Complications of middle ear infection 

Serious complications of middle ear infections (otitis media) are rare but very young children are still at risk because their immune systems are still developing.

Some of the main complications associated with middle ear infections are detailed below.


Mastoiditis can develop if an infection spreads out of the middle ear and into the area of bone underneath the ear (the mastoids).

Symptoms of mastoiditis can include:

  • a high temperature (fever)
  • swelling behind the ear, which pushes it forward 
  • redness and tenderness or pain behind the ear
  • a creamy discharge from the ear 
  • headache
  • hearing loss

Mastoiditis is usually treated in hospital with antibiotics given through a drip directly into a vein (intravenously). In some cases, surgery may be required to drain the ear and remove the infected mastoid bone.


A cholesteatoma is an abnormal collection of skin cells inside the ear that can sometimes develop as a result of recurring or persistent middle ear infections.

If it's not treated, a cholesteatoma can eventually damage the delicate structures deep inside your ear, such as the tiny bones that are essential for hearing.

Symptoms of a cholesteatoma can include:

  • hearing loss
  • weakness in half your face
  • dizziness
  • tinnitus – hearing sounds from inside their body rather than from an outside source

In most cases, surgery is required to remove a cholesteatoma.


In some cases, an infection in the middle ear can spread into the inner ear and affect the delicate structure deep inside the ear called the labyrinth. This is known as labyrinthitis.

Symptoms of labyrinthitis can include:

  • dizziness
  • vertigo (the feeling that you, or the environment around you, is moving or spinning)
  • loss of balance
  • hearing loss

The symptoms of labyrinthitis usually pass within a few weeks, although medication to relieve the symptoms and treat the underlying infection may sometimes be prescribed. Read more about treating labyrinthitis.

Problems with speech and language development

If your child has frequent ear infections that affect their hearing while they're very young, there's a risk their speech and language development may be affected.

Contact your GP for advice if you're concerned about your child's development at any point.

Facial paralysis

In very rare cases, the swelling associated with otitis media can cause the facial nerve to become compressed. The facial nerve is a section of nerve that runs through the skull and is used by the brain to control facial expressions.

Compression of the nerve can lead to a person being unable to move some or all of their face. This is known as facial paralysis.

This can be frightening when it first occurs, as many parents are concerned their child may have experienced a stroke. However, the condition usually resolves once the underlying infection has passed and rarely causes any long-term problems.


A very rare and serious complication of a middle ear infection is meningitis. This can occur if the infection spreads to the protective outer layer of the brain and spinal cord (the meninges).

Symptoms of meningitis can include:

  • severe headache
  • being sick
  • a high temperature (fever)
  • stiff neck
  • sensitivity to light
  • rapid breathing
  • a blotchy red rash that does not fade or change colour when you place a glass against it (although this is not always present)

If you think your child may have meningitis, call 999 and ask for an ambulance.

Meningitis caused by a bacterial infection is usually treated in hospital with antibiotics given through a drip directly into a vein (intravenously). Read more about treating meningitis.

Brain abscess

Another very rare and serious complication of a middle ear infection is a brain abscess. This is a pus-filled swelling that develops inside the brain.

Symptoms of a brain abscess can include:

  • a severe headache
  • changes in mental state, such as confusion
  • weakness or paralysis on one side of the body
  • a high temperature (fever)
  • seizures (fits) 

If you suspect that you or someone you know may have a brain abscess, call 999 for an ambulance.

A brain abscess is usually treated using a combination of antibiotics and surgery. The surgeon will usually open the skull and drain the pus from the abscess or remove the abscess entirely. Read more about treating brain abscesses

Page last reviewed: 28/02/2016

Next review due: 28/02/2018