What are the main symptoms of middle ear infection (otitis media) in young children?

Otitis media is one of the most common reasons for children to visit a doctor, with about three out of four children experiencing at least one ear infection before their third birthday [1]. Since young children may not be able to express their pain, it is important to recognize the main symptoms that may indicate a middle ear infection.

Signs of middle ear infection in infants and young children

If your child cannot express ear pain in words, here are some signs to watch for:

• Ear tugging or pulling: The child may tug or pull at the affected ear [1].
• Excessive crying and irritability: The child may cry more than usual and become more fussy [1].
• Difficulty sleeping: Pain can affect the child's ability to sleep comfortably [1].
• Fever: Especially in infants and young children [2].
• Fluid draining from the ear: Parents may notice fluid or discharge coming from the child's ear [1].
• Balance problems or clumsiness: The child may have difficulty maintaining their balance [1].
• Hearing problems or lack of response to quiet sounds: You may notice that your child is not responding to sounds as usual [1].

Types of otitis media and their symptoms

There are three main types of otitis media, each with a different set of symptoms:

• Acute Otitis Media (AOM): This is the most common type. It occurs when parts of the middle ear become infected and swollen, and fluid is trapped behind the eardrum, causing ear pain (earache) which may be accompanied by a fever [2].
• Otitis Media with Effusion (OME): This sometimes occurs after an acute ear infection has resolved, where fluid remains trapped behind the eardrum. The child may not show any symptoms, but a doctor can see the fluid using a special instrument [2].
• Chronic Otitis Media with Effusion (COME): This happens when fluid stays in the middle ear for a long time or returns repeatedly, even without an infection. This type makes it difficult for children to fight off new infections and can affect their hearing [2].

When to see a doctor?

If you notice any of the above symptoms in your child, it is important to consult a doctor to evaluate the condition. The doctor will diagnose the ear infection by examining the ear using an instrument called an otoscope [1]. A red and bulging eardrum can indicate the presence of an infection [2].

In some cases, the doctor may recommend observing the child for a few days to see if the ear pain resolves on its own, especially if there is no severe pain or fever [2]. However, in cases of severe infection or in very young infants, antibiotics may be necessary [1]. If there is no improvement within 48 to 72 hours of symptom onset, guidelines recommend starting antibiotic treatment [2].

For more information on when to observe and when to use antibiotics, you can visit Otitis media in children: When to observe and when to use antibiotics? (Arabic)

Potential complications

In rare cases, chronic middle ear infection can lead to complications such as cholesteatoma, which is a skin cyst that grows in the middle ear and may affect hearing and balance [3]. Prompt and thorough treatment of chronic ear infections can help prevent the development of these complications [3].

Medical references

• Ear Infections
• Ear Infections in Children
• Cholesteatoma