Middle ear infection: causes, symptoms, treatment

An inflammation of the middle ear is also called otitis media. It is a common disease, especially in infants and young children. But you can also get a middle ear infection at other ages. What are the causes and symptoms? How is a middle ear infection diagnosed and treated?

Article content

  • The ear
  • Middle ear infection
  • Causes of middle ear infection
  • Symptoms of middle ear infection
  • Diagnosis of middle ear infection
  • Treatment of middle ear infection
  • Complications
  • Swimming


The ear

The ear is the organ of hearing and balance. It consists of three parts: the external ear, the middle ear and the inner ear. The parts of the external ear: the auricle and the external auditory canal. The ear canal ends at the eardrum. The middle ear is the space behind the eardrum, where the ossicles are located. The middle ear is connected to the nasopharynx via the Eustachian tube. The inner ear consists of the cochlea and the three semicircular canals. The cochlea is the real hearing organ, the three semicircular canals play a role in the sense of balance. They transmit movements of the head to the brain. The most common ear disorders are inflammation of the ear canal (otitis) and middle ear infection (otitis media). An inner ear infection is not that common. With mastoiditis, the bone behind the ear is also inflamed.

Middle ear infection

(Acute) otitis media is an infection of the middle ear, which often causes (severe) ear pain. It often occurs in children under four years of age. Gender is not a significant factor. It is the most common cause of earache in children. The Eustachian tube runs between the middle ear and the nasopharynx. Fluid from the middle ear can be drained via the Eustachian tube to the nasopharynx. If the Eustachian tube is blocked, viruses, bacteria and inflammatory fluid are trapped in the middle ear. The pressure will rise, the eardrum will bulge and that will cause pain. A middle ear infection is more common when parents smoke. The condition sometimes runs in families, and there may be a hereditary factor.

Causes of middle ear infection

A middle ear infection usually starts with a common cold. This can cause the Eustachian tube to become blocked. In most cases, the inflammation is caused by bacteria. It is unclear whether viruses can cause a middle ear infection. It is suspected that viruses make the middle ear more sensitive to bacterial invasion due to the initiated inflammatory response.

Symptoms of middle ear infection

The symptoms of a middle ear infection often develop within a few hours. A middle ear infection is often accompanied by pain in the ear, general malaise, increased body temperature, and runny ears. A runny ear is an ear with fluid discharge, which can be bloody. Very young children cannot yet point out the location of the pain. The symptoms in a young child are: increased body temperature and crying. Older children may indicate more: they report pain in the ear, pulling or rubbing on the affected ear, and they may temporarily have difficulty hearing in the inflamed ear. If nothing is done, the eardrum may rupture and the pain will diminish. If the eardrum ruptures, blood and pus may come out of the ear.

Diagnosis of middle ear infection

The ear canal and eardrum can be examined with an otoscope. This is an otoscope that illuminates and magnifies the inside of the ear. The examination is used to diagnose, for example, a middle ear infection or a ruptured eardrum. It is checked whether there is pus present.

Treatment of middle ear infection

A doctor will usually prescribe something to reduce the pain and for many pain complaints the eardrum can be punctured. If there is a blocked nose, nasal drops can be prescribed. In children older than six months, antibiotics are usually not necessary. If the complaints do not subside after three days or if the child becomes increasingly ill, drinks poorly or if the pain becomes worse, always contact a doctor! If you have a child under six months of age, please contact us immediately (i.e. on day one). Children with a cleft palate, children with Down syndrome and children with reduced resistance belong to the so-called risk groups. It is also important for them to consult a doctor immediately. It may be decided to give antibiotics, a referral to an ENT doctor is also an option. With proper treatment, symptoms usually disappear within a few days. A ruptured eardrum takes a little longer: the eardrum will heal within a few weeks. If a middle ear infection keeps recurring and does not respond to antibiotics, you can consider placing eardrum tubes, possibly in combination with removing the tonsils.


If a child has a repeated middle ear infection, this can lead to a chronic accumulation of mucus. This is also called chronic otitis media with effusion. Effusion is the leakage of (body) fluids into a body cavity or other tissue. People also speak of: glue ear or glue ear.


With a runny ear, swimming with the head under water is not recommended, but it is also better not to swim with a dry eardrum perforation, because dizziness can occur due to labyrinth stimulation. You can shower because the chance of water entering the middle ear is minimal. Further information can be found at: nhg.org.

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