February 28, 2026, 9:22 am | Read time: 9 minutes

“Otitis media” is the medical term for acute inflammation of the middle ear. It mainly affects children between the ages of one and six.¹ Typical symptoms include a throbbing earache, fever, and restlessness.² In most cases, the inflammation heals on its own, but a visit to the doctor is advisable in most cases.

What Is a Middle Ear Infection?

The middle ear, situated behind the eardrum, is often susceptible to infections that typically arise from upper respiratory tract infections. When cold viruses or bacteria invade the throat, they can cause the mucous membranes to become inflamed. The middle ear is connected to the throat via the so-called Eustachian tube. The Eustachian tube, a narrow channel about four centimetres long, connects the middle ear to the throat.³ The inflammation in the pharynx can migrate into the middle ear via the eustachian tube. The mucous membrane of the eustachian tube swells, and the tube becomes blocked. Fluid collects in the middle ear, can no longer drain away, and presses on the eardrum. This pressure causes the dreaded characteristic pain of middle ear inflammation and impairs hearing.

Why Are Children Particularly Often Affected?

Acute middle ear infections are a very common condition in babies and small children: By the age of three, eight out of ten children have already had a middle ear infection. Up to a third of sick children have even had to deal with it several times.⁴ This is because the eustachian tube is shorter and narrower in children than in adults. This makes it easier for germs to get from the nasopharynx into the middle ear and cause inflammation there. In addition, young children’s immune systems are still developing, making them more susceptible to infections. They also have a lot of contact with other children at nursery and kindergarten, which makes it easier for germs to “jump over.” Middle ear infections are less common after the age of seven, by which time the eustachian tube and the immune system have developed further.

Other Risk Factors for Middle Ear Infections in Children:

• If children have not been breastfed but have been bottle-fed from birth
• Frequent use of a pacifier or milk bottle while lying down
• Enlarged tonsils (“adenoids”)
• If children are frequently exposed to tobacco smoke
• Genetic factors⁵

Typical Symptoms of Middle Ear Infection

The signs can vary, but the following symptoms are common:

• Earache: Sudden onset and often very intense (stabbing, pulsating, often occurring in waves)
• Fever above 38 degrees Celsius
• Restlessness and crying: Particularly in infants and young children, are an indication of pain.
• Sleep disturbances: The pain can interfere with sleep.
• Hearing problems or ringing in the ears: The accumulation of fluid in the middle ear can impair hearing.

In very young children, the symptoms may be less clear: they often grab their ears, are fussy, or do not want to eat. Sometimes vomiting or diarrhea may also occur,⁶

The Diagnosis

To determine whether the cause of the earache is really a middle ear infection, the eardrum is first examined with an otoscope, a special magnifying glass. During a middle ear infection, the eardrum typically appears pink rather than its usual grayish color. Because the ventilation is not working properly, the eardrum pulls inwards, and the blood vessels dilate—this causes the discoloration. If fluid is present, it may sometimes be visible, shimmering behind the eardrum. When pus accumulates, it can cause the eardrum to bulge outward, and in some cases, a small tear may be visible. Additionally, the doctor will examine the nose and the back of the throat.

Should the middle ear infection recur, various hearing tests are performed. One such test is tympanometry, which assesses the eardrum’s ability to vibrate and measures the pressure within the middle ear.⁷ For infants and toddlers, a specialized procedure involves sending small sound waves into the ear to check for reactions from the inner ear. Additionally, tone audiometry is used to determine the range of sounds that the child is able to hear.

Treatment Options

In 80 percent of cases, middle ear infections in children heal on their own within two to three days. The main aims of treatment are therefore to relieve the pain and reduce the fever. Active ingredients such as paracetamol or ibuprofen can be administered in age-appropriate doses as a juice or suppository. They relieve pain and reduce fever. Nasal drops can help to improve the ventilation of the middle ear because they reduce swelling of the mucous membranes in the nose. This allows the secretions to drain better. However, these remedies should only be used after consulting a doctor! Nasal drops, if used excessively, can cause lasting damage to the mucous membranes; babies should not be given oily nasal drops, and painkillers must be precisely dosed based on the child’s weight.

Antibiotics are only used in special cases. As many middle ear infections are viral in origin, antibiotics do not help in these cases anyway. They are mainly used if:

• The child is under six months old.
• Both ears are affected (in children under two years of age).
• There is purulent discharge from the ear.
• The symptoms do not improve or worsen after two to three days.⁸

As long as the inflammation is still active, the ear should be protected from water – i.e., no immersion in the bathtub, no rinsing the ear in the shower, and no visits to the swimming pool.

