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Association Between Pneumonia and Otitis Media - An Overview

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Pneumonia is lung inflammation, and otitis media is middle ear inflammation. Read this article to learn about their association and possible treatments.

Written by

Dr. Sri Ramya M

Medically reviewed by

Dr. Kaushal Bhavsar

Published At October 7, 2022
Reviewed AtFebruary 13, 2024


Pneumonia and otitis media are respiratory infections with common pathophysiology. Otitis media is a common infection caused by bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) and viruses (Adenovirus, Influenza virus, Respiratory syncytial virus, Enterovirus, Coronavirus, Rhinovirus and Parainfluenza virus). Streptococcus pneumoniae, the leading cause of pneumonia, effectively colonizes the nasopharynx and weakens the immune response. In addition, bacterial infection co-exists with viral pathogenesis rather than individual bacterial or viral infection. This further leads to the spread of infection to the middle ear.

What Is Pneumonia?

Pneumonia is an infection that affects one or both lungs. The air sacs in the lungs (alveoli) are filled with fluid or pus, resulting in difficulty in breathing.

Types of pneumonia include:

  • Bacterial, viral, or fungal pneumonia.

  • Walking pneumonia - The individual is infected but can do daily activities.

  • Chemical pneumonia - It is caused by inhaling chemical fumes.

  • Aspiration pneumonia -It is caused by inhaling acid from the stomach, vomit, or food particles.

  • Hospital-acquired - Infection acquired during a stay in the hospital.

What Is Otitis Media?

Otitis media is a middle ear infection where fluid builds up and causes pain and swelling in the eardrum. Types include:

  • Acute otitis media - It is when the middle ear is infected and swollen with fluid build-up.

  • Otitis media with effusion- post-infection, some fluid remains inside and causes infection.

  • Chronic otitis media - accumulated fluid repeatedly returns to the middle ear and compromises hearing ability. Infection may or may not be present.

Why Does Pneumonia Affect the Middle Ear?

The middle ear is between the tympanic membrane (eardrum) and the inner ear. The eustachian tube connects it to the upper throat (nasopharynx). This connection continues down to the middle throat (oropharynx), the lower throat (hypopharynx), the windpipe (trachea), and finally, the lungs. This interconnection causes the infection from the lungs to reach the middle ear.

How Does Pneumonia Cause Otitis Media?

Persistent and recurrent infection results in colonization of the nasopharynx with Streptococcus pneumoniae. Viral infection co-exists and induces the adherence of bacteria to mucosal epithelial cells of the middle ear, which is close to the nasopharynx. This causes mucosal membrane inflammation, narrowing of the eustachian tube (ear canal), and reduced ventilation. Negative pressure is created, resulting in increased mucosal secretions that allow the growth of bacteria and viruses. As a result, the middle ear is filled with thick, amber-colored fluid and tympanic membrane retraction. In severe cases, perforation of the membrane can also occur.

Who Gets It?

Anyone can get both infections. But it is more common in children between 3 months - 3 years, and eight years of age. It also occurs in adults but is less common compared to infants and children. It also affects individuals with weak immune systems.

What Are the Symptoms?


  • Chest pain.

  • Fatigue.

  • Fever and chills.

  • Cough with phlegm.

  • Nausea, vomiting, and diarrhea.

  • Difficulty in breathing.

Otitis Media:

  • Ear pain.

  • Fever.

  • Fluid from the ear.

  • Poor sleep.

  • Poor appetite.

  • Difficulty in hearing.

What Are the Complications?

Complications are often seen in children and adults with pre-existing conditions.


  • Pleurisy - Inflammation of the lining between the lungs and ribcage, resulting in respiratory failure.

  • Lung abscess - Pus formation in the lungs, a rare complication.

  • Sepsis - This is a serious complication where the infection travels into the blood, leading to organ dysfunction.

Otitis Media:

  • Loss of hearing.

  • Perforation of the eardrum.

  • Pus formation.

  • Facial paralysis.

  • Meningitis.

  • Brain abscess.

  • Otitic hydrocephalus.

How to Prevent It?

  • Practice and teach personal hygiene to prevent the common cold.

  • Avoid smoking and passive smoking.

  • Ask your physician about flu, pneumococcal and other vaccines for your children to prevent respiratory infections.

How Is It Diagnosed?

Pneumonia is diagnosed with a few of the following tests;

  • A Chest X-Ray -To examine inflammation of the lungs.

  • Blood Tests - Complete blood count to detect infection.

  • Pulse Oximeter- To measure blood oxygen levels.

  • Sputum Test - To find out the causative microorganism.

  • A Polymerase Chain Reaction Test - Blood or sputum is tested to know the DNA (deoxyribonucleic acid) of the microorganism.

  • CT Scan - To find if lung abscesses or any pleural disorders are present.

  • Thoracentesis - Pleural fluid present between lungs and rib cage is removed and cultured to find microorganisms.

Otitis media is diagnosed based on the symptoms. The tests done for examination are:

  • Pneumatic Otoscope -An instrument used to observe the eardrum.

  • Tympanometry - To assess the movement of the eardrum. There will be slight or no movement if the eardrum is swollen.

  • Acoustic Reflectometry -Measures the sound reflected from the eardrum. More sound indicates high pressure in the eardrum because of fluid accumulation.

  • Tympanocentesis - A rare test in which the fluid is removed through a small tube to find the causative microorganisms.

What Are the Treatment Options?


Treatment is based on symptoms and severity. Mild pneumonia is manageable at home under the guidance of your doctor.

