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Otitis Media: Causes, Symptoms, and Diagnosis

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Acute otitis media (AOM) is a painful type of ear infection. It occurs when the area behind the eardrum called the middle ear becomes inflamed and infected.

The following behaviours in children often mean they have AOM:

  • fits of fussiness and intense crying (in infants)
  • clutching the ear while wincing in pain (in toddlers)
  • complaining about a pain in the ear (in older children)

What are the symptoms of acute otitis media?

  • crying
  • irritability
  • sleeplessness
  • pulling on the ears
  • ear pain
  • a headache
  • neck pain
  • a feeling of fullness in the ear
  • fluid drainage from the ear
  • a fever
  • vomiting
  • diarrhoea
  • irritability
  • a lack of balance
  • hearing loss

What causes acute otitis media?

The eustachian tube is the tube that runs from the middle of the ear to the back of the throat. An AOM occurs when your child’s eustachian tube becomes swollen or blocked and traps fluid in the middle ear. The trapped fluid can become infected. In young children, the eustachian tube is shorter and more horizontal than it is in older children and adults. This makes it more likely to become infected.

The eustachian tube can become swollen or blocked for several reasons:

  • allergies
  • a cold
  • the flu
  • a sinus infection
  • infected or enlarged adenoids
  • cigarette smoke
  • drinking while laying down (in infants)

Who’s at risk for acute otitis media?

The risk factors for AOM include:

  • being between 6 and 36 months old
  • using a pacifier
  • attending daycare
  • being bottle fed instead of breastfed (in infants)
  • drinking while laying down (in infants)
  • being exposed to cigarette smoke
  • being exposed to high levels of air pollution
  • experiencing changes in altitude
  • experiencing changes in climate
  • being in a cold climate
  • having had a recent cold, flu, sinus, or ear infection

Genetics also plays a role in increasing your child’s risk of AOM.

How is acute otitis media diagnosed?

Your child’s doctor may use one or more of the following methods to diagnose AOM:


Your child’s doctor uses an instrument called an otoscope to look into your child’s ear and detect:

  • redness
  • swelling
  • blood
  • pus
  • air bubbles
  • fluid in the middle ear
  • perforation of the eardrum

During a tympanometry test, your child’s doctor uses a small instrument to measure the air pressure in your child’s ear and determine if the eardrum is ruptured.


During a reflectometry test, your child’s doctor uses a small instrument that makes a sound near your child’s ear. Your child’s doctor can determine if there’s fluid in the ear by listening to the sound reflected back from the ear.

Hearing Test

Your doctor may perform a hearing test to determine if your child is experiencing hearing loss.

How is acute otitis media treated?

The majority of AOM infections resolve without antibiotic treatment. Home treatment and pain medications are usually recommended before antibiotics are tried to avoid the overuse of antibiotics and reduce the risk of adverse reactions from antibiotics. Treatments for AOM include:


Your doctor may suggest the following home care treatments to relieve your child’s pain while waiting for the AOM infection to go away:

  • applying a warm, moist washcloth over the infected ear
  • using over-the-counter (OTC) ear drops for pain relief
  • taking OTC pain relievers such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol)


Your doctor may also prescribe eardrops for pain relief and other pain relievers. Your doctor may prescribe antibiotics if your symptoms don’t go away after a few days of home treatment.


Your doctor may recommend surgery if your child’s infection doesn’t respond to treatment or if your child has recurrent ear infections. Surgery options for AOM include:

Adenoid removal

Your child’s doctor may recommend that your child’s adenoids be surgically removed if they’re enlarged or infected and your child has recurrent ear infections.

Ear tubes

Your doctor may suggest a surgical procedure to insert tiny tubes in your child’s ear. The tubes allow air and fluid to drain from the middle ear.

How to prevent acute otitis media

You can reduce the chances of your child having AOM by doing the following:

  1. Wash hands and toys frequently to reduce your chances of getting a cold or other respiratory infection
  2. Avoid cigarette smoke
  3. Get seasonal flu shots and pneumococcal vaccines
  4. Breastfeed infants instead of bottle feeding them if possible
  5. Avoid giving your infant a pacifier

What’s the long-term outlook?

AOM infections generally get better without any complications, but the infection may occur again. Your child may also experience temporary hearing loss for a short time. But your child’s hearing should return quickly after treatment. Sometimes, AOM infections can cause:

  • recurrent ear infections
  • enlarged adenoids
  • enlarged tonsils
  • a ruptured eardrum
  • a cholesteatoma, which is a growth in the middle ear
  • speech delays (in children who have recurrent otitis media infections)

In rare cases, an infection in the mastoid bone in the skull (mastoiditis) or an infection in the brain (meningitis) can occur.



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