The middle ear is the cavity behind the eardrum containing the auditory ossicles, small bones that transmit sound from the eardrum to the inner ear and the auditory nerves. Middle ear inflammation frequently occurs in children, usually affecting both ears. In adults generally only one ear is affected. Inflammation often begins as the result of a cold or other infectious illness such as measles, scarlet fever or a sore throat. The mucous membrane of the nasal cavity and the pharynx swells up. The same occurs in the Eustachian tube, which connects the pharynx with the middle ear. The tube becomes blocked, mucus can no longer pass to the pharynx and accumulates in the middle ear, where inflammation can occur, causing pus to form from the bacteria and dead cells. Blockage of the Eustachian tube by an enlarged adenoid can also cause inflammation. The child snores, sleeps with its mouth open, and is subject to frequent colds and inflammation of the middle ear. If the complaint persists the adenoid can be removed. Another cause of inflammation of the middle ear in children is swimming in chlorinated water, which causes swelling of the mucous membranes, blocking the Eustachian tube. Middle ear inflammation causes earache, possibly severe. In infants the symptoms are not so clear. There is usually fever, but sometimes the child simply has difficulties in taking nourishment. When pus forms in the middle ear the pain is more severe, the patient feels extremely ill and hearing is badly affected. Inflammation of the middle ear can persist for a long time – more than six weeks – and the ear will discharge matter throughout this period. The inflammation can spread in two directions, to the cerebral membranes, resulting in meningitis, or to the inner ear and to the surrounding bone cavities. Another consequence of inflammation of the middle ear is so-called glue ear. Thick, viscous mucus accumulates in the middle ear, reducing hearing considerably, and has to be removed by a small incision in the eardrum or by the insertion of a grommet. In cases of earache or fever a doctor should examine the eardrum. If inflammation of the middle ear is acute the eardrum is red and swollen because of the accumulated pus. Hearing should also be tested. If the condition persists for only a short time, treatment with nasal drops may be attempted; this reduces swelling in the mucous membrane and may halt the progress of the illness. Often measures have to be taken against fever and pain. If inflammation persists for a longer period and hearing deteriorates then the pus has to be released by an incision in the eardrum (paracentesis). This is painful and usually performed under anaesthetic. Some family doctors will perform paracentesis, although it may have to be done in a hospital outpatients’department. Hearing should return to normal after four weeks. Antibiotics are usually prescribed if the ear is still discharging after one to two weeks, to destroy the bacteria causing the inflammation. If inflammation of the middle ear persists for longer than six weeks in spite of treatment, then an ENT specialist should be consulted. If the inflammation spreads to the bone, which is rare, then an operation may be necessary to remove the affected bone.