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Ear infection, an infection that occurs in the space behind the eardrum, is a common reason why your child sees a healthcare provider. Ear infections happen when bacteria or virus infect and trap fluid behind the eardrum, causing pain and swelling/bulging of the eardrum. Treatments include antibiotics, pain-relieving medications and placement of ear tubes.
The commonly used term “ear infection” is known medically as acute otitis media or a sudden infection in the middle ear (the space behind the eardrum). Anyone can get an ear infection — children as well as adults — although ear infections are one of the most common reasons why young children visit healthcare providers. In many cases, ear infections clear up on their own. Your healthcare provider may recommend a medication to relieve pain. If the ear infection has worsened or not improved, your healthcare provider may prescribe an antibiotic. In children younger than the age of two years, an antibiotic is usually needed for ear infections. It’s important to see your healthcare provider to make sure the ear infection has healed or if you or your child has ongoing pain or discomfort. Hearing problems and other serious effects can occur with ongoing ear infections, frequent infections and when fluid builds up behind the eardrum. Where is the middle ear?The middle ear is behind the eardrum (tympanic membrane) and is also home to the delicate bones that aid in hearing. These bones (ossicles) are the hammer (malleus), anvil (incus) and stirrup (stapes). To provide the bigger picture, let’s look at the whole structure and function of the ear: The ear structure and function There are three main parts of the ear: outer, middle and inner.
Other nearby parts
Middle ear infection is the most common childhood illness (other than a cold). Ear infections occur most often in children who are between age 3 months and 3 years, and are common until age 8. Some 25% of all children will have repeated ear infections. Adults can get ear infections too, but they don’t happen nearly as often as they do in children. Risk factors for ear infections include:
Ear infections are caused by bacteria and viruses. Many times, an ear infection begins after a cold or other respiratory infection. The bacteria or virus travel into the middle ear through the eustachian tube (there’s one in each ear). This tube connects the middle ear to the back of the throat. The bacteria or virus can also cause the eustachian tube to swell. This swelling can cause the tube to become blocked, which keeps normally produced fluids to build up in the middle ear instead of being able to be drained away. Adding to the problem is that the eustachian tube is shorter and has less of a slope in children than in adults. This physical difference makes these tubes easier to become clogged and more difficult to drain. The trapped fluid can become infected by a virus or bacteria, causing pain. Medical terminology and related conditions Because your healthcare provider may use these terms, it’s important to have a basic understanding of them:
Symptoms of ear infection include:
Ear exam Your healthcare provider will look at your or your child’s ear using an instrument called an otoscope. A healthy eardrum will be pinkish gray in color and translucent (clear). If infection is present, the eardrum may be inflamed, swollen or red. Your healthcare provider may also check the fluid in the middle ear using a pneumatic otoscope, which blows a small amount of air at the eardrum. This should cause the eardrum to move back and forth. The eardrum will not move as easily if there is fluid inside the ear. Another test, tympanometry, uses air pressure to check for fluid in the middle ear. This test doesn’t test hearing. If needed, your healthcare provider will order a hearing test, performed by an audiologist, to determine possible hearing loss if you or your child has had long lasting or frequent ear infections or fluid in the middle ears that is not draining. Other checks Your healthcare provider will also check your throat and nasal passage and listen to your breathing with a stethoscope for signs of upper respiratory infections.
