Why Is Acute Otitis Media More Common in Children?

The Eustachian tube connects the middle ear to the back of the nose. Its function is to ventilate the middle ear, balance pressure and allow fluid to drain.

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In babies and young children, this tube is shorter, narrower and more horizontal than in adults. It can therefore become blocked more easily during a cold or nasal infection.

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Other factors that may increase the risk of childhood ear infections include:

• Frequent colds or upper respiratory infections

• Attendance at childcare or kindergarten

• Enlarged adenoids

• Allergic rhinitis and persistent nasal congestion

• Exposure to cigarette smoke

• Bottle-feeding while lying flat

• Craniofacial conditions such as cleft palate

• A previous history of recurrent ear infections

 

Children are more likely than adults to develop middle ear infections, but acute otitis media can occur at any age.

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Symptoms of Acute Otitis Media in Children

Older children can usually describe ear pain, pressure or reduced hearing. Babies and toddlers may not be able to explain what they are feeling.

 

Possible symptoms include:

• Sudden ear pain

• Fever

• Crying or unusual irritability

• Pulling, rubbing or tugging at the ear

• Difficulty sleeping

• Poor feeding

• Reduced response to sounds

• Muffled hearing

• A sensation of ear blockage

• Loss of balance

• Pus or fluid coming from the ear

 

Ear discharge may occur when pressure from infected fluid causes the eardrum to perforate. The pain may suddenly improve after the eardrum ruptures because the pressure has been released, but the child should still be examined.

 

Ear pulling alone does not always mean that a baby has an ear infection. Teething, tiredness, earwax and irritation of the outer ear may produce similar behaviour.

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Acute Otitis Media in Adults

Although less common than childhood ear infections, adults may also develop acute otitis media, particularly after:

• A cold or influenza

• Severe nasal congestion

• Sinus infection

• Allergic rhinitis

• Eustachian tube dysfunction

• Air travel or pressure changes

• Reduced immunity

 

Adults may experience severe ear pain, pressure, muffled hearing, fever, tinnitus or ear discharge. Repeated infections in the same ear, persistent one-sided middle-ear fluid or hearing loss that does not recover should be assessed by an ENT specialist. The ear, Eustachian tube, nose and nasopharynx may need to be examined to identify the underlying cause.

 

How Is Acute Otitis Media Diagnosed?

An ENT specialist or doctor will examine the ear canal and eardrum using an otoscope or microscope.

Typical findings may include:

• A red and inflamed eardrum

• Bulging of the eardrum

• Pus or fluid behind the eardrum

• Reduced movement of the eardrum

• An eardrum perforation with discharge

 

A red eardrum alone does not always confirm acute otitis media. A crying child, fever or irritation of the ear canal can also make the eardrum appear red. A more reliable diagnosis usually requires evidence of middle-ear fluid together with bulging or inflammation of the eardrum.

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Additional investigations are not required for every patient. Depending on the situation, an ENT assessment may include:

• Ear examination under a microscope

• Tympanometry to assess middle-ear pressure and fluid

• Hearing assessment

• Ear-discharge swab for culture

• Nasal or nasopharyngeal examination

• Imaging when complications such as mastoiditis are suspected

 

Is Acute Otitis Media the Same as Glue Ear?

No. They are related but different conditions. Acute otitis media is an active middle-ear infection that usually causes pain, inflammation and sometimes fever or pus.

 

Otitis media with effusion, commonly called glue ear, refers to fluid remaining behind the eardrum without the symptoms of an acute infection. The child may appear well but have muffled hearing, poor concentration, delayed speech or difficulty following conversations.

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Middle-ear fluid can remain temporarily after an acute infection has settled. Antibiotics do not automatically remove this residual fluid. Persistent glue ear may require hearing monitoring and, in selected cases, grommet tube insertion.

 

Does Every Ear Infection Need Antibiotics?

Not every mild ear infection requires immediate antibiotics. Pain relief, fever control and close observation may be appropriate for selected children with mild symptoms, provided that reliable follow-up is available. Many uncomplicated cases begin improving within a few days.

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Antibiotics are more likely to be considered when:

• The child is very young

• Pain is moderate or severe

• Fever is high

• Both ears are affected in a young child

• Pus is coming from the ear

• Symptoms are worsening

• The infection has not improved after observation

• The child has significant underlying medical conditions

• Complications are suspected

 

The antibiotic choice should be based on the patient’s age, severity, allergy history, recent antibiotic exposure and clinical findings. Parents should not use leftover antibiotics or stop a prescribed course without medical advice.

 

Guidelines support selective observation for suitable mild cases while recommending prompt treatment for severe disease and close reassessment if symptoms fail to improve within 48 to 72 hours.

