Acute Otitis Media
A middle ear infection that causes ear pain and fever, mostly in young children.
TL;DR
A middle ear infection, mostly in children under five. Treat pain first; many mild cases settle without antibiotics. Call a clinician for fever of 39 C or higher, ear discharge or worsening symptoms. No supplement is proven to treat it.
Overview
Acute otitis media (AOM) is an infection of the middle ear, the air-filled space behind the eardrum. It is more common in children than in adults. Treatment starts with pain relief, and many mild cases settle without antibiotics, but severe illness, a fever of 39 C or higher, ear discharge, or a fever in a baby under 3 months needs a clinician. Bacteria such as Streptococcus pneumoniae and nontypeable Haemophilus influenzae are the two most common causes, and the viruses that cause colds can also cause it. Typical signs are ear pain, fever, fussiness, rubbing or tugging at the ear, and trouble sleeping. A global estimate put the burden at 709 million cases in 2005, about half of them in children under five. A clinician diagnoses AOM by examining the eardrum. The American Academy of Pediatrics (AAP) guideline, which covers children 6 months through 12 years with uncomplicated AOM, requires specific findings: a bulging eardrum, new discharge from the ear, or mild bulging with ear pain that began in the last 48 hours. Fluid behind the eardrum without infection is a different condition, called otitis media with effusion, and swimmer's ear is an infection of the outer ear canal. A Cochrane review of 13 placebo-controlled trials in high-income countries found that by 24 hours 60% of children had recovered whether or not they received an antibiotic, and the AAP lets clinicians offer careful observation instead of immediate antibiotics for some children with milder illness. Antibiotics remain the standard for severe illness and for children 6 to 23 months old with infection in both ears. No supplement has been shown to treat AOM. For prevention, xylitol, probiotics and vitamin D have been studied in children, with results that are limited or inconsistent. This page is general information for families and does not replace an examination.
Common Symptoms
- •Ear pain, sometimes severe
- •Fever
- •Fussiness or irritability
- •Rubbing or tugging at the ear (in babies and toddlers)
- •Difficulty sleeping
- •Pus or fluid draining from the ear
Common Causes
- •Bacterial infection, mainly Streptococcus pneumoniae and nontypeable Haemophilus influenzae
- •Viral infections such as the common cold
- •Young age: about half of cases occur in children under five
Root Causes
Bacteria and viruses can reach the middle ear and cause inflammation and pus behind the eardrum. Streptococcus pneumoniae and nontypeable Haemophilus influenzae are the two most common bacterial causes, and viruses like those that cause colds can also cause it. Young children are affected most, with about half of all cases worldwide occurring in children under five. Pneumococcal and influenza vaccination, exclusive breastfeeding for the first 6 months and avoiding tobacco smoke are the prevention steps the AAP guideline recommends.
How It's Diagnosed
Diagnostic Markers
- Moderate to severe bulging of the eardrum on otoscopy
- New ear discharge not caused by swimmer's ear
- Mild bulging with ear pain that began within 48 hours, or an intensely red eardrum
- Pus behind the eardrum seen on examination
- Recurrent AOM: 3 or more separate episodes in 6 months, or 4 or more in 12 months with at least one in the last 6 months
When to See a Doctor
See a clinician for a fever of 39 C (102.2 F) or higher, pus or fluid draining from the ear, worsening symptoms, symptoms lasting more than 2 to 3 days, or any hearing loss. Call right away if a baby under 3 months has a fever of 38 C (100.4 F) or higher. Get same-day care for tenderness or swelling behind the ear, an ear pushed out of its usual position, or a persistent high fever: these can signal mastoiditis, the most common complication of AOM. It is rare, about 1 in 400 cases, but usually affects very young children and can be serious. The AAP treats moderate or severe ear pain, pain lasting at least 48 hours, or a fever of 39 C or higher as severe illness that calls for antibiotics.
Supplements Studied For This
Xylitol
Xylitol may lower ear infection rates in healthy day care children in older trials, but later trials conflict and guidelines do not recommend it.
Vitamin D
A single small trial found fewer children with ear infections on vitamin D, but it is unreplicated and guidelines do not recommend vitamin D for prevention.
Probiotics
Probiotics may lower ear infection rates in children not prone to them in pooled data, but not in otitis-prone children, and large recent trials found no benefit.
Diet & Lifestyle
Suggested Pattern
No diet treats or prevents acute otitis media. The dietary measure with guideline support is exclusive breastfeeding for at least 6 months, which the AAP and CDC both recommend to lower ear infection risk. Xylitol, probiotics and vitamin D have been tested for prevention, but none is a guideline-endorsed treatment; their evidence is covered on the supplement pages.
Eat more
- Extra fluids while feverish
- No food or supplement treats an ear infection; the evidence does not support any specific diet
Avoid
- No food has been shown to cause or worsen AOM in the sources reviewed for this page; there is no evidence-based foods-to-avoid list
Supporting Research
Antibiotics for acute otitis media in children
Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children: A Randomized Clinical Trial
Xylitol syrup for the prevention of acute otitis media
Association between vitamin D and development of otitis media: A PRISMA-compliant meta-analysis and systematic review
Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial
Frequently Asked Questions
Do ear infections always need antibiotics?
What is watchful waiting for an ear infection?
What helps ear infection pain?
Can supplements prevent ear infections in children?
Do ear tubes stop recurrent ear infections?
When should I worry about an ear infection?
Who It Affects
A systematic review of global data estimated that acute otitis media affects 10.85% of people each year, about 709 million cases (estimates for 2005), with 51% of cases occurring in children under five. The same review estimated that about 21,000 people die each year from complications of otitis media of all types.
Children are more likely than adults to get ear infections, and half of all cases worldwide occur in children under five. The 2005 global estimates found the greatest burden in the first five years of life and in the poorest countries.
Quick Facts
- •An estimated 709 million cases worldwide in 2005
- •About half of cases occur in children under five
- •In high-income-country trials, 60% recovered by 24 hours with or without antibiotics
- •Pain relief is the first treatment step
- •No supplement is proven to treat it
Lifestyle Tips
- •Treat pain first: acetaminophen is the only option under 6 months, and acetaminophen or ibuprofen are both used from 6 months (CDC)
- •Never give aspirin to children, because it can cause Reye's syndrome, a rare but serious illness of the liver and brain
- •Ask a clinician or pharmacist for the dose for your child's age and size
- •Offer rest and extra fluids
- •Ask the clinician whether watchful waiting or a delayed antibiotic prescription fits your child's age and symptoms
- •Keep the child's vaccines up to date, including pneumococcal and the annual flu vaccine
- •Breastfeed exclusively for 6 months if possible, and keep the home smoke-free
- •Avoid over-the-counter cough and cold medicines in children under 4 unless a clinician advises them
- •Follow up if symptoms last more than 2 to 3 days or get worse
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This information is for educational purposes only. Always consult a healthcare professional before starting any supplement regimen.