An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.
Ear infections frequently are painful because of inflammation and buildup of fluids in the middle ear.
Because ear infections often clear up on their own, treatment may begin with managing pain and monitoring the problem. Ear infection in infants and severe cases in general often require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications.
If you have allergies or catch a cold, the eustachian tubes can get blocked up and let germs get in the middle ear. Then the number of germs can grow inside your middle ear and cause an infection. You do not catch ear infections from other people, though you might catch a cold that then leads to an ear infection.
The onset of signs and symptoms of ear infection is usually rapid.
Signs and symptoms common in children include:
- Ear pain, especially when lying down
- Tugging or pulling at an ear
- Difficulty sleeping
- Crying more than usual
- Acting more irritable than usual
- Difficulty hearing or responding to sounds
- Loss of balance
- Fever of 100 F (38 C) or higher
- Drainage of fluid from the ear
- Loss of appetite
Common signs and symptoms in adults include:
- Ear pain
- Drainage of fluid from the ear
- Diminished hearing
When to see a doctor
Signs and symptoms of an ear infection can indicate a number of conditions. It’s important to get an accurate diagnosis and prompt treatment. Call your child’s doctor if:
- Symptoms last for more than a day
- Symptoms are present in a child less than 6 months of age
- Ear pain is severe
- Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection
- You observe a discharge of fluid, pus or bloody discharge from the ear
An adult with ear pain or discharge should see a doctor as soon as possible.
An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.
Role of eustachian tubes
The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:
- Regulate air pressure in the middle ear
- Refresh air in the ear
- Drain normal secretions from the middle ear
Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection or allergy can block them, causing the accumulation of fluids in the middle ear. A bacterial or viral infection of this fluid is usually what produces the symptoms of an ear infection.
Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.
Role of adenoids
Adenoids are two small pads of tissues high in the back of the nose believed to play a role in immune system activity. This function may make them particularly vulnerable to infection, inflammation and swelling.
Because adenoids are near the opening of the eustachian tubes, inflammation or enlargement of the adenoids may block the tubes, thereby contributing to middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children because children have relatively larger adenoids.
Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include the following:
- Otitis media with effusion is inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur because the fluid buildup persists after an ear infection has resolved. It may also occur because of some dysfunction or noninfectious blockage of the eustachian tubes.
- Chronic otitis media with effusion occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection. This makes children susceptible to new ear infections, and may affect hearing.
- Chronic suppurative otitis media is a persistent ear infection that often results in tearing or perforation of the eardrum.
Risk factors for ear infections include:
- Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their eustachian tubes and because of their poorly developed immune systems.
- Group child care.Children cared for in group settings are more likely to get colds and ear infections than are children who stay home because they’re exposed to more infections, such as the common cold.
- Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.
- Seasonal factors. Ear infections are most common during the fall and winter when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.
- Poor air quality.Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.
Most ear infections don’t cause long-term complications. Frequent or persistent infections and persistent fluid buildup can result in some serious complications:
- Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was before the infection after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
- Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
- Spread of infection.Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).
- Tearing of the eardrum.Most eardrum tears heal within 72 hours. In some cases, surgical repair is neededYour doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and an exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope.
An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to make a diagnosis of an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.
Your doctor may perform other diagnostic tests if there is any doubt about a diagnosis, if the condition hasn’t responded to previous treatments, or if there are other persistent or serious problems.
- Tympanometry. This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, thereby causing the eardrum to move. The device quantifies how well the eardrum moves and provides an indirect measure of pressure within the middle ear.
- Acoustic reflectometry.This test measures how much sound emitted from a device is reflected back from the eardrum — an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect.
- Tympanocentesis.Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis. Tests to determine the infectious agent in the fluid may be beneficial if an infection hasn’t responded well to previous treatments.
- Other tests. If your child has had persistent ear infections or persistent fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities.
What a diagnosis means
- Acute otitis media. The diagnosis of “ear infection” is generally shorthand for acute otitis media. Your doctor likely makes this diagnosis if he or she observes signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if the onset of symptoms was relatively sudden.
- Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection.
- Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, he or she has found that a persistent ear infection resulted in tearing or perforation of the eardrum.
Ear Infections – Cause
Middle ear infections are caused by bacteria and viruses.
Swelling from an upper respiratory infection or allergy can block theeustachian tubes, which connect the middle ears to the throat. So air can’t reach the middle ear. This creates a vacuum and suction, which pulls fluid and germs from the nose and throat into the middle ear. The swollen tube prevents this fluid from draining. The fluid is a perfect breeding ground for bacteria or viruses to grow into an ear infection.
