Ear Infections
Infection and inflammation of the ear, often the middle ear
Quick Facts
- Type: Ear, nose, and throat infection
- Most common in: Infants and young children
- Common symptoms: Ear pain, fluid, fever, irritability
- Often follows: A cold or upper respiratory infection
Overview
Ear infections occur when germs cause inflammation and fluid buildup in the ear. The most common type is a middle ear infection, called otitis media, which sits behind the eardrum. Infections can also affect the ear canal (otitis externa, or swimmer's ear). Ear infections are very common in young children because of the small size and angle of their ear tubes.
Most ear infections follow a cold or other upper respiratory infection and many clear up on their own within a few days. Treatment focuses on relieving pain and, when needed, treating infection. Recurrent or persistent ear infections sometimes need additional evaluation or procedures.
Symptoms
Symptoms depend on age and the type of infection:
- Ear pain, which may be worse when lying down
- Tugging or pulling at the ear in young children
- Fussiness, crying, and trouble sleeping
- Fever
- Fluid or pus draining from the ear
- Trouble hearing or responding to sounds
- Loss of balance in some children
- Headache or reduced appetite
Drainage of pus or fluid can mean the eardrum has a small tear, which often relieves pain and usually heals.
Causes
Ear infections are usually caused by bacteria or viruses, often after a cold causes swelling and blockage of the tubes that drain the middle ear. Contributing factors include:
- Upper respiratory infections, which lead to fluid buildup behind the eardrum
- Blocked or poorly draining eustachian tubes, especially in young children
- Enlarged adenoids that block drainage
- Allergies that cause congestion
- Water trapped in the ear canal, which can cause swimmer's ear
Risk Factors
- Young age, particularly between 6 months and 2 years
- Attending group childcare
- Exposure to tobacco smoke or air pollution
- Bottle-feeding while lying down
- Frequent colds or allergies
- A family history of ear infections
Diagnosis
A clinician diagnoses an ear infection by examining the ear and reviewing symptoms.
- Otoscope examination: Looking at the eardrum for redness, bulging, or fluid behind it.
- Pneumatic otoscopy: Gently puffing air to see if the eardrum moves normally, which it may not when fluid is present.
- Tympanometry: A test that measures eardrum movement and middle ear fluid.
- Hearing evaluation for recurrent or persistent infections.
Treatment
Treatment depends on the child's age, the severity, and the type of infection.
- Pain relief: Acetaminophen or ibuprofen as appropriate, plus warm compresses, are often the main treatment.
- Watchful waiting: Many middle ear infections improve on their own, so antibiotics are sometimes delayed for a day or two in mild cases.
- Antibiotics: Prescribed when the infection is more severe, in very young children, or when symptoms do not improve.
- Ear drops: Used for swimmer's ear, an infection of the ear canal.
- Ear tubes: A small procedure to place tubes that drain fluid may be considered for frequent or persistent infections.
Prevention
- Keep children away from tobacco smoke
- Stay up to date on recommended vaccines
- Breastfeed when possible, and avoid bottle-feeding a baby lying flat
- Wash hands and reduce the spread of colds
- Manage allergies that cause congestion
- Dry the ears after swimming to help prevent swimmer's ear
When to See a Doctor
See a doctor if you or your child has:
- Severe ear pain or pain lasting more than a day or two
- Fluid, pus, or blood draining from the ear
- A high fever
- Symptoms in an infant under 6 months
- Hearing problems or repeated ear infections
Seek prompt care for severe headache, stiff neck, swelling or redness behind the ear, dizziness, or facial weakness, which can signal a more serious complication.
Frequently Asked Questions
Are ear infections contagious?
The ear infection itself is not contagious, but the colds and respiratory infections that often lead to ear infections can spread from person to person. Good hand hygiene and reducing the spread of colds can lower the chance of ear infections.
Do ear infections always need antibiotics?
No. Many middle ear infections, especially mild ones, improve on their own, so doctors may recommend pain relief and watchful waiting for a day or two. Antibiotics are used for more severe infections, very young children, or symptoms that do not improve.
Why do children get ear infections so often?
Young children have shorter, more horizontal eustachian tubes that drain the middle ear less effectively, so fluid and germs build up more easily after colds. Frequent colds, group childcare, and exposure to smoke also increase the risk.
When is an ear infection serious?
Seek prompt care for severe headache, stiff neck, high fever, swelling or redness behind the ear, dizziness, or facial weakness, which can signal a complication. Repeated infections or ongoing hearing problems also warrant evaluation.
References
- Centers for Disease Control and Prevention (CDC).
- American Academy of Pediatrics. Ear infections in children.
- Mayo Clinic. Ear infection (middle ear).
- MedlinePlus, U.S. National Library of Medicine. Ear infections.