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Complications of Otitis Media - What Are They?

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An infection or swelling affecting the middle ear is called otitis media. It results in the build-up of fluid behind the eardrum. Read the article to know more.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Akshay. B. K.

Published At March 29, 2023
Reviewed AtJuly 27, 2023


Viral infections are very common these days and can affect children and adults. Our ear is divided into three parts: the outer, middle, and inner ears. The function of the middle ear is to transfer sound waves from the outer ear to the inner ear. Viral infections like cold, flu, and other upper respiratory tract infections can result in the swelling of the middle ear, referred to as otitis media. It results in the build-up of fluid or pus behind the eardrum resulting in pain and pressure changes in the ear. Otitis media is a prevalent ear infection that affects children more than adults.

What Are Different Types of Otitis Media?

  • Acute Otitis Media (AOM) - Spontaneous ear infection on exposure to cold or flu resulting in pain and swelling in the middle ear.

  • Otitis Media with Effusion (OME) -The absence of early symptoms of ear infections characterizes it. Still, fluid build-up is behind the eardrum, resulting in temporary hearing loss or reduced hearing ability.

  • Chronic Otitis Media with Effusion (COME) - It is characterized by the repeated fluid build-up behind the eardrum despite treatment for ear infection. It can result in the perforation of the eardrum.

What Is the Prevalence of the Complications Associated With Otitis Media?

The prevalence of intracranial (affecting brain) complications and extracranial (affecting other body parts except for the brain) complications of otitis media is approximately 0.69 to 5 percent.

What Is the Incidence of the Complications Associated With Otitis Media?

  • The incidence of complications due to otitis media is around 0.78 percent.

  • The incidence of complications due to otitis media is observed mostly in young children in the age group of fewer than 20 years.

What Are the Causes of Otitis Media?

Various causes of middle ear swelling include:

  • Cold or flu.

  • Upper respiratory tract infections.

  • Bacterial infections.

What Are the Signs and Symptoms of Otitis Media?

  • Ear pain.

  • The fullness of the ear.

  • Loss of balance.

  • Fever.

  • Pressure changes in the ear.

  • Ringing sensation in the ears (tinnitus).

  • Mild to severe hearing loss.

  • Discharge from the ears.

  • Headaches.

  • Disturbed sleep.

What Are the Complications Associated With Otitis Media?

Repeated ear infections and fluid build-up in the middle ear can turn into complications which are divided into:

  1. Extracranial complications (other body parts except for the brain).

  2. Intracranial complications (affecting the brain).

Extracranial Complications:

  • Hearing Loss: The build-up of fluid repeatedly in the middle ear can lead to perforation of the eardrum due to repeated ear infections that can result in significant hearing loss.

  • Facial Nerve Paralysis: It is one of the most severe complications associated with otitis media. Facial nerve (seventh cranial nerve) palsy occurs due to the compression of the nerves by pressure produced by the fluid build-up in the ears. It accounts for about 25 percent of extracranial complications.

  • Labyrinthitis: It is a common complication that occurs due to the spread of infection from the middle ear to the inner ear resulting in swelling in the inner ear. It also causes swelling of the hearing nerve that supplies the ears (the eighth cranial nerve- vestibulocochlear nerve). It accounts for about 23 percent of extracranial complications.

  • Mastoiditis: It occurs due to the spread of the infection from the middle ear to the mastoid bone (present behind the ear), resulting in damage or swelling of the mastoid bone (mastoiditis). It accounts for about 25 percent of extracranial complications.

  • Mastoid Abscess: It occurs due to the accumulation of pus in the mastoid air cells (within the mastoid bone present behind the ear).

Intracranial Complications:

  • Meningitis - It is the most common life-threatening complication of otitis media that results in swelling of the outer layer of the brain (meningitis). It accounts for about 35 percent of extracranial complications.

  • Brain Abscess - It occurs due to the spread of the infection from the ear to the brain resulting in fluid build-up in the brain (brain abscess), mostly in the temporal part (lateral part of the skull). It can lead to symptoms like changes in the pupils of the eye and paralysis of the oculomotor nerve (the third cranial nerve that supplies the eyes).

  • Extradural Abscess - It occurs due to the accumulation of pus in between the outer covering of the brain. It accounts for about nine percent of extracranial complications.

  • Subdural Abscess - It occurs due to the accumulation of fluid between the outer and the middle layers of the brain. It accounts for about four percent of extracranial complications.

What Are the Methods Used to Diagnose the Complications Associated With Otitis Media?

  • Computed Tomography (CT) Scan - These scans of the brain help to rule out complications like meningitis (swelling of the outer layer of the brain) and brain abscess (fluid build-up in the brain tissues).

  • Lumbar Puncture - A fluid (cerebrospinal fluid) sample is collected from the spinal cord to diagnose underlying brain infections like meningitis and brain abscess.

  • Pure Tone Audiometry Test - It is done to check the severity and type of hearing loss.

How To Manage the Complications of Otitis Media?

Complications associated with otitis media are treated by a multidisciplinary team (doctors from different specialties). It can be managed by:

  • Antibiotics - Antibiotics are prescribed to the patient to control the underlying infections.

  • Steroids - Steroid therapy is given to the patient to reduce the swelling of the middle ear and brain tissues in case of the spread of infection to the brain.