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Treatment for Acute Otitis Media

Treatment depends on the patient’s age, symptoms, examination findings and whether complications are present.

 

Pain and Fever Relief

Controlling ear pain is an important part of treatment. Appropriate pain and fever medicine may be prescribed or recommended according to the child’s age and weight.

Do not give aspirin to children.

 

Observation and Follow-Up

A mild infection may be monitored for a short period when the patient is otherwise well and follow-up is available.

The ear should be reviewed if symptoms become worse or fail to improve.

 

Antibiotics

Antibiotics may be prescribed when bacterial infection is likely or the illness is severe. The exact medication and duration should be determined by the treating doctor.

 

Treatment of Nasal Problems

Allergic rhinitis, severe nasal blockage, sinus infection or enlarged adenoids may contribute to poor Eustachian tube ventilation. Treating the associated nasal condition may form part of the overall management, particularly in patients with recurrent ear infections or persistent middle-ear fluid.

 

Ear Microsuction

Microsuction may be required when ear discharge blocks the ear canal and prevents proper examination of the eardrum.

Microsuction removes discharge from the external ear canal. It does not directly remove pus trapped behind an intact eardrum.

 

When Is Myringotomy Needed?

A myringotomy is a procedure in which a very small opening is made in the eardrum. This allows trapped fluid or pus in the middle ear to be suctioned out.

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It may be considered in selected situations such as:

• Severe pressure and pain from pus behind the eardrum

• Infection that is not responding to appropriate treatment

• Complicated acute otitis media

• Persistent middle-ear fluid causing hearing problems

• The need to obtain a middle-ear fluid sample

• Recurrent infections with persistent middle-ear effusion

 

Myringotomy is not routinely required for every episode of acute otitis media.

 

What Is a Tympanostomy or Grommet Tube?

A tympanostomy tube, ventilation tube or grommet is a tiny tube inserted through the opening created during myringotomy.

 

The grommet:

• Ventilates the middle ear

• Equalises middle-ear pressure

• Allows trapped fluid to drain

• Reduces the effect of Eustachian tube blockage

• Makes future middle-ear discharge easier to treat with ear drops

Short-term grommets usually remain in the eardrum temporarily and are gradually pushed out as the eardrum heals.

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Grommet insertion may be considered for children with persistent glue ear and documented hearing difficulty, or recurrent acute otitis media when middle-ear fluid is present during the ENT assessment. It is not normally recommended solely because a child has had one uncomplicated ear infection.

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When Is Mastoidectomy Required?

The mastoid is the air-containing bone located behind the ear. A middle-ear infection can occasionally spread into the mastoid air cells, causing acute mastoiditis.

 

Possible signs include:

• Redness or swelling behind the ear

• Tenderness over the mastoid bone

• The outer ear being pushed forwards

• Persistent fever

• Severe or worsening ear pain

• Continued ear discharge

• Headache, lethargy or neurological symptoms

 

Mastoiditis usually requires urgent hospital assessment and intravenous antibiotics. Drainage procedures or mastoidectomy may be necessary when there is an abscess, infected mastoid tissue or inadequate response to medical treatment.

 

A mastoidectomy removes infected or diseased mastoid air cells. It is a substantially more involved operation than myringotomy or grommet insertion and is not part of the routine treatment for uncomplicated acute otitis media.

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Possible Complications of Acute Otitis Media

Most patients recover completely. Possible complications include:

• Perforated eardrum

• Persistent ear discharge

• Recurrent acute otitis media

• Glue ear

• Temporary conductive hearing loss

• Speech or learning difficulties associated with prolonged hearing impairment

• Scarring or retraction of the eardrum

• Mastoiditis

• Facial nerve weakness

• Inner-ear inflammation

• Meningitis or an intracranial abscess

Serious complications are uncommon, but early medical assessment is important when red-flag symptoms are present.

 

When Should You See an ENT Specialist?

Consider an ENT assessment when:

• Ear pain is severe or persistent

• Symptoms are not improving after 48 to 72 hours

• Ear infections keep returning

• Pus or blood is coming from the ear

• The eardrum is perforated

• Hearing remains reduced after the infection

• Middle-ear fluid has persisted

• Speech or language development is a concern

• The child has balance problems

• There is swelling or tenderness behind the ear

• An adult has repeated one-sided ear infections or persistent middle-ear fluid

 

Patients searching for the nearest ENT specialist in Johor Bahru or Pasir Gudang may arrange an ear assessment with Dr Cheong at KPJ Pasir Gudang Specialist Hospital.

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How Can Childhood Ear Infections Be Reduced?

