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Ear infection, inner - Complications of middle ear infection

NHS Choices Medical Reference

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Complications of middle ear infection (otitis media) are now less common than they were in the past.

Very young children may have an increased risk of developing complications as their immune systems (the body's defence against infection) are still developing.

Some of the most commonly reported complications are detailed below.


Mastoiditis is one of the most common complications of otitis media (though still rare in general terms) and is caused when the infection spreads out of the middle ear and into the area of bone underneath the ear (the mastoids).

Symptoms of mastoiditis include:

  • earache
  • a drainage of fluid from the ear
  • a high temperature of 38C (100.4F), or above
  • hearing loss
  • headache 
  • redness and swelling in, and sometimes behind the ear

Mastoiditis is treated by injecting antibiotics directly into the mastoid bone. In some cases surgery may be required to remove a damaged section of bone and drain fluid out of the middle ear.


Cholesteatoma is an abnormal pocket of skin (cyst) that can sometimes develop as a complication of reoccurring or persistent middle ear infections.

Symptoms of a cholesteatoma include:

  • dizziness
  • hearing loss in the affected ear
  • drainage of fluid from the ear

Surgery is usually required to remove the cyst.


In some cases the infection can move into the inner ear causing a delicate structure deep inside the ear, called the labyrinth, to become inflamed. This is known as labyrinthitis.

Symptoms of labyrinthitis include:

  • dizziness
  • vertigo - the feeling that the world is moving or spinning around you
  • loss of balance
  • hearing loss

Treatment options include taking a medication called prochlorperazine to combat symptoms of vertigo and dizziness and taking antibiotics to treat the underlying infection.

Read more about the treatment of labyrinthitis.

Facial paralysis

In 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 expression.

Compression of the nerve can lead to people being unable to move some, or all, of their face, which is known as facial paralysis.

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


A rare and serious complication of otitis media is that the infection spreads to the protective outer layer of the brain and spinal cord (the meninges) leading a serious infection known as meningitis.

Symptoms of meningitis include:

  • severe headache
  • being sick
  • high temperature (fever) of 38ºC (100.4ºF) or over
  • stiff neck
  • sensitivity to light
  • a blotchy red rash that does not fade or change colour when you place a glass against it - the rash is not always present

Bacterial meningitis is a medical emergency. If you think your child may have meningitis call 999 and ask for an ambulance.

Bacterial meningitis is treated using injections of antibiotics. Read more about the treatment of meningitis.

Brain abscess

Another rare and serious complication of otitis media is a brain abscess. A brain abscess is a pus filled swelling that develops inside the brain.

Symptoms of a brain abscess include:

  • headache
  • changes in mental state, such as confusion or irritability
  • problems with nerve function, such as muscle weakness, slurred speech or paralysis on one side of the body
  • fever
  • seizures (fits)
  • feeling and being sick

A brain abscess is a medical emergency and requires prompt treatment with 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 the treatment of brain abscesses


  • Numbing: Numbness refers to a lack of sensation in a part of the body.
  • Brain: The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
  • Swelling: Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Medical Review: April 21, 2012
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