In infants and young children, the Eustachian tubes are short and horizontal. By age seven, the Eustachian tubes are larger and more vertical, which improves their ability to function. Many problems within the middle ear space are related to the Eustachian tubes.

Normally, the Eustachian tube opens when a person swallows or yawns. Obstruction or blockage of the Eustachian tubes caused by inflammation and swelling from cold symptoms or allergies can prevent them from opening and create negative pressure. Over time, the negative pressure can pull the eardrum inward. If this happens, some fluid may be drawn into the middle ear space and cause a fluid buildup. This frequently occurs in children with upper respiratory infections or allergic symptoms.

If bacteria or a virus enters the middle ear fluid through the Eustachian tube, an ear infection called “acute otitis media” may develop. Symptoms include fever, ear pain, irritability, and sometimes drainage.

Anatomical, environmental, or lifestyle factors that may lead to otitis media include:

• An immature Eustachian tube
• A cleft palate
• Colds and sinus or other respiratory infections
• Allergies
• Exposure to tobacco smoke or other irritants
• Excess mucus and saliva produced during teething
• Infected or enlarged adenoids, and
• Being bottle fed in bed

The adenoids are tonsil-like tissues that are located in the back of the nose, next to the opening of the Eustachian tube.