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Otitis media — A common ear infection

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By Dr Johannes Marisa

Otitis media is an infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.

Signs and symptoms

The onset of signs and symptoms of ear infections is usually rapid. It is better to look at these symptoms with age groups.


The following signs and symptoms are quite common in children. Please observe your child for the following:

  • Ear pain, especially when lying down
  • Tugging or pulling at an ear
  • Trouble sleeping
  • Excessive crying
  • Trouble hearing or responding to sound
  • Discharge from the ear
  • Fever
  • Headache
  • Refusing to feed or loss of appetite
  • Loss of balance

In adults, the following signs and symptoms are quite common and take action if you happen to have them.

  • Ear pain
  • Drainage of fluid from the ear
  • Trouble hearing.

When should one see a doctor?

You should know that an ear infection can be a pointer to a number of conditions. An accurate diagnosis should thus be made. Visit your clinician if:

  • Symptoms last for more than a day
  • If there is a discharge from the ear which can be blood, fluid or pus
  • Symptoms are present in a child less than 6 months of age
  • If ear pain is unbearable
  • If your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection.

Risk factors

There are many factors that predispose one to ear infections.

The following are some of them.

  • Age — Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of the Eustachian tubes and that their immune system is still growing.
  • Group child care — Children cared for in group settings are more likely to get colds and ear infections than children who are at home. Crowded children are at more risk of getting common colds.
  • Seasonal factors — Ear infections are more common during winter than in summer. People with seasonal allergies may be at greater risk of ear infections.
  • Poor air quality—Exposure to tobacco smoke or high levels of air pollution predisposes to ear infections.
  • Cleft palate — Differences in the bone structure and muscles in children who have cleft palates may make it more difficult for the Eustachian tube to drain.


You should be wary of complications of otitis media and that is why early treatment should be sought.

Repetitive ear infections are the ones that can cause serious complications. The following should be borne in mind:

  • Impaired hearing — Mild hearing loss that can come and go is quite common but usually disappears after the infection is cleared.

If there is some permanent damage to the eardrum or middle ear structures, permanent hearing loss can ensue.

  • Speech or developmental delays — If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
  • Spread of infection — Untreated or unresponsive treatments can spread to nearby tissues.

Infections such as mastoiditis can occur with damage to the bone and formation of pus-filled cysts.

Brain abscess can develop and rarely, one can develop meningitis.

  • Tearing of the eardrum—Most eardrum tears heal within 72 hours.

In some cases, surgical repair is needed.


The following tips may reduce the risk of developing ear infections:

  • Preventing common colds—Teach your children to wash their hands frequently and thoroughly and to avoid sharing utensils. If possible, limit the time your child spends in group child care.
  • Breast-feed your baby — Breast milk contains antibodies that may offer protection from ear infections
  • Avoid secondhand smoke — Make sure you are kept away from smokers at your home. When you are away from home, stay in smoke-free areas.
  • Be up-to-date with vaccination — let your children get the appropriate vaccinations for their ages. Seasonal flu shots, pneumococcal and other bacterial vaccines may help prevent ear infections.


Diagnosis of an ear infection can come from the presented history and examination. Doctor can likely use a lighted instrument, an otoscope, to look at the ears, throat and nasal passage.

  • Pneumatic otoscope — The use of the pneumatic otoscope allows a doctor to look in the ear and determine whether there is fluid behind the eardrum
  • Tympanometry — This test measures the movement of the eardrum
  • Acoustic reflectometry — The test measures how much sound is reflected back from the eardrum, an indirect measure of fluids in the middle ear.
  • Tympanocentesis — A tiny tube can be inserted into the eardrum to drain some fluid from the middle ear. This is rarely done nowadays.


Some ear infections can resolve without antibiotics. What is best for your child depends on many factors including the child’s age and the severity of symptoms.

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