Middle Ear Infection

A middle ear infection is inflammation or infection behind the eardrum that can cause pain, pressure and temporary hearing change.

It is also called otitis media. Fluid can collect behind the eardrum when the tube that connects the middle ear to the back of the nose is swollen or blocked. This is common after a respiratory infection, especially in children.

Earache, ear discharge and hearing loss are very common presentations of middle ear infection. Fever and vertigo are common presentations. Children may pull at an ear, cry more than usual, sleep poorly, seem less responsive to sound or have reduced appetite.

Discharge can happen if pressure causes a small tear in the eardrum. Pain may then ease, but the ear still needs clinical advice. Severe pain behind the ear, swelling around it, marked dizziness, facial weakness or a very unwell child need urgent assessment.

A cold can swell the nose and eustachian tube, trapping fluid behind the eardrum where infection may develop. Allergic rhinitis can also contribute by causing nasal swelling. Bacteria or viruses may be involved, and the cause is not always clear from symptoms alone.

Pain and fever may ease as inflammation settles, while a blocked sensation or reduced hearing can continue while fluid clears. Repeated episodes or persistent fluid can affect communication and sleep. Arrange review if symptoms are not improving, keep returning, or hearing remains changed.

Young children are more prone because their eustachian tubes are smaller and lie more horizontally. Recent respiratory infections, nasal allergies, smoke exposure, feeding while lying flat and structural differences affecting the nose or palate can contribute. These factors do not mean an infection is inevitable.

A clinician asks about pain, fever, discharge, hearing and recent colds, then looks into the ear with an otoscope. They may assess the eardrum's colour and movement, examine the nose and throat, and consider a hearing assessment when fluid or hearing difficulty persists.

Comfort measures such as fluids, rest and appropriate pain relief may be recommended. Antibiotics are useful in selected situations, depending on age, severity, examination findings and how long symptoms have lasted; they are not suitable for every ear infection. Take any prescribed medicine exactly as directed and do not put objects or unadvised drops into a draining ear.

Keep the ear dry if it is discharging unless a clinician gives different advice. Help children rest and offer regular drinks. Track fever, pain, discharge and hearing so you can report whether the pattern is improving. Avoid smoke exposure around children.

Most cases settle, but fluid, a perforated eardrum, repeated infections or persistent hearing difficulty may need follow-up. Urgent review is important for redness or swelling behind the ear, worsening severe headache, stiff neck, severe dizziness, weakness of the face or increasing illness.

Hand hygiene and reducing close contact during colds can limit respiratory infections. Managing nasal allergy symptoms with a clinician's advice and keeping homes smoke-free can reduce irritation around the eustachian tube. Keep routine vaccinations up to date according to local advice.

A GP can assess ear pain, fever, discharge or hearing changes and decide whether further care is needed. Ear, nose and throat referral may be considered for repeated infections, persistent fluid, a perforation that does not heal, or ongoing hearing concerns.