Inflammation and fluid buildup can occur without infection and cause a feeling of stuffiness in the ears. This is known as otitis media with effusion.
Ear Infections – Symptoms
Symptoms of a middle ear infection (acute otitis media) often start 2 to 7 days after the start of a cold or other upper respiratory infection. Symptoms of an ear infection may include:
- Ear pain (mild to severe). Babies often pull or tug at their ears when they have an earache.
- Drainage from the ear that is thick and yellow or bloody. This means the eardrum has probably burst (ruptured). The hole in the eardrum often heals by itself in a few weeks.
- Loss of appetite, vomiting, and grumpy behavior.
- Trouble sleeping.Symptoms of fluid buildup may include:
- Popping, ringing, or a feeling of fullness or pressure in the ear. Children often have trouble describing this feeling. They may rub their ears trying to relieve pressure.
- Trouble hearing. Children who have problems hearing may seem dreamy or inattentive, or they may appear grumpy or cranky.
- Balance problems and dizziness.
Ear infection – chronicChronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back. It causes long-term or permanent damage to the ear.
The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur. A chronic ear infection develops when fluid or an infection behind the eardrum does not go away.
A chronic ear infection may be caused by:
“Suppurative chronic otitis” is a phrase health care providers use to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area and does not go away.
Ear infections are more common in children because their Eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections.
Symptoms of a chronic ear infection may be less severe than symptoms of an acute infection. The problem may go unnoticed and untreated for a long time.
Symptoms may include:
Symptoms may continue or come and go. They may occur in one or both ears.
The health care provider will examine the ears. This may reveal:
- Dullness, redness in the middle ear
- Air bubbles in the middle ear
- Thick fluid in the middle ear
- Eardrum that sticks to the bones in the middle ear
- Draining fluid from the eardrum
- A hole (perforation) in the eardrum
- An eardrum that bulges out or pulls back inward (collapses)
Tests may include:
Ear Infections – Treatment Overview
The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess your child for any risk of complications.
If your child’s condition improves in the first couple of days, treating the symptoms at home may be all that is needed. For more information, seeHome Treatment.
If your child isn’t better after a couple of days of home treatment, call your doctor. He or she may prescribe antibiotics.
Follow-up exams with a doctor are important to check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections. Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young.
Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you useantibiotics will depend on how old your child is and how bad the infection is. For more information, see Medications.
Antibiotics can treat ear infections caused by bacteria. But most children with ear infections get better without them. If the care you give at home relieves pain and the symptoms are getting better after a few days, you may not need antibiotics.
Your doctor will likely give antibiotics if:1
- Your child has an ear infection and appears very ill.
- Your child is younger than 2 and has an infection in both ears or has more than mild pain or fever.
- Your child is at risk for complications from the infection.
For children ages 2 and older, many doctors wait for a few days to see if the ear infection will get better on its own. When doctors do prescribe antibiotics, they most often use amoxicillin, because it works well and costs less than other brands.
When your child takes antibiotics for an ear infection, it is very important to take all of the medicine as directed, even if your child feels better. Do not use leftover antibiotics to treat another illness. Misuse of antibiotics can lead to drug-resistant bacteria.
Deciding about antibiotics
Some doctors prefer to treat all ear infections with antibiotics, because it’s hard to tell which ear infections will clear up on their own. Some things to consider before your child takes antibiotics include:
- Risk for antibiotic-resistant bacteria. The greatest problem with using antibiotics to treat ear infections is the possibility of creating bacteria that can’t be killed by the usual antibiotics (antibiotic-resistant bacteria). Use antibiotics only when they’re needed.
- Side effects of antibiotics. Mild side effects, such as diarrhea and rash, from taking antibiotics are common. Severe side effects are rare.
- Cost. Most antibiotics are expensive. You may want to weigh the cost against the fact that most ear infections clear up without treatment.
Antibiotics have only minimal benefits in reducing pain and fever.
If your child still has symptoms (fever and earache) longer than 48 hours after starting an antibiotic, a different antibiotic may work better. Call your doctor if your child isn’t feeling better after 2 days of antibiotic treatment.
Ear Infections – Prevention
You may be able to prevent your child from getting middle ear infections.
- Don’t smoke. Ear infections are more common in children who are around cigarette smoke in the home. Even fumes from tobacco smoke on your hair and clothes can affect the child.
