Inflammation of the middle ear in which there is fluid in the middle ear accompanied by signs or symptoms of ear infection: a bulging eardrum usually accompanied by sever ear pain; or a perforated ear drum, often with drainage of purulent material from the affected ear. Acute otitis media is the most frequent diagnosis in sick children having ear pain especially affecting infants and preschoolers. Almost all children have one or more bouts of otitis media before age 6.

The Eustachian tube is shorter in children than adults which allows easy entry of bacteria and viruses into the middle ear, resulting in acute otitis media. Bacteria such as Streptococcus pneumonia and Hemophilus influenza, account for about 85% of cases of acute otitis media and viruses the remaining 15%.

Bottlefeeding is a risk factor for otitis media. The position of the breastfeeding child is better than the bottle feeding position for eustachian tube function.

Upper respiratory infections are a prominent risk factor for acute otitis media so exposure to groups of children as in child care centers results in more frequent colds and therefore more earaches.

Young children with otitis media may be irritable, fussy, or have problems feeding or sleeping. Older children may complain about pain and fullness in the ear. Fever may be present in a child of any age. These symptoms are often associated with signs of upper respiratory infectionsuch as a runny or stuffy nose or a cough.

The buildup of pus within the middle ear causes pain and dampens the vibrations of the eardrum (so there is usually transient hearing loss during the infection). Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal. The hole in the eardrum from the rupture usually heals with medical treatment.

Glue ear, known as adhesive otitis, is a condition that occurs when the middle part of the ear fills with fluid. This part of the ear is located behind the eardrum. The fluid can become thick and sticky, like glue. Around 50 per cent of cases of glue ear develop after a previous ear infection (otitis media). However, glue ear is known not to result from water getting into the ear through activities such as swimming and showering, or due to a build-up of 'ear wax'

It can affect one or both ears. The fluid has a deadening effect on the vibrations of the eardrum and tiny bones (ossicles) created by sound. These affected vibrations are received by the cochlea and so the volume of the hearing is turned down. Glue ear usually occurs in young children but it can develop at any age. As with general ear infections, glue ear tends to be more common in children. This is because the eustachian tubes deep inside the ear are narrower than an adult's and more prone to becoming clogged.

Possible complications of glue ear include ear infections and, where hearing loss is more severe, a minor temporary delay in speech and language development. If left untreated for a long period of time, glue ear can sometimes cause damage to the ear drum (tympanic membrane) requiring surgery.

Surgery may be required if the glue ear is not better after three months and your child has severe hearing loss. Surgery is also an option if your child's learning or development is affected. The main surgery for glue ear is to make a tiny cut in the ear drum and put in a teflon tube called a grommet.