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Home > Services > Ear, Nose and Throat > ENT Conditions > Middle Ear Infection

Middle Ear Infection

With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.

The Middle Ear
Middle Ear

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Bacteria and viruses both cause this condition. 

Ear Infection Risks

Middle ear infections are more common in the winter. These factors increase your chance of developing middle ear infection:

  • Recent viral infection (e.g., cold or flu)
  • Recent sinusitis
  • Exposure to second-hand smoke, usually cigarette smoke, but also from cooking and wood-heating
  • Medical conditions that cause abnormalities of the eustachian tubes, such as:
    • Cleft palate
    • Down syndrome
  • History of allergies (environmental allergies, food allergies)
  • Gastroesophageal reflux disease (GERD)

Tell your doctor if you have any of these risk factors.

Symptoms of an Ear Infection

Watch for:

  • Ear pain 
  • Fever
  • Irritability
  • Hearing loss (temporary, due to fluid accumulation)
  • Decreased appetite, difficulty feeding
  • Disturbed sleep
  • Drainage from ear
  • Difficulty with balance

Diagnosing an Ear Infection

The doctor will ask about symptoms and medical history and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.

The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.

Other tests may include:

  • Tympanometry — measures pressure in the middle ear and responsiveness of the eardrum; also used to check for fluid or pus
  • Hearing test — may be done if you have had many ear infections
  • Tympanocentesis — used to drain fluid or pus from the middle ear using a needle, or to check for bacteria

Ear Infection Treatments


Oral antibiotics are commonly used to treat ear infections. 

Antibiotic ear drops may be used if ear drums ruptures.

Some doctors may take a "wait and see" approach. In some cases, your doctor may prescribe an antibiotic for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective.

While antibiotics may be effective, it is important to discuss the risks and benefits of taking antibiotics with your doctor.

A virus causes a lot of ear infections. This type will not go away faster with antibiotics. Most middle ear infections (including bacterial ones) tend to improve on their own in 2-3 days.

Pain relievers can help reduce pain, fever and irritability.

Decongestants and antihistamines are not recommended to treat an ear infection.


Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus.

Preventing Ear Infections

To reduce the chance of getting an ear infection:

  • Avoid exposure to smoke.
  • Keep allergy symptoms well controlled.
  • Treat related conditions, such as GERD.
  • Practice good hand washing.
  • Consider getting a flu vaccine. Pneumococcal vaccine may prevent some ear infections caused by pneumococcus, but the overall effect on ear infections is not known.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum and prevent fluid build-up and infection.
  • Xylitol is a natural sugar that is used as a sweetener in gum, candy and other types of food. Eating food with xylitol on a regular basis may help to reduce your risk of ear infections.


Call 434.243.3675.

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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