Otitis media is inflammation located in the middle ear. It can occur as a result of a cold, sore throat, or respiratory infection. More than 80 percent of children have at least one episode of otitis media by the time they are 3 years old. Nearly half of these children have three or more episodes by the time they are 3 years old. Otitis media can also affect adults, although it’s primarily a condition that occurs in children. Otitis media is the most common diagnosis for children in the United States. It occurs more often in the winter and early spring. Risk Factors While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections: being around someone who smokes, having a family history of ear infections, having a poor immune system, spending time in a daycare setting, not being breastfed, and having a cold. Causes Middle ear infections are usually a result of a malfunction of the eustachian tube, a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear like when your ears 'pop' during air travel. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a buildup of fluid behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. The eustachian tube may not work properly because of a malformation or a cold or allergy, which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube. Types There are two different types of otitis media: acute otitis media (AOM) and otitis media with effusion (OME). Acute Otitis Media (AOM): The middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain, and hearing loss. Otitis Media with Effusion (OME): Fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and hearing loss. Diagnostic Tests and Procedures To diagnose an ear infection, your child’s doctor will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the doctor to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement. Tympanometry is a test that can be performed in most doctors' offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to remain still and not cry, talk, or move. A hearing test may be performed for children who have frequent ear infections. Treatment Otitis media responds to antibiotics and decongestants. Surgery may be recommended for serious or recurring infections. Untreated, otitis media can result in infection in other parts of the head, permanent hearing loss, and problems with speech and language development.