Otitis Media (Middle Ear Infection)

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What is Otitis Media?

Otitis Media is a common childhood condition which affects the ears.

Usually starting with a cold, the Eustachian tube (the tube between the back of the nose and the ear) on each side gets blocked with fluid and stops the airflow that keeps each middle ear healthy (see picture below).  This then allows bacteria to infect the middle ear. After the ear infection is gone if the sticky fluid lasts for three months or more it is described as ‘glue ear’. This ‘glue’ acts like an ear plug and stops sound from being heard properly.

What causes it?

  • Colds and other upper respiratory infections
  • Allergies
  • Previous ear infections

What makes it more likely to happen?

  • Smoking around children
  • Lots of children in enclosed areas, like crowded bedrooms and day-care
  • Not eating a healthy diet

Some facts about Otitis Media (OM)

  • OM is a common childhood disease which often goes away on its own
  • Three of every four children have experienced one episode of OM by the age of five. But some children experience it many times throughout childhood
  • Children born with Down Syndrome or Cleft Palate have a very high risk of OM
  • Aboriginal children also have a very high risk of OM
  • Hearing trouble - even just in one ear - can make it harder for your child to listen and learn, particularly when in a noisy background (like a classroom)
  • Hearing loss because of OM can change, so that on some days it can seem worse than others 
  • Your child may have learning difficulties or behaviour problems, often from the frustration of not being able to hear clearly
  • Hearing loss can make things much harder at school for Aboriginal children, especially if English is a second language, and if the teachers are not aware of the problem

What are the signs of Otitis Media?

Acute Otitis Media (AOM) is when the ear is painful, or if the doctor looks into the ear and finds the ear drum is bulging with pus. This is an infection that needs antibiotics.

Signs include:

  • Ear ache or pain in the ear
  • Cranky, upset or behaviour problems
  • High temperature or fever

Otitis Media with Effusion  (OME) is when the ear is not painful but may be  annoying and there might be a hearing problem  (Glue Ear) 

  • Rubbing or pulling ears
  • Not paying attention or always saying "what"
  • Speech delay
  • Needing the TV to be louder
  • Not “listening” at school or pre-school
  • Off balance

How does it affect learning?

Cover your own ears and listen to the world around you for a moment. This is what your child hears when the sticky fluid builds up behind the eardrum. Sounds will be softer, and muffled. If your child cannot hear what is being said it is tricky to learn new sounds and words. Older children with hearing loss can appear “switched off” and naughty or distracted in the classroom, and may miss what friends are saying in the playground.

What can you do to help?


  • Breast feeding helps to protect against infection
  • Do not give baby a bottle to drink in the cot or bed
  • When feeding, hold baby’s head and back in an upright position

All children:

  • Visit your family doctor if your child often has a blocked, snuffly or runny nose
  • Each time you visit your family doctor or nurse ask them to check the ears for signs of OM
  • Try to find housing that is not over crowded - eg one child per bed
  • Don't smoke around children, in the car or in the home, because smoking makes it much easier to get OM
  • Ask for your child's hearing to be tested if they do not seem to be speaking or hearing properly or are not doing well at school
  • If your child does not seem to get better ask to see an Ear, Nose and Throat (ENT) Surgeon

What can be done?

  • At least half of children with glue ear get better within three months without any treatment
  • Around 95 out of 100  children get better within a year
  • Only a small number of children have persisting problems that need treatment

If AOM happens too often or if OME lasts too long there is a very effective operation carried out by ENT surgeons: this is placing Ventilation Tubes (often called ‘grommets’) in the ears. These allow air to flow directly into the middle ear. Hearing improves immediately. The adenoids are often removed at the same time.

Antihistamines and decongestants are not recommended for glue ear.

There also is no evidence that complementary therapies such as homeopathy, osteopathy, acupuncture, ear candles or special diets help with glue ear.

How to help your child learn to speak and listen

  • Get your child's attention by calling their name before speaking and speak slowly and clearly, looking at their face so that they can see you and see your facial expressions. Don’t shout - louder does not mean clearer
  • Reduce the background noise when you are playing or reading to your child – turn off the radio or TV when you are playing. Any noise makes it harder for them to listen but caring and spending time with your child will help them to learn
  • Let teachers or carers know that your child has a hearing problem. Ask them to be patient, speak slowly and clearly and help your child learn to listen. Ask for your child to sit toward the front of the class
  • Speak to your family doctor who can refer you for a hearing test and to an Ear, Nose and Throat Specialist or Paediatrician as there may be ways of improving your child’s hearing


Adenoids: The adenoids are lymph nodes found in the back of the throat, behind the nose. Swollen adenoids can block the nose.

Cochlea: The cochlea is part of the inner ear. In X-rays it looks like a snail shell. Its job is to receive sound vibrations and turn them into electrical messages to send to the brain.

Ear Drum: The eardrum membrane is part of the middle ear and separates the outer ear from the middle ear.

Eustachian Tube: This is a tube that goes from the middle ear to the back of the nose. The tube does two things:

  • Let air flow up to the ear to keep it healthy.
  • Drains fluid from the ear down to the nose.

Pinna: The outside part of the ear (the ear “flap”). It collects sound into the ear to help you hear better.


  • Otitis Media is also very common in children with an allergic nose.
  • It is important to find it and treat it early.
  • Learn how to prevent it. 
The Children's Hospital at Westmead
Sydney Children's Hospital, Randwick
Hunter New England Kids Health

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