Ear infections are one of the most common reasons parents take their children to the doctor. 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.
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)
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.