Treatment of ear infections depends on age, severity of the infection, the nature of the infection (is the infection a first-time infection, ongoing infection or repeating infection) and if fluid remains in the middle ear for a long period of time. Your healthcare provider will recommend medications to relieve you or your child’s pain and fever. If the ear infection is mild, depending on the age of the child, your healthcare provider may choose to wait a few days to see if the infection goes away on its own before prescribing an antibiotic. Antibiotics Antibiotics may be prescribed if bacteria are thought to be the cause of the ear infection. Your healthcare provider may want to wait up to three days before prescribing antibiotics to see if a mild infection clears up on its own when the child is older. If your or your child’s ear infection is severe, antibiotics might be started right away. The American Academy of Pediatrics has recommended when to prescribe antibiotics and when to consider waiting before prescribing based on your child’s age, severity of their infection, and your child’s temperature. Their recommendations are shown in the table below. American Academy of Pediatrics Treatment Guide for Acute Otitis Media (AOM)
If your healthcare provider prescribes an antibiotic, take it exactly as instructed. You or your child will start feeling better a few days after starting treatment. Even if you feel better and when pain has gone away, don’t stop taking the medication until you were told to stop. The infection can come back if you don’t take all of the medication. If the antibiotic prescribed for your child is a liquid, be sure to use a measuring spoon designed for liquid medications to be sure that you give the right amount. A hole or tear in your eardrum caused by a severe infection or an ongoing infection (chronic suppurative otitis media) is treated with antibiotic eardrops and sometimes by using a suctioning device to remove fluids. Your healthcare provider will give you specific instructions about what to do. Pain-relieving medications Over-the-counter acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) can help relieve earache or fever. Pain-relieving eardrops can also be prescribed. These medications usually start to lessen the pain within a couple hours. Your healthcare provider will recommend pain-relieving medications for you or your child and provide any additional instructions. Never give aspirin to children. Aspirin can cause a life-threatening condition called Reye’s Syndrome. Earaches tend to hurt more at bedtime. Using a warm compress on the outside of the ear may also help relieve pain. (This is not recommended for infants.) Ear tubes (tympanostomy tubes) Sometimes ear infections can be ongoing (chronic), frequently recurring or the fluid in the middle ear can even remain for months after the infection has cleared (otitis media with effusion). Most children will experience an ear infection by age 5 and some children may have frequent ear infections. Telltale signs of an ear infection in a child can include pain inside the ear, a sense of fullness in the ear, muffled hearing, fever, nausea, vomiting, diarrhea, crying, irritability and tugging at the ears (especially in very young children). If your child has experienced frequent ear infections (three ear infections in six months or four infections in a year), had ear infections that weren’t resolved with antibiotics, or experienced hearing loss from fluid buildup behind the eardrum, you may be a candidate for ear tubes. Ear tubes can provide immediate relief and are sometimes recommended for small children who are developing their speech and language skills. You may be referred to an ear, nose and throat (ENT) specialist for this outpatient surgical procedure, which is called a myringotomy with placement of tube. During the procedure, a small metal or plastic tube is inserted through a tiny incision (cut) in the eardrum. The tube lets air into the middle ear and allows fluid to drain. The procedure is very short — approximately 10 minutes — and there’s a low complication rate with this procedure. This tube usually stays in place from six to 12 months. It often falls out on its own, but it can also be removed by your doctor. The outer ear will need to be kept dry and free of dirty water, like lake water, until the hole in the eardrum heals completely and closes. What are the harms of fluid buildup in your ears or repeated or ongoing ear infections?Most ear infections don’t cause long-term problems, but when they do happen, complications can include:
Here are some ways to reduce risk of ear infections in you or your child:
Ear infections are common in children. Adults can get them too. Most ear infections are not serious. Your healthcare provider will recommend over-the-counter medications to relieve pain and fever. Pain relief may begin as soon as a few hours after taking the drug. Your healthcare provider may wait a few days before prescribing an antibiotic. Many infections go away on their own without the need for antibiotics. If you or your child receives an antibiotic, you should start to see improvement within two to three days. If you or your child has ongoing or frequent infections, or if fluid remains in the middle ear and puts hearing at risk, ear tubes may be surgically implanted in the eardrum to keep fluid draining from the eustachian tube as it normally should. Never hesitate to contact your healthcare provider if you have any concerns or questions.
Your healthcare provider will let you know when you need to return for a follow-up visit. At that visit, you or your child’s eardrum will be examined to be certain that the infection is going away. Your healthcare provider may also want to test you or your child's hearing. Follow-up exams are very important, especially if the infection has caused a hole in the eardrum. When should I call the doctor about an ear infection?Call your healthcare provider immediately if:
Call your healthcare provider during office hours if:
Why do children get many more ear infections than adults? Will my child always get ear infections?Children are more likely than adults to get ear infections for these reasons:
Most children stop getting ear infections by age 8. No, you do not need to cover your ears if you go outside. Can I swim if I have an ear infection?Swimming is okay as long as you don’t have a tear (perforation) in your eardrum or have drainage coming out of your ear. Can I travel by air or be in high altitudes if I have an ear infection?Air travel or a trip to the mountains is safe, although temporary pain is possible during takeoff and landing when flying. Swallowing fluids, chewing on gum during descent, or having a child suck on a pacifier will help relieve discomfort during air travel. Are ear infections contagious?No, ear infections are not contagious. When can my child return to normal daily activities?Children can return to school or day care as soon as the fever is gone. What are other causes of ear pain?Other causes of ear pain include:
Last reviewed by a Cleveland Clinic medical professional on 04/16/2020. References
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy |