Middle Ear Disease


The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Three tiny ear bones are attached to the eardrum. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear.

A healthy middle ear keeps air at the same pressure as outside the ear, allowing free vibration. Air enters the middle ear through the Eustachian tube which connects the back of the nose to the ear. The pop you hear when you yawn means your Eustachian tube has sent a tiny air bubble to your middle ear to equalize the air pressure.

Fluid in Ears
Blockage of the Eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to fluid (a build-up of pus and mucus) behind the ear. This is the infection called acute otitis media, the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children.

This infection can cause earache, swelling, and redness, as well as hearing problems.




Conditions, Causes and Treatment


Infants and Toddlers

  • Pulling or scratching at the ear (especially if accompanied by the following)
  • Hearing problems
  • Crying, irritability
  • Fever
  • Vomiting
  • Ear drainage


Young Children, Adolescents, Adults
  • Earache
  • Feeling of fullness or pressure
  • Hearing problems
  • Dizziness, loss of balance
  • Nausea, vomiting
  • Ear drainage
  • Fever


Serous Otitis Media

Sometimes the eardrum will rupture and pus will drain out of the ear. More often, the pus and mucus remain in the ear because of the swollen and inflamed Eustachian tube. This is called middle ear effusion or serous otitis media. Even after the infection has passed, the effusion may remain and become chronic, lasting for weeks, months or even years. This causes the patient to have frequent recurrences of the acute infection and may cause difficulty in hearing.


The doctor may prescribe medications. It is important that all medications be taken and follow-up visits kept. Antibiotics may be used to fight the ear infections and they may cause the ear ache to go away. However, the infection may need more time to clear up, so be sure the medication is taken for the full time your doctor has indicated. Other medications that may be prescribed include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear.

Other Treatment?

Most of the time, otitis media clears up with the proper medication and home treatment. Your physician may recommend an operation called a myringotomy if further treatment is needed. A small surgical opening into the eardrum will allow drainage of fluid to relieve pain. The incision heals within a few days. It sometimes closes before the infection and fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and improving hearing.

A tube will be placed in your child’s ear for as long as needed for the infection to improve and the Eustachian tube to return to normal. This could require several weeks or months. During this time, water must be kept out of the ears because it could start an infection. You should notice a great improvement in hearing and a decrease in the frequency of ear infections.



Perforated Eardrum

A perforated eardrum is a hole or rupture in the eardrum. Its symptoms can include decreased hearing and occasional discharge. Pain is usually not persistent.

Most perforations will heal on their own within a few weeks, although some may take up to several months. During this healing process, the ear must be protected from water and trauma. Using a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. If your physician feels this paper patch will not provide prompt or adequate closure of the hole in the eardrum, surgery may be considered.

Perforated Eardrum

The size and location of the perforation, as well as the extent of the trauma causing it, all determine the amount of hearing loss that may occur. If a sudden traumatic or explosive event cause the perforated eardrum, the hearing loss can be great and ringing in the ear may be severe. In this case, hearing usually returns partially, and the ringing will go away in a few days. Chronic infection caused by the perforation can cause major hearing loss.