Conditions InDepth: Middle Ear Infection

Infections can affect the outer, middle or the inner part of the ear. Middle ear infection is the most common type. The middle ear is just behind the ear drum.

Ear infections may begin after a cold or other virus that causes nasal problems. Some can start without a known cause. Children are more likely to have ear infections than adults.

The Middle Ear

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Ear infections start when bacteria or viruses get inside the ear. A tube connects the inner ear to space behind the nose. Viruses or bacteria that cause an infection in sinuses, nose, or throat can pass up this tube to the ear. There the infection can grow. Children are more likely to get ear infections than adults because:

  • Children have shorter tubes from ear to behind the nose. This makes it easier for infections to travel up to the ear.
  • Children have larger adenoids than do adults. Adenoids sit in the back of the nose. They can block the tube to the ear when they swell. It will make it hard for fluid to drain from the ear.


Acute otitis media (AOM) in Adults. EBSCO DynaMed website. Available at: Updated September 4, 2019. Accessed December 5, 2019.
Acute otitis media (AOM) in Children. EBSCO DynaMed website. Available at: https://www.dyname.... Updated September 4, 2019. Accessed December 5, 2019.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
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Updated May 12, 2017. Accessed December 5, 2019.
Lieberthal AS, Carroll AE, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-e999
Middle ear infections. Healthy Children—American Academy of Pediatrics website. Available at: Updated February 22, 2013. Accessed December 5, 2019.
Last reviewed September 2019 by EBSCO Medical Review Board Nicole S. Meregian, PA
Last Updated: 8/25/2020

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