The following steps are advised:

  • Acetaminophen or Ibuprofen is prescribed to control fever.

  • Consuming plenty of liquids is essential for hydration.

  • Cough medicines should be taken only if your doctor advises you to do so.

  • Good rest is essential.

Severe cases are treated in a hospital setup,

  • Antibiotics: antibiotics are given only for bacterial pneumonia after the culture test. Systemic antibiotics are given.

  • Antivirals: to treat viral pneumonia.

  • Acetaminophen or Ibuprofen is given to reduce fever.

  • Cough medicines are not given unless it is essential because coughing evacuates sputum.

  • Nebulizer with Ventolin, ProAir, or Proventil to ease breathing.

  • Oxygen or a ventilator is used to ease breathing.

Otitis Media:

Ear infections settle within one to two weeks. The doctor will advise following management based on symptoms.

  • Pain Medications -the doctor will prescribe drugs like Acetaminophen or Ibuprofen to relieve pain.

  • Ear Drops - Anesthetic drops to relieve pain.

  • Antibiotics -Antibiotics are prescribed in the following cases;

    • Age 6 months and above with moderate to severe pain or temperature 102.2 degrees.

    • 6-23 months with mild pain and fever of less than 102.2 degrees

    • Twenty-four months and above with mild pain and fever less than 102.2 degrees.

  • Ear Tubes - A small hole is surgically created in the eardrum, and a tiny plastic or metal tube is placed to prevent fluid accumulation and ventilation. This is done in case of recurrent fluid build-up.

When to Consult a Doctor?

Symptoms can be mild to severe. It is important to consult a physician if the symptoms are present for more than a day. Children and infants with the infection should be consulted to avoid severe illness. Individuals with fluid or blood discharge from the ear should immediately visit the doctor. It is essential to get proper treatment to prevent further progression.


Pneumonia and otitis media are common childhood diseases. Microorganisms are common in the nose and throat of children. They affect individuals with weak immunity. Doctors recommend vaccination for children and adults to protect them from pneumococcal diseases. Consult the doctor for early intervention and treatment.

Frequently Asked Questions


Can Pneumonia Cause a Middle Ear Infection?

Streptococcus pneumonia can cause infection in the middle ear cavity through the eustachian tubes that connect the middle ear to the back of the throat and cause acute otitis media. In severe cases, it can also lead to hearing loss. This is more commonly seen in children after a respiratory tract infection such as flu or cold.


How Does an Ear Infection Affect Our Lungs?

The bacteria found in infected middle ears or sore throats are the same variety of organisms responsible for causing pneumonia, sinusitis, and other respiratory infections. This is more commonly seen during the winter and early spring.


What Are the Different Forms of Otitis Media?

There are four types of otitis media:
  - Acute Otitis Media - This type of infection occurs abruptly. It can cause swelling and redness due to the mucus trapped inside the ear.
- Otitis Media with Effusion - There is an accumulation of fluid and mucus in the middle ear after the initial infection subsides. The child may experience fullness and hearing loss.
- Chronic Otitis Media - In this type, the fluid or the mucus stays in the middle ear for a long period and may lead to hearing impairment.


How Does Otitis Media Progress

Otitis media is a complex inflammatory process following a viral upper respiratory tract infection. This involves the obstruction of the eustachian tube, causing a decrease in ventilation. This leads to an increase in negative pressure in the middle ear and mucosal secretions. The build-up of mucosal secretion serves to colonize bacteria and viral organisms in the middle ear. This is associated with frank purulence in the middle ear space and can be clinically observed.


How Do We Classify Pneumonia as a Bacterial or Viral Disease?

Pneumonia usually results from a bacterial infection affecting the upper respiratory tract. It is a serious infection that may involve one or both lungs. Streptococcus pneumonia is the most common type of bacteria causing Pneumococcal pneumonia.


How Is Otitis Media Treated?

Treatment of otitis media may depend on age, severity, and the nature of the infection. The most effective treatment for otitis media is using analgesics, such as non-steroidal anti-inflammatory medications. Antibiotics may be taken by mouth or as ear drops. In case of chronic infection, ear tubes (tympanostomy tubes) may drain the secretions out.


How Is Otitis Media Diagnosed?

An ENT (ear, nose, and throat) doctor can identify the ear infection using an otoscope. The healthcare provider can examine the middle ear for fluid accumulation using a special instrument, a pneumatic otoscope. Another test, known as tympanometry, can be used to check the air pressure in the middle ear. A hearing test performed by an audiologist can help to determine the possibility of hearing loss. It may be required to check the throat and the nasal passage for other signs of upper respiratory infections.


Can We Leave Otitis Media Untreated?

Untreated ear infections can cause several complications, such as
- Hearing Loss - Chronic infections can damage the ear's internal structures and cause significant loss of hearing.
- Delayed Speech and Language Skills - Impaired hearing due to damage to the ear can delay or affect speech development and clarity of language in children.
- Tear in the Drum - Long-lasting fluid in the middle ear can develop a tear in the eardrum in children. This may lead to hearing loss.
- Spread of Infection - Untreated infection can affect the adjacent mastoid bone (bone behind the ear). It may rarely extend the infection to the surrounding brain and spinal cord membranes.


How Does Antibiotics Help in Treating Otitis Media?

Antibiotics may be used to kill the bacteria and are used to treat ear infections that last for more than two to three days. The ear drops can be given directly into the ears. High doses of Amoxicillin are usually the first line of therapy for ear infections. The effect of antibiotics may be seen in two to three days.
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


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