  • Neurological Treatment - An increase in the pressure within the brain to fluid build-up is managed by neurosurgeons (specialists in brain disorders) by performing surgical drainage. After the patient is neurologically stable, the intracranial complications are managed, then other complications management is carried out further.

  • Mastoidectomy - This procedure done by an ENT (ear, nose, and throat) specialist, and it involves surgical drainage of the fluid-filled sacs within the mastoid bone is done to treat the mastoid abscess.

  • Ophthalmologic Management - An increase in intraocular (eye) pressure or other symptoms affecting the eyes are managed by an ophthalmologist (eye specialist).

  • Hearing Aids - Hearing aids (artificial devices that aid in hearing) is recommended for a patient with permanent hearing loss.


Otitis media infections are common among young children in the age group below twenty years. Early diagnosis and management of the middle ear infection are crucial to avoid the associated complications. Any delay in the diagnosis and management of the ear swelling can lead to the worsening of the condition due to the spread of the infection to the brain resulting in life-threatening complications like meningitis and brain abscess that may lead to death.

Frequently Asked Questions


Which Bacteria Causes Otitis Media?

In the case of otitis media, bacterial coinfection with viruses of the upper respiratory tract is more commonly seen than bacterial or viral pathogenesis alone. The three most common associated bacterium that causes otitis media are Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. All these are commensal organisms within the nasopharynx.


What Is Chronic Otitis Media?

Chronic otitis media, also called chronic suppurative otitis media, is the chronic inflammation of the mastoid cavity and the middle ear. It is that stage of ear disease that is characterized by an ongoing chronic middle ear infection without an intact tympanic membrane.


What Is Serous Otitis Media?

Serous otitis media is a frequent condition during early childhood. It is a chronic inflammatory condition of the middle ear and presents with a pressure sensation in the ear, which the kid cannot explain. The condition is followed by mild to moderate hearing loss.


What Is Bilateral Otitis Media?

Bilateral otitis media is a rare condition seen in adults. It may be the initial symptom of some life-threatening systemic conditions. Appropriate recognition and treatment of the underlying condition are required to preserve auditory function and to prevent other system involvement.


Why Is Otitis Media More Common in Infants?

Infants are more likely to get otitis media than adults because:
- Their eustachian tubes are narrower, horizontal, and shorter. As a result, it is difficult for the fluid to drain, and bacteria can get in easily.
- Their immune system is weaker and, therefore, more susceptible to infections.


Which Disorder Is a Complication of Acute Otitis Media?

If untreated acute otitis media can lead to the following complications:
- Mastoiditis (infection of the mastoid bone).
- Tympanic membrane perforation.
- Brain abscess.
- Meningitis (inflammation of the meninges which is the protective membrane that covers the spinal cord and the brain).
- Hearing loss.
- Petrositis (infection and inflammation of the petrous temporal bone).
- Labyrinthitis (inner ear infection that results in inflammation of the labyrinth).
- Cavernous sinus thrombosis (an uncommon life-threatening condition due to blood clot formation in the cavernous sinuses).


What Is the Best Antibiotic for Otitis Media in Adults?

The antibiotic of choice for treating otitis media in both adults and children is high-dose Amoxicillin for ten days in case of patients without penicillin allergy. Amoxicillin is an effective treatment option due to its high concentration in the middle ear.


What Is Otitis Media With Effusion?

Otitis media with effusion is a condition characterized by fluid in the middle ear without signs of acute infection. Fluid build-up occurs in the eustachian tube and middle ear; as a result, pressure is placed on the tympanic membrane.


Which Group of Individuals Has a Higher Risk of Acute Otitis Media?

The incidence of acute otitis media is the highest in children between the age of one to four years. Peak incidence is reported in the first year of life.


Why Is a Ventilation Tube Used in the Treatment of Otitis Media?

Ear ventilation tubes are small tubes placed in the eardrum that helps in draining fluid trapped behind the ear drum. It is also referred to as a tympanoplasty, pressure equalization, or myringotomy tube.


How Does Pharyngitis Result in Otitis Media?

Pharyngitis or pharyngeal infection is caused by respiratory viruses or streptococci. The complications as a result of pharyngitis can predispose an individual to bacterial middle ear infections like otitis media.


What Happens if Otitis Media Is Left Untreated?

If left untreated, otitis media can result in:
- Permanent hearing loss.
- Speech and language issues.
- Infections in adjacent anatomic locations.


What Has Reduced the Incidence of Purulent Otitis Media in Children?

Some studies showed that breastfeeding may reduce the incidence of otitis media in infants. However, studies suggest that this benefit is seen in those infants who were exclusively breastfed for the first three to six months of life. Breastfeeding was reported to reduce the incidence of otitis media by 13%.


What Is the Difference Between Otitis Media and Otitis Externa?

Otitis media infections affect the middle ear. On the other hand, otitis externa, or swimmer’s ear, affects the ear canal and outer ear. If the infection becomes severe, it affects the cartilage and bones around the ear.


How Does Acute Otitis Media Lead To Facial Nerve Palsy and Vertigo?

Facial paralysis is a rare complication of acute otitis media. The infection may spread directly from the middle ear to the facial nerve. The inflamed nerve swells that resulting in compression injury of the nerve within the bony canal resulting in facial nerve paralysis. 
Otitis media or middle ear infections lead to fluid accumulation in the middle ear that lead to imbalance and spinning vertigo.
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Dr. Akshay. B. K.
Dr. Akshay. B. K.

Otolaryngology (E.N.T)


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