Middle Ear Infections 

Childhood Ear Infections (Acute Suppurative Otitis Media)


This bacterial infection of the middle ear is very common in childhood. Few children will escape an episode. Bacteria can reach the middle ear space via its normal drainage tube, the Eustachian tube, via a hole in the eardrum or rarely by the bloodstream. Bacterial infection may be a primary event or may follow initial viral infection. The result is the formation of pus in the middle ear. It is a self-limiting condition in the vast majority of cases; for the unfortunate few middle ear infections can progress to major and life-threatening complications.

Middle Ear Infection | My ENT Specialist
Middle Ear Infection Clinical Presentation | My ENT Specialist

Clinical Presentation

The patient is most often a child. There is often a cold or flu like illness leading up to the ear infection. Infection of the middle ear results in severe earache, a loss of hearing and a child who is unwell and has a high temperature. In very young children who cannot describe what is happening ear infections may cause crying and screaming along with ear pulling and generalised restlessness.

Examination of the eardrum shows a red inflamed appearance which eventually progresses to a bulging yellow ear-drum (the yellow is the pus in the middle ear) and finally if untreated to a perforation of the ear –drum and a wet, runny ear. Once the eardrum perforates and the ear discharges the pain, temperature and hearing loss begin to get better. Sometimes this natural resolution doesn’t happen and complications may occur. (See below)


Clinical examination – reveals a red or bulging drum. At a later stage there is obvious ear discharge and a hole in the eardrum.

No other investigations are usually required. In some cases, an ear swab will be taken to guide antibiotic treatment.


Most cases are seen and managed in general practice.

Complications of Suppurative Ear Infections

Complications within the ear:

Middle Ear Infection Complications | My ENT Specialist
Complications Outside Ear | My ENT Specialist

Complications outside the ear

These conditions are rarely seen following acute ear infections: