An ear infection, also called acute otitis media, is a sudden infection in your middle ear. The middle ear is the air-filled space between your eardrum and inner ear. It houses the delicate bones that transmit sound vibrations from your eardrum to your inner ear so you can hear.
Eustachian tubes are canals that connect your middle ear to the back of your throat. They regulate air pressure in your ear and prevent fluid from accumulating in your middle ear space.
If a eustachian tube doesn’t function well, fluid has a hard time draining from your middle ear space and can cause muffled hearing. Ear infections (from viruses and bacteria) also cause middle ear fluid. In these cases, the middle ear fluid is infected and often causes discomfort in addition to muffled hearing.
How common are ear infections?
Middle ear infections are the most common childhood illness other than colds. Ear infections occur most often in children between 6 months and 2 years. They’re common until age 8.
Older children and adults can get ear infections, too, but they don’t happen nearly as often as in young children.
Why are children more likely to get ear infections than adults?
Children get ear infections more often than adults because:
Their eustachian tubes don’t function as well as adults, and this encourages fluid to gather behind the eardrum.
Their immune system, the body’s infection-fighting system, is still developing.
They’re more likely to catch illnesses from other children.
What are the symptoms of an ear infection?
Symptoms of an ear infection often begin after a cold. They include:
Yellow, brown or white drainage from your ear. (This may mean that your eardrum has broken.)
Don’t place anything in your ear canal if you have drainage from your ear. An item touching a torn (ruptured) eardrum can cause more damage.
Infants and children
Since small children and infants can’t always communicate their symptoms, it’s important to recognize the signs. A child with an ear infection may:
Rub or tug on their ears.
Cry more than usual or act fussy.
Have a fever ranging from 100.5 to 104 degrees Fahrenheit (38 to 40 degrees Celsius). (Half of children have fevers with ear infections.)
Start mouth breathing or have increased snoring. Mouth breathing may be a sign of enlarged adenoids. (Adenoids are small pads of tissue above your throat, behind your nose and near your eustachian tubes.) Adenoids may become infected/inflamed with the same viruses or bacteria that cause ear infections.
Refuse to eat during feedings. (Pressure in the middle ear changes as your child swallows, causing more pain and less desire to eat.)
What causes an ear infection?
Bacteria and viruses cause ear infections. Often, ear infections begin after a cold or another upper respiratory infection. The germs travel into your middle ear through the eustachian tube. Once inside, the virus or bacteria can cause your eustachian tubes to swell. The swelling can cause the tube to become blocked, leading to poor eustachian tube function and infected fluid in your middle ear.
Are ear infections contagious?
Ear infections aren’t contagious, but the virus and/or bacteria causing the infection are. Multiple types of bacteria and viruses cause ear infections, including ones that cause colds and the flu.
What are the risk factors for ear infections?
Risk factors for ear infections include:
Age: Infants and young children (between 6 months and 2 years) are at a greater risk for ear infections.
Family history: Getting ear infections can run in the family.
Colds: Having a cold increases your risk of developing an ear infection. Children in daycare and group settings are at a greater risk of ear infections because they’re more likely to be around children with colds or other contagious respiratory illnesses.
Chronic illnesses: Long-term illnesses, including immune deficiency and chronic respiratory diseases (such as cystic fibrosis and asthma), can increase your risk of ear infections.
Ethnicity: Children who are Native American, Hispanic and Alaska Natives have more ear infections than children of other ethnic groups.
Poor air quality and smoky environments: Air pollution and exposure to secondhand smoke increase your risk of getting an ear infection.
What are the complications of ear infections?
Most ear infections don’t cause long-term issues. When complications happen, they’re usually related to repeated or ongoing ear infections. Complications include:
Hearing loss: Temporary hearing loss or changes in your hearing (muffling or sound distortions) are common during an ear infection. Repeated or ongoing infections or damage to internal structures in your ear can cause more significant hearing loss.
Delayed speech and language development: Children need to hear to learn language and develop speech. Muffled hearing or hearing loss for any length of time can significantly delay development.
Torn eardrum: About 5% to 10% of children with an ear infection develop a small tear in their eardrum. Often, the tear heals on its own. If it doesn’t, your child may need surgery.
Spread of the infection: Untreated infections or infections that don’t improve on their own can spread. Infection can spread to the bone behind your ear (mastoiditis). Occasionally, an infection can spread to the membranes surrounding your brain and spinal cord (meninges) and cause meningitis.
How is an ear infection treated?
Treatment depends on many factors, including:
Your child’s age.
The severity of the infection.
The nature of the infection (first-time, ongoing or repeat infection).
Whether fluid remains in the middle ear for a long time.
Often, ear infections heal without treatment. Your provider may monitor your child’s condition to see if it improves before prescribing treatments. Your child may need antibiotics or surgery for infections that don’t go away. In the meantime, pain medicines can help with symptoms like ear pain.
Antibiotics
Your child may need antibiotics if bacteria are causing the ear infection. Healthcare providers may wait up to three days before prescribing antibiotics to see if a mild infection clears on its own. If an infection is severe, your child may need to start antibiotics immediately.
The American Academy of Pediatrics provides guidelines on when a child should receive antibiotics and when it’s better to observe. Factors include your child’s age, the severity of their infection and their temperature. The table below summarizes the recommendations.
How is an ear infection diagnosed?
Most healthcare providers can tell if your child has an ear infection based on their symptoms, a physical exam to check for signs of a cold and an ear exam. For the ear exam, your child’s healthcare provider will view your child’s eardrum using a lighted instrument called an otoscope. An inflamed, swollen or red eardrum is a sign of an ear infection.
Your child’s provider may use a pneumatic otoscope to check for fluid in your child’s middle ear. A pneumatic otoscope blows a puff of air at the eardrum, which should cause it to move back and forth. It won’t move easily if there’s fluid inside your child’s ear.
Are there additional tests my child may need?
Your child may need other tests, including:
Tympanometry: This test uses air pressure to check for fluid in your child’s middle ear.
Acoustic reflectometry: This test uses sound waves to check for fluid in your child’s middle ear.
Tympanocentesis: This procedure allows your child’s provider to remove fluid from your child’s middle ear and test it for viruses and bacteria. Their provider may recommend tympanocentesis if other treatments haven’t cleared the infection.
Hearing tests: A provider called an audiologist might perform hearing tests to determine if your child has hearing loss. Hearing loss is more common in children with long-lasting or frequent ear infections or fluid in the middle ear that doesn’t drain.
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