Otitis Media (Middle Ear Infection)

What Is It

• Infection/inflammation of the middle ear (behind the eardrum)

• Common in children

Causes

• Usually follows a cold/URTI

• Eustachian tube dysfunction → fluid builds up → infection

• Viral (common) or bacterial

Who commonly gets it?

• Children (especially 6 months–2 years) ⭐ most common

• More frequent in:

  • Kids in daycare

  • After a cold/URTI

  • Bottle-fed or exposed to smoke (Bottle feeding (especially lying down) lets fluid reach and block the ear, while smoke irritates and reduces drainage, both increasing infection risk.)

• Adults → less common, but can still occur

Symptoms

• Deep ear pain (NOT worse on touching ear)

• Fever

• Reduced hearing / blocked feeling

• Irritability, crying (children)

• Poor feeding, sleep disturbance (infants)

• Sometimes discharge if eardrum ruptures

Diagnosis clue (OSCE GOLD)

👉 No pain when touching ear + fever → think otitis media

🚨 Red flags (urgent referral)

• Child < 6 months

• Very unwell / lethargic

• Neck stiffness, photophobia (meningitis signs)

• Persistent vomiting

• Severe headache

• Swelling behind ear (mastoiditis)

• Hearing loss

• Symptoms not improving after 48–72 hrs

When to refer to GP

• No improvement after 48–72 hours

• Severe ear pain or high fever

• Hearing loss

• Ear discharge

• Recurrent infections

• Diagnosis unclear (could be something else)

• Redflags

Treatment

Treatment (NZ approach)

• First-line: analgesia

  • Paracetamol or ibuprofen

Self Care

• Rest and fluids

• Pain relief regularly

• Warm compress for comfort

• Keep child upright if possible

• Avoid smoke exposure

Duration

• Pain and fever improve in 2–3 days

• Usually resolves in 3–5 days

• Hearing/fullness may take a few weeks

👉 Most cases are self-limiting

younger children 2-3 days if not refer

Complications (important)

• Eardrum rupture (→ discharge)

• Glue ear

• Mastoiditis (rare but serious)

Glue ear (Otitis media with effusion)

• Symptoms: reduced hearing, fullness, “blocked ear”, usually no pain/fever

• Serious? Usually not serious

• Duration: often resolves in weeks, may last up to 3 months

• Treatment: mostly no meds, watch & wait

• When to refer:

  3 months

  • Hearing/speech issues

  • Learning problems

Eardrum rupture (perforation)

• Symptoms: sudden pain → relief → discharge, hearing loss

• Serious? Usually heals, but needs assessment

• Duration: heals in 2–8 weeks

• Treatment: keep ear dry, GP may give drops/antibiotics

• When to refer:

  • Always refer to GP

  • Urgent if severe symptoms

🧠 Quick rule

• Glue ear → monitor

• Rupture → refer

Key differences vs otitis externa

• Media → deep pain, fever, no tenderness on touch

• Externa → pain on touch, itching, discharge more common