Dangers of Untreated Middle Ear Infections in Children

A middle ear infection (otitis media) is the second most common infectious condition in children, after upper respiratory tract infections. Understandably many parents are not immediately concerned when otitis media is diagnosed in their children as it is so common and often just goes away on its own. Sometimes treatment is necessary. However, leaving otitis media without treatment or close monitoring can lead to some very serious complications. It is even possible that what was a simple middle ear infection today can progress to a brain problem and cause other life threatening consequences.

No matter how many times a middle ear infection (otitis media) tends to occur in a child, it needs to be managed by a medical practitioner. Most cases of otitis media in children clears up on its own and the symptoms do not often last beyond a few days. Symptomatic treatment is all that is necessary until the conditions resolves spontaneously. However, there is no way for parents to know for sure whether this bout of otitis media will complicate and lead to serious consequences without seeking the advice of a medical practitioner. Ear drops, antibiotics and even air ventilation tubes (grommets) may be necessary in some cases even though it was not needed in the past for the same child.

Here are some of the potential dangers of otitis media. These complications tend to arise in severe cases but it is often a consequence of untreated otitis media. Remember that if otitis media is severe, persistent or recurrent then it should be managed by an ear, nose and the throat specialist (ENT), also known as an otorhinolaryngologist. Failure to seek treatment promptly may require hospitalisation and surgery. In the worst case scenario, it can even lead to death.

Middle Ear

Common Complications of Otitis Media

One of the common complications of otitis media is a perforated eardrum. Here the ear drum ruptures and often it heals on its own within about 72 hours. Sometimes surgery is necessary to repair the ear drum. It is usually not considered to be serious and in fact can prevent more serious complications by letting the pus from the middle ear to drain out if the eustachian tube is blocked. Nevertheless a perforated ear drum needs to be assessed by a doctor and necessary measures taken to prevent damage to the middle ear.

Other relatively common complications with otitis media, particularly when recurrent, is that speech and social development can be impaired. The sense of hearing is important for proper speech development and social interaction and otitis media can affect hearing to varying degrees. Often the hearing impairment is not permanent. It can have a host of other effects on the child’s development and performance in school as well which can be avoided by properly managing otitis media.

Inner ear inflammation and damage

Hearing problems and poor balance are common consequences of severe middle ear infections. However, the problem may be much more serious than many parents realize. When otitis media complicates, it can affect the inner ear structures sitting in the labyrinths of the skull. The condition is therefore known as labyrinthitis or otitis interna (inner ear infection). The hearing apparatus (cochlea) and balance system (vestibular system) are located here and if affected it can lead to hearing loss and/or poor balance.

Paralysis of the face muscles

Severe otitis media can affect the facial nerve in several ways, especially if a cholesteatoma develops (discussed below). The nerve may become infected itself or inflammation with swelling cause compression of the nerve. The function of the nerve is therefore affected which is to conduct nerve impulses. This may manifest as facial palsy or paralysis of the muscles being supplied by the facial nerve. Usually the paralysis of the face muscles affects the same side as where the middle ear infection occurs. It may appear as a facial droop or sagging of one side of the face.

Infection of the back of the skull

The middle ear and the inner ear are located within the skull and therefore any infection in the middle ear can spread to the skull bone. The mastoid bone of the skull is more likely to be infected and this is known as mastoiditis. Although largely treatable, mastoiditis is considered as a serious complication of otitis media. It arises primarily when the pus accumulated within the middle ear cannot drain out through the eustachian tube because of a blockage. This allow the infection within the middle ear to spread to surrounding tissue.

Abnormal growth in the middle ear

An abnormal growth of skin cells can arise in the middle ear in cases of severe, persistent, recurrent and/or untreated otitis media. This type of growth is known as a keratoma or cholesteatoma. It may contain enzymes that can cause significant damage to the middle ear and even extend to the inner ear. A cholesteatoma can lead to even further complications if left untreated such as deafness, facial nerve palsy, meningitis or a brain abscess. Surgery is necessary to remove a cholesteatoma.

Brain and spinal cord lining infection

Infection from the middle ear can also extend to the lining of the brain and spinal cord known as the meninges. This condition is known as meningitis and is very serious. It can possibly even lead to death. Meningitis arising as a complication of otitis media may not always be as obvious to parents. Some of the symptoms like head pain can be confused with otitis media but when there is neck stiffness, coupled with sensitivity to light and confusion, immediate medical attention is required.

Abscess in the brain and skull spaces

An abscess is a collection of pus and with otitis media it can arise in the brain tissue or the space in the skull and spinal bones. This is known as a brain abscess or epidural abscess respectively. A brain abscess may arise when the infection extends directly from the middle ear to the brain tissue, usually near the temporal bone. An epidural abscess may occur when the infection erodes the bone lying in between or possibly spreads through the bloodstream. Both abscesses are very severe complications of otitis media and needs specialist medical attention.


Otitis media complications. Medscape

Ear infection (middle ear) complications. Mayo Clinic

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