Otitis media is an infection of the middle ear of which there are two major types:

- Acute otitis media

- Otitis media with effusion

Otitis media is diagnosed by your doctor/audiologist by taking a history and doing an examination of the ear canal.

1 in 10 children suffer from otitis media annually. This is 10 times the amount of adults who suffer from the same condition. Otitis media is one of the most common reasons for children below the age of 4 with a fever to visit a GP. 

Acute otitis media usually starts with the symptoms of a common cold (e.g. runny nose, cough, fever and tiredness). The symptoms of otitis media (e.g. ear pain) develop soon after that. In children, the pain can be difficult to locate, so it is important to take your child to the doctor to be checked for otitis media whenever they have a fever.

The pain in the ear usually resolves over a few days. Sometimes it resolves abruptly when the ear drum perforates and the fluid drains out of the ear canal. Perforation of the ear drum is not a catastrophic event since the drum can repair itself quickly and easily.

There are many complications of otitis media. They are classified as those that occur outside of the brain (extracranial) and those that occur within the brain (intracranial). These complications are extremely rare and usually occur in very young children, or those with serious medical conditions.

Risk factors for otitis media are:

- Age: This is the most important risk factor for developing otitis media. Most commonly, it occurs between the ages of 6 and 18 months. The younger the child, the more severe the disease and greater the risk of complications.

- Non-breastfed children

- Tobacco smoke

- Pacifier use

- Genetic factors: Increased incidence among twins

- Social and economic conditions

- Sleep position

- Season: Increased incidence during autumn and winter.

- Underlying disease (e.g. cleft palate, Down’s syndrome, allergic rhinitis)

- Ethnicity (e.g. Aboriginal and Torres Strait Islanders)

- Children in developing areas

- Family history of otitis media

Some of the common symptoms of otitis media that a parent should look out for are:

- Rubbing ear

- Earache

- Excessive crying

- Diarrhoea

- Fever

- Vomiting

- Vertigo

-Other signs and symptoms of an upper respiratory tract infection (e.g. rhinorrhoea, cough, malaise)

- History of atopic disease (e.g. hayfever, eczema, asthma)

Most people with otitis media respond well to general measures such as pain relief and increased fluid intake. Pain relief should be given according to your doctor’s instructions. It is especially important to use the correct dose in young children.

Fluid intake is important, especially if your child has a fever or diarrhoea. In older children, regular intake of water and not juices or sweetened drinks is important. If your child is severely dehydrated, your doctor may give your child an oral rehydration solution which contains all the essential minerals needed to maintain your child’s body fluids.

Antibiotics have been shown to have little effect on the course of acute otitis media, and they are not used in all circumstances.

- In children without fever and vomiting, antibiotics are not given unless the child’s symptoms have not resolved within 2 days, or unless the child is less than 2 years of age.

- In children with fever and vomiting, antibiotics are generally given.

In otitis media with effusion, a longer course of antibiotics is generally needed. Children should be referred to specialists if they experience learning difficulties or structural damage to the ear drum.