Otitis Media in Infants and Children: What Is It and How Is It Treated?

Otitis media in infants and children is common in the first 5 years and usually appears together with respiratory symptoms.
Otitis Media in Infants and Children: What Is It and How Is It Treated?

Last update: 16 June, 2022

Otitis media in infants in children is one of the most common childhood illnesses. It’s estimated that between 70 and 80% of healthy children develop at least one case of otitis media in their first 5 years of life.

This condition causes great pain in the ear and a characteristic discomfort, and although it’s advisable to offer relief measures, it’s not always necessary to resort to antibiotics.

Here’s everything you need to know about this disease to take better care of your children. Don’t miss it!

What is otitis media in infants and children?

Otitis media (OM) is the inflammation of the middle ear, usually caused by an infectious agent (a virus or bacteria). These microorganisms usually originate from an adjacent structure of the airway.

The ear has three well-defined cavities. The middle ear is the one located behind the eardrum and which, in turn, communicates with the nose (and throat) through the Eustachian tube.

Infants and young children have a greater predisposition to develop otitis than older children and this occurs due to immune and anatomical factors. For this reason, it’s one of the main reasons for consulting a pediatrician during childhood, both in the summer and winter months.

What’s the cause of otitis media in infancy?

The main cause of OM in infancy is respiratory infections. This is because, as we’ve said, they’re the gateway for germs to enter the middle ear. Thus, the most frequent causative bacteria are Streptococcus pneumoniae and Haemophylus influenzae.

In infants and young children, the Eustachian tube is shorter, wider, and more horizontal than in adults. This particular anatomy of the duct favors the entry of mucus (and germs) from the nose and causes it to become partially blocked. This phenomenon provides a favorable environment for microorganisms to develop and infect nearby organs, such as the middle ear.

When bacteria reach the middle ear, there’s an increase in secretions and pus in the middle ear, which puts pressure on the eardrum, pushing it outwards. This causes considerable pain in the infant and limits their ability to hear on that side.

If otitis becomes frequent or prolonged, the condition is no longer acute and is considered recurrent or chronic, respectively. This is quite common in infancy, due to the immaturity of the defense system. Therefore, it’s to be expected that from the age of 5, otitis media will occur less and less.

The anatomy of the ear.
The middle ear is the cavity located behind the eardrum that communicates with the airway through the Eustachian tube. This connection is the one that favors the flow of germs from one place to another.

Other causes of otitis media

We must keep in mind that there are other non-infectious conditions that can also generate this discomfort. Among them, we highlight the following:

  • Respiratory allergies
  • Direct irritation of the tympanic membrane (direct contact with chemical agents, such as chlorine from swimming pools)
  • Sudden changes in air pressure
  • Eustachian tube obstruction from other causes

Symptoms of otitis media in infants and children

Detecting the focus of pain in infants and young children can be a somewhat complicated task. However, if you suspect that your little one has otitis, you can observe their symptoms as a guide.

A key sign that you’ll surely register is that the baby cries a lot and brings their hand to the sick ear.

In addition to the otalgia (pain in the ear), your little one may externalize some of the following signs and symptoms:

  • Fever
  • Irritability and constant crying, especially at night
  • Inappetence
  • Redness of the external ear and pain on palpation of the ear (this doesn’t always appear)
  • The outflow of clear fluid or pus through the ear canal
  • Loss of balance

In the presence of these symptoms, it’s best to see your pediatrician to examine your child and determine the best course of action.

How is otitis media in infants and children treated?

Treatment of otitis media in infants and children is based on the symptomatology, the cause, and the infant’s baseline health condition. That is, their age and medical history.

In most cases, otitis media resolves on its own within a few days and, in fact, up to 90% of children resolve the condition within the first week. This is especially true when it’s caused by common germs such as Haemophilus influenzae.

However, in other cases, antibiotic treatment should be considered to avoid complications. Especially in infants and children under 2 years of age, as their immune system isn’t fully mature.

As a general guideline, the treatment of otitis media usually starts with the prescription of analgesics and fever reducers, such as paracetamol and ibuprofen.

If after 2 or 3 days the symptoms don’t subside or if the pediatrician finds that the otitis is bilateral or suppurative (pus comes out of the ear), antibiotic treatment may be indicated, either with ear drops or orally.

It’s important that once the antibiotic regimen is started, it’s completed, even if the symptoms improve quickly. This is key to avoiding recurrences and germ resistance to the medication.

Can otitis media in infants and children be prevented?

Otitis media is a condition that can become common in young children. Therefore, it’s worth implementing some preventive measures at home:

  • Offer your child breastfeeding until at least the first year of life. This milk will also provide antibodies that will protect against common infections.
  • When offering a bottle, make sure the baby isn’t lying down completely. If the bottle’s upright, it predisposes part of its contents to reach the Eustachian tube due to gravity.
  • Avoids colds and flus in children. In case they develop respiratory symptoms, a good technique to help them eliminate the mucus is through nasal washes.
  • Keep your baby’s ears dry. During their bath, avoid pouring soapy water directly on this cavity and when getting out of the water, dry everything you can reach with a towel. Never insert swabs or cotton swabs into the ears, as you could accidentally hurt the eardrum.
  • Make sure the child is kept in ventilated and smoke-free environments.
  • Strictly comply with the vaccination schedule. Vaccinations help prevent infections by several of the germs involved in otitis.
  • Wash your hands and your child’s hands with soap and water frequently. Even keep frequently used surfaces clean.
A mother nursing her baby.
Breastfeeding is the best infectious disease prevention strategy in early childhood. Offer to breastfeed your child as long as you can to help strengthen their defenses.

About otitis media in early childhood

Otitis media is a fairly common condition in young children and a major cause of school and work absenteeism worldwide. Fortunately, it’s preventable and its course is generally mild and self-limiting. However, when you suspect that your baby may be suffering from otitis media, see your pediatrician for guidelines.

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  • De la flor, J. (2017). Infecciones de vías respiratorias altas-2: otitis media aguda (etiología, clínica y diagnóstico; complicaciones y tratamiento); otitis media aguda de repetición y otitis media crónica; otitis externa. Pediatría Integral 2017; XXI (6): 399–417.
  • National institute on deafness and other communication disorders (2017). Infecciones del oído en los niños. Recuperado de: https://www.nidcd.nih.gov/es/espanol/infecciones-del-oido-en-los-ninos
  • Yolik, J. (2017). Otitis media aguda.  Revista de la Facultad de Medicina de la UNAM. Vol. 60, Nº 1, Enero-Febrero 2017. Páginas 50-58.
  • Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. (2015) Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015 Jun 23;2015(6):CD000219. doi: 10.1002/14651858.CD000219.pub4. PMID: 26099233; PMCID: PMC7043305. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26099233/
  • Muñoz, J. (2013). Otitis media aguda Revista pediatría en atención primaria. Vol. 15 – Num. 22. Recuperado de: https://pap.es/articulo/11815/otitis-media-aguda
  • López, G. et al. (2008). Guía-ABE. Infecciones en Pediatría. Guía rápida para la selección del tratamiento antimicrobiano empírico. Otitis media aguda. Recuperado de: https://www.guia-abe.es/temas-clinicos-otitis-media-aguda
  • Hijano, F. (2003). Otitis media aguda. Anales de pediatría. Vol. 01. Núm. S1. páginas 3-9 (Junio 2003).
  • Richardson, V. et al (1998). Otitis media aguda en pediatría. Revista de salud pública de México Vol.40, N°.5. Recuperado de: https://www.scielosp.org/pdf/spm/1998.v40n5/450-455/es