The inflammation of the middle ear (otitis media) is a common disease in childhood. The causes are usually a ventilation disorder of the tuba auditiva with the migration of bacteria from the throat and nose into the middle ear. The tuba auditiva is an approximately 30 to 35 mm long tube that connects the ear to the nose and mouth. This is naturally shorter in the child, which favors infection. Inflammation of the middle ear in children is a clinical diagnosis. With the corresponding symptoms and the otoscopic finding, no laboratory confirmation of the diagnosis by inflammation parameters is necessary to initiate the appropriate drug therapy. The typical symptoms are primarily pain in the affected ear (the child often touches the hurting ear and cries) with or without discharge (purulent or serous), runny or stuffy nose, sometimes, but not always, accompanied by fever. When looking into the ear with the otoscope, the physician can see the typical changes for otitis media that confirm the diagnosis. Although in most cases it is a bacterial infection, it does not always have to be treated with antibiotics. The focus is on inflammation with pain, which can initially be treated with an anti-inflammatory pain killer (e.g. Ibuprofene). It is also important to keep the connection between the ear, nose and mouth as open as possible. The nose should be kept free. Decongestant nasal drops or spray should be avoided in smaller children. Irrigation with sea salt is more suitable. Excess secretions can be carefully sucked out through the nose. If possible, ear drops should not be used unless expressly prescribed by the doctor. Likewise, cotton swabs should not be placed in the ear with the intention of keeping the ear warm or protected. Other manipulations (like cleaning with cotton swabs) have to be avoided. The most middle ear infections can be cured with an anti-inflammatory and decongestant therapy alone. If the symptoms do not improve or even worsen under this therapy, antibiotic treatment must be started. Bleeding from the ear and temporary hearing loss may occur in the course of otitis media, but these are not a cause for concern. Most middle ear infections heal without any consequences.