When Should You See a Doctor for a Middle Ear Infection?

An acute middle ear infection is not a medical emergency, but it should definitely be treated by a doctor to avoid consequential damage. A pediatrician can use an otoscope to determine whether the eardrum is reddened or bulging, which are typical signs of inflammation.

The doctor can also assess whether there is any fluid behind the eardrum. If necessary, child-friendly painkillers such as ibuprofen or paracetamol can be recommended. The doctor can also assess whether antibiotics can help. Antibiotics are effective only against bacterial pathogens and are ineffective against viruses. Approximately 70 percent of middle ear infections involve both viral and bacterial pathogens, and 20 percent are exclusively bacterial.⁹

Symptoms such as facial paralysis or dizziness are alarming. It is then possible that the inflammation has spread to the cranial nerves or the inner ear, and immediate treatment with antibiotics must be initiated.

Possible Complications or Consequential Damage

If an inflammation of the middle ear persists for several weeks, it is called chronic otitis media. The pain and fever may subside, but the fluid continues to collect in the middle ear. Many children have recurrent purulent discharge from the ear.

Permanent Hearing Loss

A middle ear infection caused by flu viruses is also critical. The eardrum is then covered in bloody fluid, small blisters can form, and the fluid can run into the ear canal. The inner ear is also often affected, which often leads to permanent hearing loss at high pitches.

Mastoiditis

Two to four weeks after an acute middle ear infection, so-called “mastoiditis” can also occur: This is when the mastoid process (a bony protrusion of the temporal bone behind the ear) becomes inflamed. This can also lead to permanent damage to the eardrum and impaired hearing. In recent years, this complication has become increasingly common—ENT specialists therefore urgently recommend that middle ear infections should not be left untreated.¹⁰

Facial Nerve Paralysis

Another possible complication is facial nerve paralysis (facial nerve palsy). As the facial nerve runs directly to the middle ear, the inflammation can spread to it and cause paralysis of one side of the facial muscles.¹¹

Labyrinthitis

If the inflammation reaches the inner ear, it can lead to a condition known as “labyrinthitis”: This causes severe dizziness, hearing loss, and vomiting. Labyrinthitis is characterized by a sudden twitching of the eye on the affected side. If you experience these symptoms, see a doctor immediately, as untreated, this can lead to meningitis or permanent hearing damage.

Meningitis

Meningitis can occur if the inflammation spreads to the meninges. Warning signs are sudden high fever, severe headache, stiff neck, confusion, sensitivity to light, and vomiting. Brain abscesses, i.e., accumulations of pus in the brain, are also possible and can cause headaches, fever, or neurological disorders, depending on their location. Another dangerous complication is sinus vein thrombosis, in which blood clots form in the large veins of the brain. This can cause headaches, swelling, and neurological deficits. In the presence of such symptoms, it is crucial to seek immediate medical attention.

More on the topic

Transmitted by Ticks Lyme Borreliosis – Causes, Symptoms and Treatment

Pacifier Use Increases Risk of Middle Ear Infections

Can Middle Ear Infections Be Prevented?

Middle ear infections are usually secondary to colds or flu-like infections. This challenge in prevention is compounded by the fact that preschool children can experience as many as eleven colds annually.¹² However, there are strategies to mitigate the risk factors associated with middle ear infections:

• Protect children from tobacco smoke
• Breastfeeding up to six months¹³
• Vaccination against pneumococci and ¹⁴
• Do not go to the swimming pool with a cold (and certainly not afterwards with wet hair in the cold air)
• If you have a cold, use nose drops to ensure adequate ventilation of the middle ear

Are There Effective Home Remedies for Middle Ear Infections?

Many parents explore home remedies or alternative treatments for their ailing children. However, there is hardly any scientific evidence that they really help against earache or fever—often they have not even been properly tested.

For example, some parents use calf compresses to reduce fever. Others put an onion bag on the aching ear or use red light to warm it. Whether this really helps has not been proven, but some children at least find it pleasant.

Various applications of complementary medicine are also being discussed in the scientific community (acupuncture, administration of probiotics, ear candles, and herbal medicines). However, the research findings to date are limited, leading to the current view that these methods may be less effective.¹⁵ The use of pain-relieving and fever-reducing medications, along with attentive care, typically provides relief. It is important to keep a close eye on the course of the disease, as further treatment may be necessary in some cases.