Ear infection

Overview

A middle ear infection (acute otitis media) is an infection in the space behind the eardrum. It usually starts after a cold, when the tube connecting the ear to the back of the throat swells and fluid gets trapped. Germs in that fluid cause the infection.

Children get ear infections much more often than adults. Many get better without antibiotics because the body fights off the infection. An infection of the outer ear canal is a different problem called swimmer's ear.

Symptoms

Symptoms often start a few days into a cold. Babies can't say their ear hurts, so watch for fussiness and pulling or tugging at an ear.

• Ear pain
• Pulling, rubbing, or tugging at an ear
• Fussiness or crying more than usual
• Trouble sleeping

Less common

• Fever
• Fluid or pus draining from the ear
• Trouble hearing
• Headache, or a poor appetite

How it usually goes

• Days 1–2: Ear pain and fussiness, often during a cold. Pain relievers help.
• Days 2–3: Many children start to feel better on their own. If not, call about antibiotics.
• Weeks after: Some fluid can stay behind the eardrum for weeks after the infection. It usually clears on its own.

Look up a symptom: Ear pain · Fever · Headache · Pulling or tugging at an ear

When to get medical care

Causes

Middle ear infections are caused by bacteria, like Streptococcus pneumoniae and Haemophilus influenzae (the two most common bacterial causes), or by viruses like those that cause colds and flu.

During a cold, the tube that drains the middle ear into the back of the throat swells. Fluid gets trapped, and germs grow. Young children's tubes are shorter and flatter, so they block more easily.

Does it spread or run in families?

• Yes, it can spread from person to person.
• How it spreads: coughs or sneezes.
• Washing hands often and staying home when sick help protect others.

Who is more likely to get it

• Age 6 months to 2 years, when ear infections are most common
• Daycare, where colds spread easily
• Tobacco smoke, including secondhand smoke
• Bottle-feeding while lying down, or falling asleep with a bottle
• Cold and flu season, and seasonal allergies

Possible complications

• Burst eardrum: Pus draining from the ear; usually heals on its own
• Fluid behind the eardrum: Can muffle hearing for weeks
• Mastoiditis: Rare; swelling and pain behind the ear
• Meningitis: Very rare; stiff neck, high fever

Diagnosis

A healthcare professional can tell if it's a middle ear infection by asking about symptoms and looking in the ear.

Questions you may be asked

• When the ear pain or fussiness started
• Whether there's a fever, and how high
• Whether there's been fluid or pus draining from the ear
• Whether there's been a recent cold
• How many ear infections your child has had

The exam

They'll look at the eardrum with a lighted tool (an otoscope). An infected eardrum often looks red and bulging, with pus behind it. They may puff a little air into the ear to see how the eardrum moves.

Tests

Usually no other tests are needed. Sometimes:

• Tympanometry: A quick, painless test that checks how the eardrum moves, which shows whether fluid is behind it.
• Hearing test: If fluid stays behind the eardrum for months or hearing seems low.

Treatment

The body can often fight off a middle ear infection on its own. Pain relief is the most important first step. Antibiotics are needed right away for severe infections, very young babies, and infections that last longer than 2 to 3 days.

Self-care

• Treat pain and fever with acetaminophen or ibuprofen at the right ages (see Medicines)
• Rest and drink extra fluids
• A warm compress held over the ear may ease pain

Medicines

Pain relievers help whether or not antibiotics are needed. Ask a pharmacist if your child takes other medicines.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

For a mild infection, your healthcare professional may suggest watchful waiting: watching for 2 to 3 days to see if your child gets better without antibiotics. Or they may give a prescription to fill only if your child isn't better in 2 to 3 days. Two out of 3 children with mild ear infections get better without antibiotics. If antibiotics are needed, amoxicillin is usually used. Children with many ear infections or fluid that won't go away may be sent to an ear, nose, and throat doctor; ear tubes are sometimes an option.

How it compares

Prevention

You can't prevent every ear infection, but these steps help:

• Keep up with vaccines, including flu and pneumococcal vaccines
• Wash hands often to prevent colds
• Breastfeed if you can, ideally only breast milk for the first 6 months
• Don't smoke, and keep children away from secondhand smoke
• Don't let a baby fall asleep with a bottle
• Dry ears well after swimming

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to an ENT doctor (ear, nose, and throat doctor).

Back to school, work, or sports

• Stay home until you've had no fever for 24 hours without fever medicine and you're feeling better.
• For the next 5 days, wash hands often and wear a mask around others.

Children, pregnancy, and older adults

• Babies: Call right away for a baby under 3 months with a fever of 100.4°F (38°C) or higher. Babies under 6 months with an ear infection usually get antibiotics. Only give acetaminophen, not ibuprofen, under 6 months.
• Adults: Ear infections are less common in adults. See a healthcare professional for ear pain with fever, hearing loss, or drainage.
• Repeat infections: Children with many ear infections in a year, or fluid that lasts for months, may need a hearing test or a visit to an ear, nose, and throat doctor.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Most ear infections clear up in a few days, with or without antibiotics. Fluid can stay behind the eardrum for a few weeks and may muffle hearing for a while. Most children outgrow frequent ear infections as they get older.

Myths and facts

Getting ready for your visit

A little preparation helps you get the most from a short visit.

What to bring

• When the pain or fussiness started, and the highest temperature
• Which medicines you've given, and when
• Any antibiotic allergies
• How many ear infections your child has had this year

Questions to ask

• Does my child need antibiotics now, or can we wait 2 to 3 days?
• What should I watch for at home?
• When should we come back?
• Would ear tubes or a hearing test help?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Ear infection