Otitis Media
Also known as Middle ear infection, Glue ear
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is otitis media?
Otitis media is inflammation of the middle ear, common in young children because their eustachian tubes are short and horizontal. Acute infection causes ear pain and fever and usually settles without antibiotics. Persistent fluid without infection, known as glue ear, is a leading cause of temporary hearing loss and speech delay in children.
Causes
- Bacterial infection with pneumococcus or Haemophilus influenzae
- Viral upper respiratory infection preceding it
- Eustachian tube dysfunction
- Enlarged adenoids obstructing drainage
- Allergic rhinitis
Symptoms
- Ear pain, often worse lying down
- Fever
- Reduced hearing on the affected side
- Irritability and poor feeding in infants
- Pulling or rubbing the ear
- Discharge from the ear if the eardrum perforates
- Balance disturbance
Risk factors
- Age between 6 months and 3 years
- Attending nursery or daycare
- Exposure to tobacco smoke
- Bottle feeding while lying flat
- Cleft palate or Down syndrome
- Winter season
Diagnosis
- Otoscopy showing a red bulging eardrum in acute infection
- Pneumatic otoscopy or tympanometry to detect fluid
- Hearing assessment for persistent effusion
- Speech and language review where hearing loss is prolonged
Treatment
- Adequate analgesia, which is the priority for acute pain
- Delayed or no antibiotic strategy in many uncomplicated cases
- Antibiotics for infants, severe illness or bilateral infection in young children
- Watchful waiting for around three months in glue ear
- Grommet insertion for persistent effusion with hearing loss
- Adenoidectomy in selected recurrent cases
Self care
- Give regular paracetamol or ibuprofen, which is the main treatment
- Do not put drops or cotton buds in the ear unless advised
- Keep the ear dry if there is discharge
- Encourage fluids and rest
- Use upright positioning for feeds in infants
- Avoid exposure to tobacco smoke
When to see a doctor
Book an appointment if:
- Symptoms not improving after two to three days
- Discharge from the ear
- Hearing difficulty lasting more than a few weeks
- Frequent recurrent ear infections
- Speech or language concerns in a child
- Ear infection in a baby under six months
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Avoid exposure to tobacco smoke
- Breastfeed where possible
- Feed infants upright rather than lying flat
- Keep routine vaccinations up to date
- Manage allergic rhinitis
- Consider reduced daycare exposure in recurrent cases
Outlook
Most acute ear infections resolve within a few days with pain relief alone, and eardrum perforations usually heal spontaneously. Glue ear often clears within three months without intervention. Grommets are effective where fluid and hearing loss persist. Long term hearing outcomes are generally excellent when persistent effusion is identified and managed.
Common questions
Are antibiotics usually needed?
Often not. Most acute ear infections in otherwise healthy children over two resolve within a few days with pain relief alone. Antibiotics are reserved for younger infants, severe illness or lack of improvement.
What is glue ear?
Persistent fluid in the middle ear without acute infection. It causes muffled hearing that can affect speech and learning, and it is managed with observation first, then grommets if it persists with hearing loss.
When should I seek urgent review?
Swelling or redness behind the ear, the ear pushed forward, severe headache, neck stiffness, facial weakness or a very unwell child need urgent assessment for complications such as mastoiditis.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.