behind the eardrum.4 The doctor may also use a pneumatic otoscope to check how well the eardrum moves when air is blown into the ear canal.1 In some cases, a hearing test may be necessary to determine if the infection has caused any hearing loss.3

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In many cases, antibiotics are prescribed to clear up the infection in the middle ear.1 Pain relievers such as paracetamol or ibuprofen can also be taken to manage pain and reduce fever.3 In severe cases or when other treatments have failed, surgery may be necessary to drain the fluid from the middle ear. This surgery is a simple procedure, often referred to as “grommits.” A grommit is a ventilation tube which is placed into the eardrum. The middle ear now has a back-up tube which is used to equalise pressure and helps to prevent pressure changes if the Eustachian tube becomes blocked. Most ear, nose and throat surgeons will consider grommits if a child has experienced multiple ear infections (more than 3 or 4 a year), which have required frequent antibiotic therapy.2

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Prevention and Lifestyle Changes

The following are some tips to help prevent middle ear infections:

  • Avoid exposure to cigarette smoke
  • Avoid exposure to known environmental allergens
  • Breastfeed your baby if possible
  • Keep your child up to date on vaccinations
  • Wash your hands often to avoid the spread of germs

If you or your child is prone to ear infections, talk to a doctor about other strategies to prevent future infections.4

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This referenced content has been reviewed by Dr Cilliers, who is a qualified medical doctor with extensive experience in the private healthcare sector of South Africa, particularly in the disciplines of emergency medicine, general practice, geriatrics, healthcare leadership, sub-acute care and physical rehabilitation.

  1. American Academy of Otolaryngology-Head and Neck Surgery. (2021). Ear infections in children. https://www.enthealth.org/conditions/ear-infections-in-children/
  2. Centers for Disease Control and Prevention. (2021). Ear infections. https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/ear-infections.html
  3. Mayo Clinic. (2021). Ear infections (otitis media). https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616
  4. National Institute on Deafness and Other Communication Disorders. (2020). Ear infections in children. https://www.nidcd.nih.gov/health/ear-infections-children
  5. Steele, D. W. (2021). Otitis media (middle ear infection) in children. Merck Manual Consumer Version. https://www.merckmanuals.com/home/children’s-health-issues/ear-disorders-in-children

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