Ear infection (middle ear)

An ear infection, also known as acute otitis media, is an infection of the air-filled space behind the eardrum, known as the middle ear. Children are more likely than adults to get ear infections.

Ear infections often clear up on their own. So treatment might begin with managing pain and watching the issue. Sometimes, healthcare professionals prescribe antibiotics to clear the infection.

Some people have repeated ear infections. This can cause hearing problems and other serious complications.

Symptoms of ear infection often come on fast.

Children

Ear infection symptoms common in children include:

• Ear pain.
• Tugging at an ear.
• Trouble sleeping.
• Crying more than usual.
• Fussiness.
• Trouble hearing or replying to sounds.
• Loss of balance.
• Fever.
• Fluid coming from the ear, which can be from a torn ear drum.
• Headache.
• Loss of appetite.

Adults

Common symptoms of ear infections in adults include:

• Ear pain or pressure.
• Fluid coming from the ear, which can be from a torn ear drum.
• Trouble hearing.

Many conditions have symptoms of an ear infection. It’s important to get a good diagnosis and prompt treatment. Call your child’s healthcare professional for symptoms that are severe or for:

• Symptoms that last for more than 2 to 3 days.
• Symptoms in a child younger than 6 months old.
• Symptoms that are getting worse.
• An infant or toddler who is sleepless or cranky after a cold or other infection that affected breathing, also known as an upper respiratory infection.
• Fluid, pus or blood from the ear.
• Hearing loss.

A bacterium or virus in the middle ear causes an ear infection. This infection often comes from another illness, such as a cold, flu or allergy. These can cause the inside the nose, throat and ears to be swollen and stuffy.

Role of eustachian tubes

The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nose. The throat end of the tubes open and close to:

• Keep air pressure even in the middle ear.
• Bring fresh air to the ear.
• Drain fluids from the middle ear.

Swollen eustachian tubes can become blocked, causing fluids to build up in the middle ear. This fluid can become infected and cause the symptoms of an ear infection.

In young children, these tubes are narrower and more level than adults’ are. As a result, they’re harder to drain and more likely to get clogged.

Role of adenoids

Two small pads of tissue high in the back of the nose, also known as adenoids, help fight off infection.

Adenoids are near the opening of the eustachian tubes. Swelling of the adenoids can block the tubes. This can lead to middle ear infection, especially in children.

Related conditions

Conditions of the middle ear that may be related to an ear infection or cause similar middle ear problems include:

• Otitis media with effusion. This is due to a fluid buildup, known as effusion, in the middle ear. This can happen if fluid stays in the middle ear after an ear infection has gotten better. It might also happen because of some other cause of the eustachian tubes being blocked.
• Chronic otitis media with effusion. This happens when fluid stays in the middle ear or keeps coming back. Children with this condition are likely to get new ear infections. Hearing can be affected.
• Chronic suppurative otitis media. This is an ear infection that doesn’t go away with the usual treatments. It can lead to a hole in the eardrum.

Risk factors for ear infections include:

• Age. Children between the ages of 6 months and 2 years are more likely to get ear infections. That’s due to the size and shape of their eustachian tubes.
• Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home. Children in group settings come into contact with more infections, such as the common cold.
• Bottle feeding. Babies who drink from a bottle tend to have more ear infections than do babies who breastfeed. This is especially true if they’re given a bottle while in their cribs.
• Seasons. Ear infections are most common during the fall and winter. People with allergies during certain seasons might have a greater risk of ear infections when pollen counts are high.
• Poor air quality. If you’re around tobacco smoke or a lot of air pollution, you have a higher risk of ear infections.
• Cleft palate. The bones and muscles in the faces of children who have cleft palates can make it harder for the eustachian tube to drain.

Most ear infections don’t cause long-term complications. Ear infections that happen again and again can lead to serious complications:

• Hearing loss. Mild hearing loss is common with an ear infection. But hearing usually gets better after the infection clears. Ear infections that happen again and again or constant fluid in the middle ear can cause worse hearing loss. If there’s lasting damage to the eardrum or other parts of the middle ear, hearing might not get better.
• Delays in speech or development. Hearing loss in infants and toddlers might cause delays in speaking and developing age-linked skills. This might be true even if hearing loss doesn’t last.

• Spread of infection. Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. Rarely, an ear infection can cause infection of the bony section behind the ear, known as mastoiditis. This infection can harm the bone and cause pus-filled cysts.

  Also rarely, serious middle ear infections can spread to other tissues in the head. This can infect the brain or the membranes around the brain, an infection known as meningitis.

• Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.

The following tips may lower the risk of getting ear infections:

• Prevent colds and other illnesses. Teach children to wash their hands often and well. Tell children not to share cups, forks and spoons. Teach children to cough or sneeze into their elbows.

