Ear infection - acute
Ear infections are one of the most common reasons parents take their children to the health care provider. The most common type of ear infection is called otitis media. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum.
An acute ear infection starts over a short period and is painful. Ear infections that last a long time or come and go are called chronic ear infections.
Otitis media - acute; Infection - inner ear; Middle ear infection - acute
The eustachian tube runs from the middle of each ear to the back of the throat. Normally, this tube drains fluid that is made in the middle ear. If this tube gets blocked, fluid can build up. This can lead to infection.
- Ear infections are common in infants and children because the eustachian tubes are easily clogged.
- Ear infections can also occur in adults, although they are less common than in children.
Anything that causes the eustachian tubes to become swollen or blocked makes more fluid build up in the middle ear behind the eardrum. Some causes are:
- Colds and sinus infections
- Excess mucus and saliva produced during teething
- Infected or overgrown adenoids (lymph tissue in the upper part of the throat)
- Tobacco smoke
Ear infections are also more likely in children who spend a lot of time drinking from a sippy cup or bottle while lying on their back. Getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole in it.
Acute ear infections most often occur in the winter. You cannot catch an ear infection from someone else. But a cold that spreads among children may cause some of them to get ear infections.
Risk factors for acute ear infections include:
- Attending day care (especially centers with more than 6 children)
- Changes in altitude or climate
- Cold climate
- Exposure to smoke
- Family history of ear infections
- Not being breastfed
- Pacifier use
- Recent ear infection
- Recent illness of any type (because illness lowers the body's resistance to infection)
Ear Infection Myths and Facts
Which of these may be a symptom of an ear infection in infants?
The correct answer is all of the above. Ear infections can be painful. The most common type of ear infection is called otitis media. It occurs when the tubes that drain fluid from the middle ear into the throat become blocked, causing fluid to build up. This can lead to infection.
Chances are your child will have an ear infection.
The correct answer is fact. Ear infections are the most common reason parents bring their child to a doctor. Three out of four children will have at least one ear infection by their third birthday.
Doctors use a special instrument to check for an ear infection.
The correct answer is fact. Health care providers use an instrument with a light called an otoscope to look inside the ear canal. They gently place the tip of the otoscope into the ear and move the instrument around. Then they check for red areas, fluid behind the eardrum, and other signs of infection.
This can help ease the pain from an ear infection:
The correct answer is all of the above. Often, treating the pain and allowing the body time to heal itself is all that is needed for an ear infection. However, all children younger than 6 months with a fever or other symptoms should see the doctor. Never give aspirin to children.
Ear infections are more common in children because kids don’t clean their ears.
The correct answer is myth. Fluid does not drain out of the ear as easily as in adults. When the ears and throat become swollen from colds or allergies, germs can be trapped inside and cause an ear infection.
When an ear infection doesn’t go away on its own, your child may need:
The correct answer is antibiotics. Some ear infections clear up on their own. If your child’s doctor prescribes antibiotics, make sure your child takes them as directed and finishes all the medicine. If the antibiotics don’t seem to be working within 48 to 72 hours, contact your doctor. You may need a different antibiotic.
Doctors may recommend that a child have ear tube surgery if:
The correct answer is both A and B. Ear tube surgery involves inserting a tiny tube into the child’s eardrum while the child is asleep and pain-free. This tube keeps open a small hole that allows air to get in so fluids can drain more easily. The ear tubes fall out by themselves, often within 6 - 9 months.
Ear infections can cause short-term hearing loss.
The correct answer is fact. Most children have minor, short-term hearing loss during and right after an ear infection. This is due to fluid remaining in the ear. Any fluid left in the ear should go away within 3 - 6 weeks. Always check with your doctor if you have questions or concerns.
Call your child's doctor if you notice the following:
The correct answer is all of the above. Often, an ear infection is a minor medical problem. But they can cause more serious problems, such as a more serious infection. Contact your doctor if you have concerns. Let the doctor know right away if your child younger than 6 months has a fever, even if there are no other symptoms.
Breastfeeding reduces a child’s risk for ear infections.
The correct answer is fact. While breast-feeding, babies are less likely to get ear infections. Other ways to lower your children’s risk: Make sure both you and they wash their hands often, that they are up-to-date on their immunizations, and that they are never around secondhand smoke.
In infants, often the main sign of an ear infection is acting irritable or crying that cannot be soothed. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.
Symptoms of an acute ear infection in older children or adults include:
- Ear pain or earache
- Fullness in the ear
- Feeling of general illness
- Hearing loss in the affected ear
The ear infection may start shortly after a cold. Sudden drainage of yellow or green fluid from the ear may mean the eardrum has ruptured.
All acute ear infections involve fluid behind the eardrum. At home, you can use an electronic ear monitor to check for this fluid. You can buy this device at a drugstore. You still need to see a health care provider to confirm an ear infection.
