Ear Infection
Infection of the middle ear behind the eardrum
Quick Facts
- Type: Middle ear infection (otitis media)
- Most common in: Infants and young children
- Often follows: A cold or upper respiratory infection
- Main symptom: Ear pain
Overview
An ear infection, medically called otitis media, is an infection of the middle ear, the small air-filled space behind the eardrum that contains the tiny bones of hearing. Fluid and germs build up there, often after a cold, causing pain and pressure.
Ear infections are among the most common reasons young children see a doctor, partly because the tube that drains the middle ear (the eustachian tube) is shorter and more horizontal in children, making it easier for fluid to become trapped. Most ear infections are not serious and many improve on their own, though some need antibiotics. This page focuses on middle ear infections; the outer ear canal can also become infected, a separate condition known as swimmer's ear.
Symptoms
Symptoms can come on quickly, often during or just after a cold:
- Ear pain, which may be worse when lying down
- Tugging or pulling at the ear in young children
- Fussiness, crying, and trouble sleeping in babies
- Fever
- Trouble hearing or responding to sounds
- Fluid draining from the ear
- Loss of balance, and reduced appetite
If the eardrum develops a small hole and drains, the pain often eases and pus or fluid may appear. In adults, ear infections cause similar pain, pressure, and reduced hearing. Severe headache, swelling or redness behind the ear, a stiff neck, or high fever needs prompt medical attention.
Causes
Ear infections usually develop when the eustachian tube becomes swollen or blocked, trapping fluid in the middle ear where germs can grow:
- Colds and respiratory infections: Viruses cause swelling that blocks the tube, the most common trigger.
- Bacteria and viruses: Once fluid is trapped, bacteria or viruses can multiply and cause infection.
- Allergies: Can contribute to swelling and fluid buildup.
- Anatomy in children: Shorter, more horizontal eustachian tubes make children especially prone.
Risk Factors
- Young age, especially 6 months to 2 years
- Attending group childcare with frequent colds
- Bottle-feeding while lying flat
- Exposure to tobacco smoke or air pollution
- Seasonal allergies
- Fall and winter seasons, when colds are common
- A family history of ear infections
Diagnosis
A doctor can usually diagnose an ear infection by examining the ear:
- Otoscope exam: Looking at the eardrum, which may appear red, bulging, or have fluid behind it.
- Pneumatic otoscopy: A puff of air checks whether the eardrum moves normally; reduced movement suggests trapped fluid.
- Tympanometry: A test that measures eardrum movement to confirm middle ear fluid.
For recurrent or persistent infections, a hearing test or referral to an ear specialist may be recommended.
Treatment
Treatment depends on age, severity, and how long symptoms last:
- Pain relief: Acetaminophen or ibuprofen (used appropriately for age) and a warm compress help with discomfort.
- Watchful waiting: Many ear infections, especially mild ones in older children, improve on their own within a few days, so doctors may observe before prescribing antibiotics.
- Antibiotics: Recommended for young infants, severe infections, or symptoms that do not improve, to treat bacterial infection.
- Ear tubes: For frequent recurrent infections or persistent fluid affecting hearing, small tubes may be placed to drain the middle ear.
Aspirin should not be given to children. Follow your doctor's guidance on whether and when antibiotics are needed.
Prevention
- Keep up with recommended childhood vaccines, including pneumococcal and flu vaccines
- Avoid exposing children to tobacco smoke
- Breastfeed when possible, which may offer some protection
- Feed bottles in an upright rather than flat position
- Practice good hand hygiene to reduce colds
- Manage allergies that contribute to congestion
When to See a Doctor
See a doctor if ear pain is severe, lasts more than a day or two, or comes with a high fever, or for any ear symptoms in an infant under 6 months. Seek urgent medical care if there is:
- Swelling, redness, or tenderness behind the ear
- A stiff neck, severe headache, or high fever
- Drainage of pus or blood from the ear, or sudden hearing loss
- A child who is very unwell, drowsy, or hard to wake
These can signal a complication that needs prompt treatment.
Frequently Asked Questions
What causes ear infections in children?
Most middle ear infections start with a cold that causes the eustachian tube to swell and trap fluid behind the eardrum, where bacteria or viruses then grow. Young children are especially prone because their eustachian tubes are shorter and more horizontal, so fluid drains less easily.
Do ear infections always need antibiotics?
No. Many ear infections, particularly mild ones in older children, improve on their own within a few days, so doctors often recommend pain relief and watchful waiting first. Antibiotics are used for young infants, severe infections, or symptoms that do not improve, based on a doctor's assessment.
How can I relieve ear infection pain?
Acetaminophen or ibuprofen, used appropriately for age, can ease pain and fever, and a warm compress on the ear may help. Aspirin should never be given to children. If pain is severe, lasts more than a day or two, or comes with high fever, see a doctor.
When should I see a doctor for an ear infection?
See a doctor for severe or persistent ear pain, high fever, any ear symptoms in a baby under 6 months, or drainage from the ear. Seek urgent care for swelling or redness behind the ear, a stiff neck, severe headache, or a child who is very unwell.
Are recurrent ear infections harmful?
Frequent infections or persistent middle ear fluid can affect hearing, which matters for speech development in young children. If ear infections keep recurring, a doctor may recommend a hearing test and sometimes small ear tubes to drain fluid and reduce future infections.
References
- Centers for Disease Control and Prevention (CDC). Ear infection.
- American Academy of Pediatrics (AAP).
- Mayo Clinic. Ear infection (middle ear) — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Ear infections.