Otitis media

What is acute otitis media?

It is an inflammation of the middle ear. It can appear as a result of a cold, sore throat, or a virus.

What do we know about otitis media?

Up until the age of 3, over 80% of children will suffer from at least one episode of otitis media. Half of these children will have three episodes or more. Usually the first episode takes place when the child is around 12 months old. Boys usually suffer from otitis media more often than girls. Otitis media occurs more often during the winter.

Which children get otitis media more frequently?

All children may get otitis media, however it occurs more often in children

  • Whose parents smoke
  • Who go to nursery school
  • Who have older siblings
  • Who have a family history of otitis
  • Who did not breastfeed
  • Who drink from a bottle while lying supine
  • Who have immune system deficiencies (rare)

Why does otitis media occur?

The eustachian tube is a tube that connects the middle ear with the nose. When this tube is blocked for any reason (runny nose, virus, allergy, anatomical anomaly), fluid and bacteria become trapped in the middle ear, and can cause inflammation.

What are the symptoms of otitis media?

The child has earache. A smaller child may cry, be fussy, and rub his ears. Other symptoms may include fever, runny nose, poor hearing, loss of fluid from the ear, lack of appetite, vomiting.

How is the diagnosis of otitis made?

Besides taking the child’s medical history, and performing a clinical examination, the paediatrician will examine the ear with an otoscope.

How is otitis treated?

Usually the mildest antibiotics possible will be prescribed for 7-10 days. In many cases, a trial of anti-inflammatory medication for 48 hours can prevent the need for antibiotics. Antipyretics, lots of fluids, rest. Nasal drops recommended by the paediatrician may be used, usually saline solution.

Otitis media with effusion (secretory)

Very often, after an episode of acute otitis media, fluid can remain in the middle ear for up to around 3 months. This is known as otitis media with effusion. Usually there is no pain or fever, but the child may not be able to hear very well.

How is otitis media with effusion treated?

Most of the time, the fluid is gradually absorbed, and needs only simple monitoring. If the problem is persistent, a hearing test may be necessary. The paediatrician may try nasal drops, and/or antibiotics. The problem may be with hygiene at the nursery school, vaccinations that have been missed, or an immune system deficiency. A blood test may be needed. If the fluid remains for more than 3 months, the paediatrician may refer the child to an ear, nose, and throat specialist (otolaryngologist).

If conservative measures are not enough, 2 types of operation can help.

  • Myringotomy ( insertion of grommets)
  • Removal of  pharyngeal glands (adenoids)

Ask your paediatrician/otolaryngologist for details.

Are there other risks from acute otitis media?

If it is not treated properly, or is persistent, the following may occur:

  • Infection in adjacent parts of the head (rare)
  • Permanent poor hearing, usually mild
  • Problems with speech development (rare)


Reasons a child may suffer frequently from otitis


  • Environment with smokers
  • The child did not breastfeed
  • The child drinks milk from a bottle while lying on his back
  • The child doesn’t blow his nose
  • The child has allergic rhinitis
  • The child has vasomotor rhinitis
  • The child has an anatomic anomaly of the nose/face
  • The child suffers from gastro-oesophageal reflux
  • The child has large adenoids/pharyngeal polyps
  • The child has immune system deficiencies
  • The child has missed his vaccinations
  • Poor hygiene at the nursery school
  • The child still uses a pacifier
  • The child has become immune to antibiotics from overuse


Stelios Papaventsis Paediatrician MRCPCH DCH 2011

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