- Breast-feed your baby. There is some evidence that breast-feeding helps reduce the risk of ear infections, especially if they run in your family. If you bottle-feed, don’t let your baby drink a bottle while he or she is lying down.
- Wash your hands often. Hand-washing stops infection from spreading by killing germs.
- Make sure your child receives all the recommended immunizations. For more information, see the topic Immunizations.
- Take your child to a smaller child care center. Fewer children means less contact with bacteria and viruses. Try to limit the use of any group child care, where germs can easily spread.
- Do not give your baby a pacifier. Try to wean your child from his or her pacifier before about 6 months of age. Babies who use pacifiers after 12 months of age are more likely to get ear infections.
- Rest: avoid further scuba dives,coughing, sneezing, bending, and attempts to equalize the ears.
- Pain may be relieved with 1 to 2acetaminophen (Tylenol) every four hours and/or 1 to 2 ibuprofen (Advil,Motrin) every 6 to 8 hours.
- Pseudoephedrine (the active ingredient in over-the-counter medications such as Sudafed) 30 mg tablets, one every six hours for 2 to 3 days, may ease ear pressure. (People with a history of high blood pressure should avoid this product.)
- For infections of the ear canal (otitis externa): neomycin (Ak-Spore HC, Cortisporin, Neotricin HC, Ocutricin-HC), polymyxin B, andhydrocortisone (Cortisporin, Otocort, Poly Otic), two drops in the ear canal four times per day for five days, may also be used.
- Flouroquinolone antibiotics specifically for the ear are also available (ofloxacin, and ciprofloxacin with dexamethasone) to treat otitis externa and otitis media with a perforation or in the presence of ear tubes.
- If pain occurs, discontinue treatment and seek medical attention.
- Oral antibiotics are usually recommended for discharge from the ear, nose, or mouth. If infection develops, continue antibiotics for at least five days after all signs of infection have cleared. Tell your doctor of any drug allergy prior to starting any antibiotic. The doctor will recommend the right antibiotic. Some can cause sensitivity to the sun, so use a sunscreen (at least SPF 15). Some patients may be sensitive to topical neomycin and have further irritation.
When to Seek Medical Care
- Seek medical treatment as soon as possible for an examination of the ear if an ear infection is suspected.
- Seek medical treatment immediately if you experience a sudden loss in hearing in one or both ears (usually occurring over a period of less than 24-48 hours).
- Elderly people and people with high blood pressure should use decongestants with caution.
- Consult a doctor about treatment with available medications for an ear infection.
Pictures of the Ear
The provider may prescribe antibiotics if the infection is caused by bacteria. These medicines may need to be taken for a long time. They can be given by mouth or into a vein (intravenously).
If there is a hole in the eardrum, antibiotic ear drops are used. The provider may recommend using a mild acidic solution (such as vinegar and water) for a hard-to-treat infected ear that has a hole (perforation). A surgeon may need to clean out (debride) tissue that has gathered inside the ear.
Other surgeries that may be needed include:
- Surgery to clean the infection out of the mastoid bone (mastoidectomy)
- Surgery to repair or replace the small bones in the middle ear
- Repair of the eardrum
- Ear tube surgery
Chronic ear infections most often respond to treatment. However, your child may need to keep taking medicines for several months.
Chronic ear infections are not life threatening. However, they can be uncomfortable and may result in hearing loss and other serious complications.
A chronic ear infection may cause permanent changes to the ear and nearby bones, including:
- Infection of the mastoid bone behind the ear (mastoiditis)
- Ongoing drainage from a hole in the eardrum that does not heal, or after the ear tubes are inserted
- Cyst in the middle ear (cholesteatoma)
- Hardening of the tissue in the middle ear (tympanosclerosis)
- Damage to, or wearing away of the bones of the middle ear, which help with hearing
- Paralysis of the face
- Inflammation around the brain (epidural abscess) or in the brain
- Damage to the part of the ear that helps with balance
Hearing loss from damage to the middle ear may slow language and speech development. This is more likely if both ears are affected.
Permanent hearing loss is rare, but the risk increases with the number and length of infections.
Call your health care provider if:
- You or your child has signs of a chronic ear infection
- An ear infection does not respond to treatment
- New symptoms develop during or after treatment
Getting prompt treatment for an acute ear infection may reduce the risk of developing a chronic ear infection. Have a follow-up exam with your provider after an ear infection has been treated to make sure that it is completely cured.