Ear Infection

An ear infection, or acute otitis media, is a condition where viruses or bacteria grow in fluid trapped in your middle ear. This is the space just behind your eardrum. It can cause symptoms like ear pain and muffled hearing that can feel miserable while the infection lasts.

Anyone can get an ear infection. But they’re most common in children, especially kids under 2 years old. Their ear anatomy and still-developing immune systems make them especially vulnerable to infections. Pediatricians in the U.S. diagnose about 15 million cases each year.

The good news is that most ear infections go away on their own within a few days. When they don’t, antibiotics often clear things up.

Symptoms of an ear infection

Symptoms often come on suddenly after an upper respiratory infection. They include:

• Ear pain
• Fullness or pressure in your ear
• Trouble hearing in the ear that’s blocked
• Yellow, brown or white ear drainage (a sign of a torn eardrum)

As small children can’t always tell you that their ears hurt, it’s important to recognize the signs. A baby or child may:

• Rub or tug on their ears
• Be fussy or irritable
• Have trouble eating or sleeping
• Not respond to sounds as they normally do
• Have a fever

Are ear infections contagious?

Ear infections aren’t contagious, but the germs that cause them are. Many types of bacteria and viruses can lead to ear infections, including ones that cause colds and the flu.

Ear infection causes

Often, ear infections start after a viral infection, like a cold. They can also be caused by or progress to a bacterial infection. Either way, this leads to infected fluid behind your eardrum in your middle ear space.

The most common bacteria that cause this condition are:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

Risk factors

Factors that increase your child’s risk include:

• Age: Otitis media is most common in children between 6 months and 2 years old.
• Being around lots of other kids: The germs that can lead to ear infections spread easily among children in close spaces, like classrooms and daycare.
• Family history: Children whose parents or siblings are prone to ear infections often also have issues.
• Immunodeficiency: Conditions that weaken your child’s immune system can make it harder for their body to fight off germs.
• Poor air quality and smoky environments: Exposure to toxins in the air, including secondhand smoke, increases your child’s chances of an ear infection.

Complications of this condition

Most ear infections don’t cause long-term issues. But they can become serious if the infection spreads to nearby tissue, like the bone behind your child’s ear. This is called mastoiditis.

Infections can lead to ear drainage from a torn eardrum. Most tears heal on their own within a few weeks or months. But some children need treatment.

Frequent or ongoing ear infections can damage the internal structures in your child’s ear. This can lead to hearing loss. This is always concerning. But it’s especially worrisome if your child loses hearing function when they’re learning to talk. It can delay their speech development.

Prompt treatment can prevent these worst-case scenarios from happening.

How doctors diagnose this condition

Most healthcare providers diagnose ear infections based on symptoms and an ear exam. For the exam, your child’s provider will use a lighted instrument called an otoscope to view their eardrum. A swollen eardrum is a sign of an ear infection.

They may also use tests that:

• Check for fluid behind the eardrum, such as tympanometry and acoustic reflectometry
• Remove fluid and check it for germs, like tympanocentesis

Your child may need a hearing test to check for hearing loss. This is more common in children with long-lasting or frequent ear infections.

How is an ear infection treated?

Ear infections often get better without treatment, usually within three days. Your child’s healthcare provider may observe their condition to see if it improves before prescribing treatments. They may give you a prescription for antibiotics to take home and fill just in case your child doesn’t get better.

Antibiotics

Antibiotics are the most common treatment. Your child is more likely to need them if their body has a hard time fighting the infection on its own. The American Academy of Pediatrics provides guidelines on when a child should receive antibiotics and when it’s best to observe. Pediatricians often recommend antibiotics for:

• Children younger than 6 months
• Children 6 months and older who have moderate to severe symptoms for at least 48 hours or a temperature of 102.2 degrees Fahrenheit (39 degrees Celsius) or higher
• Children 6 months to 23 months with an infection in both ears
• Children 6 months to 23 months with mild symptoms that haven’t improved within 48 to 72 hours of symptoms starting
• Children 2 years or older whose symptoms haven’t improved within 48 to 72 hours of symptoms starting

Your pediatrician knows the specifics about your child’s health best and can advise you on when they need medicine.

It’s important that your child keeps taking their meds as prescribed, even if they start to feel better. Otherwise, the infection can come back. Usually, they’ll need to be on antibiotics for about a week.

Pain relievers

Over-the-counter medicine, like acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®), can help ease your child’s pain and reduce their fever while the infection clears. Their provider may prescribe pain-relieving ear drops as long as there are no tears in your child’s eardrum.

If your child is younger than 2 years old, call their provider before giving acetaminophen.

Never give aspirin to children under 16 unless their healthcare provider says it’s OK. Aspirin can cause a life-threatening condition called Reye’s syndrome in children.

Ear tubes

Your child may need ear tubes if they get frequent ear infections or have hearing loss related to fluid buildup. An otolaryngologist specialist (ear, nose and throat, ENT) places the tubes during a tympanostomy. During this short procedure, the provider inserts tubes into your child’s eardrum. This allows fluid to drain.

The tube usually stays in place for 12 to 18 months. It may fall out on its own, or your child may need surgery to remove it. Once the tubes are gone, the hole in your child’s eardrum will heal and close.

When should I see my healthcare provider?

Call your pediatrician immediately if your child:

• Has a fever of 100.5 F (38 C) and is under 3 months old
• Develops severe ear pain, a stiff neck or a fever over 104 degrees F (40 degrees C)
• Acts sluggish, looks or acts very sick, or won’t stop crying
• Has an unsteady walk or shows signs of facial weakness, like a crooked smile
• Has blood or pus draining from an ear

If your child is taking an antibiotic, let their provider know if they have ear pain that doesn’t improve after three days. And contact them if the fever goes away but then comes back after two days (48 hours) of starting an antibiotic.

Can an ear infection go away on its own?

Yes, most infections go away on their own in about three days (72 hours). This is why your healthcare provider may wait before prescribing medications like antibiotics. This can spare your child from having antibiotic side effects, like an upset tummy. In the meantime, pain relievers can help with symptoms like ear pain.

Depending on your child’s age and symptoms, they may need antibiotics or ear tubes. Follow your healthcare provider’s guidance about caring for your child.

Can this be prevented?

You can’t prevent all ear infections. But you can greatly reduce your child’s risk if you:

• Breastfeed your baby for the first six to 24 months.
• Bottle-feed your baby in an upright position, so they don’t aspirate.
• Protect your child from exposure to secondhand smoke.
• Keep them up to date on vaccines.
• Teach your child how to avoid catching and spreading germs (like washing their hands often, coughing into their sleeve and not sharing cups or utensils).

Can my child go swimming with an ear infection?

Swimming is OK if your child doesn’t have a tear in their eardrum or drainage from their ear.

Can I travel by air or be in high altitudes if I have an ear infection?

Air travel or a trip to the mountains is safe. But you may feel temporary pain during takeoff and landing. Swallowing fluids or chewing gum during descent can help with the pain. If your small child has an ear infection, have them suck on a pacifier to relieve discomfort during air travel.

What causes an ear infection in adults?

The causes are the same in children and adults. Otitis media happens when bacteria infect fluid that gets trapped behind your eardrum.

In children, this happens more often because their immune systems aren’t as good at fighting off germs. Also, their eustachian tubes (the canals behind their ears that drain fluid) don’t function as well as in adults. This can make it easier for fluid to collect. And as most parents know, kids share germs and colds all the time.

But adults can still get ear infections. This is especially the case if your eustachian tubes are blocked. Your risk is greater if you have a weak immune system. This can happen because of a condition, procedure or even medicine you take.