Not every ear infection can be prevented, but the risk may be reduced by:

• Keeping routine childhood vaccinations up to date

• Receiving influenza vaccination when appropriate

• Avoiding cigarette smoke and second-hand smoke

• Encouraging breastfeeding where possible

• Practising good hand hygiene

• Avoiding bottle-feeding while the baby is lying flat

• Managing persistent allergic rhinitis or nasal blockage

• Seeking assessment for enlarged adenoids when clinically suspected

 

Vaccination, breastfeeding and avoidance of tobacco-smoke exposure are among the preventive measures supported by major paediatric and public-health guidance.

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Frequently Asked Questions:

Is eardrum surgery a major surgery?

“Eardrum surgery” can refer to several different procedures. A myringotomy with grommet insertion is generally considered a minor, short procedure and is commonly performed as day surgery. In children, it is usually carried out under a brief general anaesthetic because the child must remain completely still. Tympanoplasty, which repairs a persistent eardrum perforation, is a more involved operation. Mastoidectomy is also a larger operation because it involves the bone behind the ear. The seriousness and recovery period therefore depend on the exact operation rather than the term “eardrum surgery” alone.

 

How serious is ear surgery?

Most planned ear operations are performed safely, but every procedure has possible risks. Minor procedures such as myringotomy and grommet insertion usually have a relatively quick recovery. Possible complications include infection, ear discharge, blockage of the tube, early extrusion or a small residual eardrum perforation. More extensive operations such as tympanoplasty or mastoidectomy involve longer operating and recovery times. Potential risks may include hearing changes, dizziness, tinnitus, taste disturbance, infection and, rarely, injury to nearby structures such as the facial nerve. The ENT surgeon should explain the expected benefits, alternatives and individual risks before surgery.

 

What are the most common ear surgeries?

Common ENT ear procedures include:

Myringotomy: A small opening is made in the eardrum to drain middle-ear fluid or pus.

 

Tympanostomy or grommet tube insertion: A tiny ventilation tube is inserted through the eardrum, commonly for persistent glue ear or selected cases of recurrent otitis media.

 

Tympanoplasty or myringoplasty: A persistent perforation of the eardrum is repaired using a tissue graft.

 

Ossiculoplasty: Damaged middle-ear hearing bones are repaired or reconstructed.

 

Mastoidectomy: Infected or diseased mastoid air cells are removed, usually for mastoid disease, cholesteatoma or complications of infection.

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The appropriate procedure depends on the diagnosis. Most patients with an uncomplicated acute middle-ear infection do not require surgery.

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What procedure is used to treat otitis media?

Most episodes of acute otitis media are treated with pain control, observation and antibiotics when clinically indicated.

When surgery is required, the most commonly used procedure is myringotomy with tympanostomy or grommet tube insertion. This drains the middle ear and provides temporary ventilation. Mastoidectomy is reserved for selected complications such as mastoid infection, abscess formation or other significant mastoid disease. It is not the standard procedure for an ordinary childhood ear infection.

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Can an ear infection cause hearing loss?

Yes. Fluid and pus behind the eardrum reduce the movement of the eardrum and middle-ear bones, causing temporary conductive hearing loss. Hearing usually improves after the infection and middle-ear fluid resolves. A hearing assessment should be considered when hearing remains reduced, fluid persists, infections recur or speech development is affected.

 

Can the eardrum heal after it bursts?

Many small eardrum perforations caused by an acute infection heal naturally after the infection settles. The ear should be kept dry and reviewed to confirm that the perforation has closed. A perforation that remains open may require further treatment or tympanoplasty.

 

Are ear drops enough to treat acute otitis media?

Ear drops cannot usually reach an infection behind an intact eardrum. They may be useful when there is an eardrum perforation, a functioning grommet or a separate outer-ear infection. The type of ear drop must be selected carefully because some preparations are unsuitable when the eardrum is not intact.

 

Does swimming cause acute otitis media?

Swimming is more commonly associated with infection of the external ear canal, known as otitis externa or swimmer’s ear.

Acute otitis media develops behind the eardrum and is more commonly related to upper respiratory infection and Eustachian tube blockage.

 

ENT Assessment in Johor Bahru and Pasir Gudang

Children and adults with persistent ear pain, recurrent ear infections, ear discharge, reduced hearing, a perforated eardrum or suspected glue ear may require a detailed ENT examination.

 

An assessment may include microscopic examination of the ear, tympanometry, hearing evaluation and examination of the nose or nasopharynx when clinically indicated.

 

For an appointment:

Dr Cheong ENT
KPJ Pasir Gudang Specialist Hospital
Johor Bahru, Johor
Website: https://www.johorentdoctor.com

Medical images: for educational purposes only.

This article provides general health information and does not replace an individual medical examination, diagnosis or treatment plan.