Understanding Middle Ear Infections in Children

Call your health care provider's office if you notice any signs of a middle ear infection.

Middle ear infections are most common in children under age 5. Crankiness, a fever, and tugging at or rubbing the ear may all be signs that your child has a middle ear infection, particularly if your child has a cold or viral illness. It's important to call your health care provider if you notice these or any of the signs listed below.

Cross section of ear showing middle ear, eardrum, and outer ear.
Normal ear

What are middle ear infections?

Middle ear infections occur behind the eardrum. The eardrum is the thin sheet of tissue that passes sound waves between the outer and middle ear. These infections are usually caused by bacteria or viruses, which are often related to a recent cold or allergy problem.

A blocked tube

In young children, these bacteria or viruses likely reach the middle ear by traveling the short length of the eustachian tube from the back of the nose. Once in the middle ear, they multiply and spread. This irritates delicate tissues lining the middle ear and eustachian tube. If the tube lining swells enough to block off the tube, air pressure drops in the middle ear. This pulls the eardrum inward, making it stiffer and less able to transmit sound.

Fluid buildup causes pain

Once the eustachian tube swells shut, moisture can’t drain from the middle ear. Fluid that should flush out the infection builds up in the chamber. This may raise pressure behind the eardrum. This can decrease pain slightly. But if the infection spreads to this fluid, pressure behind the eardrum goes way up. The eardrum is forced outward. It becomes painful, and may break.

Chronic fluid affects hearing

If the eardrum doesn’t break and the tube remains blocked, the fluid becomes an ongoing condition (chronic). As the immediate (acute) infection passes, the middle ear fluid thickens. It becomes sticky and takes up less space. Pressure drops in the middle ear once more. Inward suction stiffens the eardrum. This affects hearing. If the fluid is not removed, the eardrum may be stretched and damaged.

Signs of middle ear problems

  • A temperature over 100.4°F (38.0°C) and cold symptoms

  • Severe ear pain

  • Any kind of discharge from the ear

  • Ear pain that gets worse or doesn’t go away after a few days

When to call your health care provider

Call your health care provider's office if your otherwise healthy child has any of the signs or symptoms described below:

  • In an infant under 3 months old, a rectal temperature of 100.4°F (38.0°C) or higher

  • In a child of any age who has a repeated temperature of 104°F (40°C) or higher

  • A fever that lasts more than 24-hours in a child under 2 years old, or for 3 days in a child 2 years or older

  • Your child has had a seizure caused by the fever

  • Rapid breathing or shortness of breath

  • A stiff neck or headache

  • Difficulty swallowing

  • Persistent brown, green, or bloody mucus

  • Signs of dehydration, which include severe thirst, dark yellow urine, infrequent urination, dull or sunken eyes, dry skin, and dry or cracked lips

  • Your child still doesn't look right to you, even after taking a non-aspirin pain reliever

Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Online Medical Reviewer: Sather, Rita, RN
Last Review Date: 7/26/2014
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