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Middle ear disease

What is it?

Middle ear disease – also known as otitis media – refers to all forms of inflammation and / or infection of the middle ear. The video below helps to explain how germs can be a cause of ear disease, and why it’s important to have healthy ears and good hearing.

As shown in the pictures below, an active inflammation or infection is nearly always associated with fluid in the middle ear space. This fluid affects the movement of the three small bones in the middle ear – the ossicles – and hence can affect hearing. Often, middle ear disease results from the Eustachian tube not functioning as it should. When you swallow or yawn, this tube normally opens to allow air into the middle ear space and prevents the build-up of fluid.

Most children experience middle ear disease at some stage during early childhood. In most cases, the condition resolves itself quickly with limited or no medical intervention.

It is a recurring problem. Much like the common cold, children can develop this problem regularly.


Otitis media figure 1

Figure 1: The anatomy of a healthy middle ear, showing the three small bones which sit between the ear drum and the cochlea. These bones and eardrum need to move freely to help with hearing. The tube running from this middle ear space to the back of the nose is the eustachian tube. This helps to get air into the middle ear space so these bones and eardrum can move freely in response to sound vibrations.

Otitis media figure 2

Figure 2: An ear with “otitis media with effusion”, sometimes also called “glue ear”. Note the bulging ear drum and the fluid in the middle ear space. This fluid affects the movement of the three small bones in the middle ear and the eardrum, which in turn affects the child’s hearing.

Otitis media figure 3

Figure 3: An ear with chronic suppurative otitis media, sometimes also called “runny ears”. Note the ear drum has perforated (or burst) and fluid from the middle ear is running down the ear canal. The hole in the eardrum and fluid in the middle ear space affects the child’s hearing.

Why is this significant for Aboriginal and Torres Strait Islander children?

Aboriginal and Torres Strait Islander children have one of the highest rates of middle ear disease and hearing loss in the world. These children experience it:

  • Earlier: They can contract the disease and hearing loss in their first weeks of life.
  • Frequently: They suffer from the disease and hearing loss often and repeatedly.
  • Severely: They can develop worse forms of the disease and greater levels of hearing loss.
  • Persistently: They can experience the disease and hearing loss for longer periods of time.

How does it affect children?

The impacts of middle ear disease and hearing loss are substantial at any age. But in young children it can affect childhood development – including speech, language and cognitive development. In some cases, the recurrent nature of the disease can also lead to permanent hearing loss.

Middle ear disease and hearing loss can lead to long-term developmental and learning problems, often seen in the educational and home environments. As children go through early childhood education and into schooling, the disease impacts upon their school readiness, communication skills, learning abilities and educational outcomes. In the home environment, it can affect a child’s family relationships, social skills and contribute to perceptions of their behavioural problems.

The impacts of middle ear disease and associated hearing loss can have far-reaching social and economic consequences because they influence the trajectory of children’s lives towards adolescence and adulthood, including future employment outcomes.

Signs and Symptoms

Often there are no obvious signs, especially in very young children.

Some signs might include: your child pulling at their ears; fever; a complaint of ear pain, discharge from the ear; dizziness or clumsiness; congestion related to a cold or your child being unusually grizzly and grumpy.

In older children these signs might include decreased alertness; asking you to repeat things; asking to turn sounds up; boredom; watching others for cues; poor concentration and behavioural problems.

What to do if you’re concerned about your child

  • Please immediately take your child to your local health centre and ask for their ears to be checked by a doctor, nurse or health worker.
  • Don’t stick anything in a child’s ears, unless recommended by a health worker, nurse or doctor.
  • Click here to listen to a parent tell their story.

How to keep ears healthy

  • Keep children clean (wash their hands and faces regularly).
  • Ensure children eat healthy foods like fruit and vegetables.
  • Make sure children get all their vaccinations.
  • Get children to blow their nose, then wash their hands.
  • Breastfeeding helps babies fight disease, so it is important to do so for as long as possible.
  • Avoid smoking around children.

Management / Treatment

This needs to occur in line with the national otitis media guidelines, available here

For more information, visit the Care for Kids Ears website

*This website may contain images and voice/video recordings of those who have passed away.

Worried about ears?

See your doctor or child health nurse as soon as possible! Call 13HEALTH (13 43 25 84) for further information

Find out more

For more information about Deadly Ears, including eligibility criteria, catchment area restrictions, location details and referral advice, view the Deadly Ears Program service page.
Download the Otitis Media Guidelines app via the Apple Store or Google Play Store.
Aboriginal and Torres Strait Islander childrens health hub