Otitis media in pregnancy

Overview

Otitis media is an infection of the middle ear, the space behind the eardrum. During pregnancy, hormonal and immune changes can make some women more likely to get ear infections. The condition causes pain, fever, and sometimes hearing loss. With proper care, it usually gets better without lasting problems.

Otitis media is common in the general population, and pregnant women can get it too, though it is not one of the most frequent pregnancy problems. It may occur slightly more often due to hormonal shifts that affect the ear's lining.

It can affect any pregnant woman, especially those in the first and second trimesters. Women with a history of ear infections, allergies, or smoking are at higher risk.

Symptoms

Common symptoms

• Ear pain, especially when lying down
• Feeling of fullness or pressure in the ear
• Muffled hearing or temporary hearing loss
• Fever (temperature above 37.5°C)
• Irritability or general feeling of being unwell

Symptoms in children

• Children may tug or pull at the affected ear
• Crying more than usual, especially at night
• Trouble sleeping or feeding
• Fever often higher than in adults

Symptoms in older adults

• Less obvious pain; may just feel dizzy or off-balance
• Hearing loss may be more noticeable
• Sometimes no fever, but confusion or fatigue

Causes

Main causes

• Bacteria or viruses that travel from the nose or throat into the middle ear
• Blocked eustachian tubes (small passages that connect the middle ear to the back of the nose), often due to a cold, flu, or allergies
• Swelling of the ear lining from pregnancy-related fluid retention

Risk factors

• Having a cold or sinus infection during pregnancy
• Allergies that cause congestion
• Smoking or being around smoke
• Weakened immune system due to pregnancy or other conditions
• Previous ear infections

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above
• If ear pain is severe or getting worse
• If you have a fever over 38°C that doesn't improve with rest and fluids

Book a routine appointment if:

• If you have ear pain or pressure that lasts more than 2 days
• If you notice hearing loss or ringing in your ears
• If you feel dizzy or off-balance

Diagnosis

Your healthcare provider will ask about your symptoms and look into your ear with a special tool called an otoscope, which has a light and a magnifying lens. They can see if the eardrum is red, swollen, or bulging.

Tests that may be done

• Otoscopic examination: looking into the ear canal and at the eardrum
• Tympanometry: a quick test that measures how the eardrum moves (this shows if fluid is behind the drum)
• Hearing test (audiometry) if hearing loss is suspected

What to expect at your appointment

The doctor will gently examine both ears. You may feel a little pressure but it is not painful. If there is fluid, they may try to see if your eardrum moves. The whole check-up takes about 10 minutes. You will get advice on treatment that is safe for you and your baby.

Treatment

Treatment for otitis media in pregnancy focuses on relieving pain and fighting the infection while keeping you and your baby safe. Many cases improve without antibiotics, but if bacteria cause the infection, your doctor may prescribe a safe antibiotic.

Self-care at home

• Rest as much as possible, especially if you have a fever.
• Drink plenty of fluids (water, warm tea) to help thin mucus.
• Use a warm compress (like a warm, damp cloth) over the affected ear for 15–20 minutes to ease pain.
• Elevate your head slightly when sleeping to help the ear drain.
• Take simple pain relief that is safe in pregnancy – ask your doctor or pharmacist which painkillers are suitable (for example, paracetamol is often recommended, but always check with them).

Medical treatments

If the infection does not get better with self-care, your doctor may recommend an antibiotic that is safe to use during pregnancy, such as a penicillin-type drug. They will choose one that has been widely used and studied. Never take leftover antibiotics or medicines from a previous illness. Always finish the full course as prescribed. Your doctor may also suggest decongestant sprays (being careful to use only those safe in pregnancy) or saline drops to relieve congestion.

When is surgery considered?

Surgery is rarely needed for otitis media in pregnancy. In very severe or recurrent cases, a small tube (grommet) may be placed in the eardrum to drain fluid, but this is usually delayed until after delivery unless the infection is life-threatening.

Living with this condition

Having an ear infection during pregnancy can be painful and tiring. Try to get extra rest and avoid loud noises that could worsen hearing symptoms. You may need to take time off work if the pain or fever is severe. Let your partner, family, or friends help with daily tasks.

Lifestyle tips

• Avoid smoking and secondhand smoke, which can worsen congestion and slow healing.
• Keep your ears dry when bathing or swimming (use a shower cap or earplugs).
• Manage allergies with pregnancy-safe antihistamines, if recommended by your doctor.
• Stay up to date with recommended vaccinations (like the flu shot) to prevent colds that can lead to ear infections.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains to support your immune system. Drink plenty of water. Light exercise, such as walking, can help you feel better but avoid strenuous activity when you have a fever or feel dizzy.

Mental health and emotional wellbeing

Dealing with pain and illness while pregnant can be stressful and worrying. You might feel anxious about the infection affecting your baby or about taking medicines. It is normal to feel this way. If feelings of anxiety or sadness become overwhelming, talk to your midwife, doctor, or a mental health professional. You are not alone.

Prevention

You cannot always prevent otitis media, but you can lower your risk by staying healthy, washing your hands often, avoiding contact with people who have colds, and not smoking. If you have allergies, managing them well can also reduce the chance of ear infections.

Vaccines

Getting the flu vaccine and the COVID-19 vaccine (or boosters) as recommended by your healthcare provider can help prevent viral infections that often lead to ear infections. The whooping cough vaccine is also recommended in pregnancy for your baby's protection and may indirectly reduce your risk of respiratory infections.

Screening programmes

There is no routine screening for ear infections. If you have frequent ear infections before pregnancy, talk to your doctor about how to best manage your ear health during pregnancy.

Complications

If left untreated

• Spread of infection to nearby structures, such as the mastoid bone behind the ear (mastoiditis)
• Persistent hearing loss
• Formation of a pocket of pus (abscess) behind the ear
• Rarely, infection can spread to the brain (meningitis) – this is very serious but extremely rare

Long-term outlook

The good news is that most cases of otitis media in pregnancy clear up completely with proper care. Even if you need antibiotics, the risk to your baby is very low with safe medications. Hearing usually returns to normal once the infection resolves. With timely treatment, both you and your baby can expect a full recovery.

Find support

International organisations

• International Federation of Gynecology and Obstetrics (FIGO) ↗

Local organisations

• NHS (UK) – Ear infections ↗ · United Kingdom

Helplines

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