Exams and Tests
The provider will look inside the ears using an instrument called an otoscope. This may show:
- Areas of dullness or redness
- Air bubbles or fluid behind the eardrum
- Bloody fluid or pus inside the middle ear
- A hole (perforation) in the eardrum
The provider might recommend a hearing test if the person has a history of ear infections.
Some ear infections clear on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:
- Apply a warm cloth or warm water bottle to the affected ear.
- Use over-the-counter pain relief drops for ears. Or, ask the provider about prescription eardrops to relieve pain.
- Take over-the-counter medicines such as ibuprofen or acetaminophen for pain or fever. DO NOT give aspirin to children.
All children younger than 6 months with a fever or symptoms of an ear infection should see a provider. Children who are older than 6 months may be watched at home if they DO NOT have:
- A fever higher than 102°F (38.9°C)
- More severe pain or other symptoms
- Other medical problems
If there is no improvement or if symptoms get worse, schedule an appointment with the provider to determine whether antibiotics are needed.
A virus or bacteria can cause ear infections. Antibiotics will not help an infection that is caused by a virus. Most providers don't prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.
Your provider is more likely to prescribe antibiotics if your child:
- Is under age 2
- Has a fever
- Appears sick
- Does not improve in 24 to 48 hours
If antibiotics are prescribed, it is important to take them every day and to take all of the medicine. DO NOT stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your provider. You may need to switch to a different antibiotic.
Side effects of antibiotics may include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.
Some children have repeat ear infections that seem to go away between episodes. They may receive a smaller, daily dose of antibiotics to prevent new infections.
If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the provider may recommend ear tubes:
- A tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily.
- Usually the tubes fall out by themselves. Those that don't fall out may be removed in the provider's office.
If the adenoids are enlarged, removing them with surgery may be considered if ear infections continue to occur. Removing tonsils does not seem to help prevent ear infections.
Most often, an ear infection is a minor problem that gets better. Ear infections can be treated, but they may occur again in the future.
Most children will have slight short-term hearing loss during and right after an ear infection. This is due to fluid in the ear. Fluid can stay behind the eardrum for weeks or even months after the infection has cleared.
Speech or language delay is uncommon. It may occur in a child who has lasting hearing loss from many repeated ear infections.
In rare cases, a more serious infection may develop, such as
When to Contact a Medical Professional
Call your child's provider if:
- Pain, fever, or irritability do not improve within 24 to 48 hours
- At the start, the child seems sicker than you would expect from an ear infection
- Your child has a high fever or severe pain
- Severe pain suddenly stops -- this may indicate a ruptured eardrum
- Symptoms get worse
- New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles
Let the provider know right away if a child younger than 6 months has a fever, even if the child doesn't have other symptoms.
You can reduce your child's risk of ear infections with the following measures:
- Wash hands and toys often.
- If possible, choose a day care that has 6 or fewer children. This can reduce your child's chances of getting a cold or other infection, and lead to fewer ear infections.
- DO NOT use pacifiers.
- Breastfeed -- This makes a child much less prone to ear infections. If you are bottle feeding, hold your infant in an upright, seated position.
- DO NOT expose your child to secondhand smoke.
- Make sure your child's immunizations are up to date. The pneumococcal vaccine prevents infections from the bacteria that most commonly cause acute ear infections and many respiratory infections.
- DO NOT overuse antibiotics. Doing so can lead to antibiotic resistance.
Casselbrandt ML, Mandel EM. Acute otitis media and otitis media with effusion. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 195.
Haddad J, Dodhia SN. General considerations and evaluation of the ear. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson, KM. eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 654.
Hoberman A, Paradise JL, Rockette HE, Kearney DH, Bhatnagar S, Shope TR, et al. Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med. 2016;375(25):2446-2456. PMID: 28002709 www.ncbi.nlm.nih.gov/pubmed/28002709.
Klein JO. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999. PMID: 23439909 www.ncbi.nlm.nih.gov/pubmed/23439909.
Ranakusuma RW, Pitoyo Y, Safitri ED, et al, Systemic corticosteroids for acute otitis media in children. Cochrane Database Syst Rev. 2018;15;3:CD012289. PMID: 29543327 www.ncbi.nlm.nih.gov/pubmed/29543327.
Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013;149(1 Suppl):S1-S35. PMID: 23818543 www.ncbi.nlm.nih.gov/pubmed/23818543.
Rosenfled RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. PMID: 26832942 www.ncbi.nlm.nih.gov/pubmed/26832942.
Vojtek I, Nordgren M, Hoet B. Impact of pneumococcal conjugate vaccines on otitis media: A review of measurement and interpretation challenges. Int J Pediatr Otorhinolaryngol. 2017;100:174-182. PMID: 28802367 www.ncbi.nlm.nih.gov/pubmed/28802367.