  Children might have less risk of getting ill if they spend less time in group child care. Or the risk of illness might be lower if they’re in child care with fewer children. Try to keep sick children home.

• Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in places that are smoke-free.
• Breastfeed. Breast milk might help protect babies from ear infections if they breastfeed for at least six months.
• Hold bottle-fed babies upright while they feed. Don’t prop a bottle in the mouth of a baby who’s lying down. Don’t put bottles in the crib with a baby.
• Getting vaccinated. Ask your child’s healthcare professional what vaccinations the child needs. Seasonal flu shots and other vaccines might help prevent ear infections.

A healthcare professional can often diagnose an ear infection based on symptoms and an exam. The exam likely includes looking inside the child’s ears with a lighted instrument known as an otoscope. If the eardrum is red and bulging, there’s likely an infection.

Other tests might be needed if there’s doubt about a diagnosis, if the condition hasn’t gotten better with treatment or if there are other issues.

What a diagnosis means

• Acute otitis media. The diagnosis of ear infection often means acute otitis media. This involves having fluid in the middle ear or symptoms of an infection, such as fluid suddenly coming from the ear.
• Otitis media with effusion. This means there’s fluid in the middle ear, but no symptoms of infection.
• Chronic suppurative otitis media. This is caused by a long-term ear infection that caused a tear in the eardrum. This condition often involves pus coming from the ear.

Many children’s ear infections clear up without antibiotics. Treatment depends on the person’s age and how bad the symptoms are.

Watchful waiting

Symptoms of ear infections usually get better in a couple of days. Most ear infections clear up in a week or two without treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one choice for:

• Children 6 to 23 months with mild pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C).
• Children 24 months and older with mild pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C).

Managing pain

Easing pain from an ear infection might involve:

• Pain medicine that you can get without a prescription. These include acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others). Follow label directions.

  Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

• Numbing drops. These can be used with caution for short-term pain relief if the eardrum doesn’t have a hole or tear in it.

Antibiotic medicines

Antibiotics might be helpful for some children and for adults with ear infections. But using antibiotics too often can cause the medicine to not work as well against the bacteria. Talk to your child’s healthcare professional about the pros and cons of using antibiotics.

Usually after a watch-and-wait time, a healthcare professional might suggest using an antibiotic for an ear infection for:

• Children 6 months and older with moderate to severe ear pain in one or both ears for at least 48 hours or a temperature of 102.2 F (39 C) or higher.
• Children 6 to 23 months with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C).
• Children 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C).

Children younger than 6 months who have acute otitis media are more likely to be treated with antibiotics without the watch-and-wait time.

It’s important to take the antibiotic as directed even after symptoms improve. Not taking all the medicine can cause the infection to return. Talk to a healthcare professional or pharmacist about what to do after missing a dose.

Ear tubes

Ear tubes drain fluid from the middle ear. Ear tubes might help children who have repeated, long-lasting ear infections, also known as chronic otitis media. Ear tubes also might help children who have fluid buildup in the ear after an infection cleared up, known as otitis media with effusion.

The tubes are placed during an outpatient surgery called a myringotomy. A surgeon makes a tiny hole in the eardrum to suction fluids out of the middle ear. The surgeon then puts the ear tube in the opening to help air get to the middle ear and to prevent the buildup of more fluids.

Young children will likely be given medicine to put them to sleep for the surgery, also known as general anesthesia.

Some tubes stay in place for 6 months to 2 years. They fall out on their own. Other tubes are meant to stay in longer. They might need to be removed with another surgery.

The hole in the eardrum usually closes again after the tube falls out.

Treatment for chronic suppurative otitis media

Chronic infection that causes a tear in the eardrum, called chronic suppurative otitis media, is hard to treat. Antibiotics drops put into the ear might treat the condition. You might get directions on how to suction fluids out through the ear canal before putting in the drops.

Monitoring

Children who have infections often or who always have fluid in the middle ear will need to be watched. Talk to your child’s healthcare professional about how often to schedule follow-up appointments. Follow-up might include regular hearing and language tests.

You’ll likely see your family healthcare professional. You may be referred to a specialist in ear, nose and throat (ENT) conditions.

You or your child can answer the questions a healthcare professional is likely to ask. These might include:

• What are the symptoms?
• When did the symptoms begin?
• Is there ear pain? Would you say the pain is mild, moderate or severe?
• Have you seen your infant or toddler pulling on ears, having trouble sleeping or being more irritable than usual?
• Has your child had a fever?
• Has there been fluid coming from the ear? Is the fluid clear, cloudy or bloody?
• Does your child seem to have trouble hearing?
• Has your child recently had a cold, flu or other symptoms that affect breathing?
• Does your child have allergies?
• Has your child had an ear infection before? When?
• Is your child allergic to any medicines, such as amoxicillin?