What is it?
- Middle ear infections, also known as otitis media, are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3.
- Although ear infections worry parents and make children uncomfortable, most ear infections clear up on their own within a few days. Most children stop having ear infections by age 4 or 5.
- Adults rarely get middle ear infections. The treatments for adult ear infections are similar to those for children, although surgery is seldom necessary.
Ear infections in children can be hard to detect, especially if your child is too young to say, "My ear hurts." Knowing what to look for can help. Children with ear infections may:
- Complain of pain in their ears
- Tug or pull at their ears
- Cry more than usual
- Have trouble sleeping
- Fail to respond to sounds
- Be unusually irritable
- Develop a fever of 100 F (38 C) or higher
- Develop a clear fluid that drains from the ears
- Have headaches
Don't stick anything in your child's ears to check for an ear infection.
Adults who have a middle ear infection may have these symptoms:
- Fever of 100 F (38 C) or higher
- A feeling of blockage in the ear
- Temporary hearing loss
Ear infections usually start with a viral infection, such as a cold. The middle ear lining becomes swollen from the viral infection, and fluid builds up behind the eardrum.
Ear infections can also be associated with blockage or swelling in the narrow passageways that connect the middle ear to the nose (eustachian tubes). When fluid gets trapped in the middle ear when the eustachian tubes become blocked during a cold, it can cause ear pain and infection.
Because children's eustachian tubes are narrower and shorter than those of adults, they are more likely to develop ear infections than do adults.
Another factor in ear infections is swelling of the adenoids. These are tissues located in the upper throat near the eustachian tubes. Adenoids contain cells that normally fight infection. But sometimes the adenoids themselves get infected or enlarged, blocking the eustachian tubes. Infection in the adenoids can also spread to the eustachian tubes.
In addition, children don't have fully developed immune systems. So it's easier for them to develop many illnesses, including colds and ear infections.
Major risk factors for middle ear infections in children include:
- Age. Children between ages 6 and 18 months are the most susceptible to ear infections, although ear infections are common from ages 4 months to 4 years.
- Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home, because they're exposed to more viruses causing colds, which may then cause or complicate an ear infection.
- Feeding position. Babies who drink from a bottle while lying down tend to have more ear infections than do babies who are held upright during feedings.
Both children and adults are affected by these risk factors:
- Season. Ear infections are most common during the fall and winter. Sometimes, seasonal allergies may also congest your sinuses, making you or your child more likely to develop a middle ear infection.
- Reduced air quality. Children exposed to tobacco smoke or higher levels of air pollution are at higher risk of ear infections.
- Family history. Your child's risk of ear infections increases if another member of the family has had ear infections.
Many ear infections clear on their own after about three days with no complications. However, long-lasting or recurrent ear infections can lead to:
- Short-term hearing loss. Fluid buildup can temporarily affect hearing. That's because it's harder for the eardrum and the tiny bones in the middle ear to send sound vibrations through fluid.
- Long-term hearing loss. Usually the fluid disappears on its own in a few weeks. But sometimes it remains in the middle ear for months, which can damage the eardrum and bones in the middle ear. Persistent middle ear fluid was once thought to contribute to speech or developmental delays in children, but researchers now say this isn't true.
- Ruptured eardrum. During ear infections, fluid and pus may press against the eardrum. This can be painful. Rarely, the pressure ruptures the eardrum. If this happens, you may see a discharge of pus and blood from the affected ear. This can be alarming. But the rupture actually relieves the pain, and in most cases the eardrum heals on its own. If the eardrum ruptures repeatedly and doesn't heal, surgical repair may be needed.
Untreated ear infections can also lead to a type of sinus infection known as mastoiditis, which affects a space in the bone of the skull that's behind your ear. Rarely, infections can move from the ear to other parts of the head.
The doctor will examine you or your child and ask some questions about the ear infection. During the exam, the doctor will look for inflammation in the middle ear with a lighted instrument known as an otoscope.
The doctor may also use an instrument called a pneumatic otoscope, which allows him or her to gently puff air on the eardrum. Normally this causes the eardrum to move. Any fluid in the middle ear will prevent that movement.
Sometimes additional, often pain-free tests for ear infections are recommended - especially if you or your child has had fluid in the middle ear for some time:
- Tympanometry. This test measures eardrum movement. A soft plug is inserted into the opening of the ear. The plug includes a device that changes air pressure inside the ear.
- Acoustic reflectometry. During this test, the doctor uses a hand-held instrument to project sounds of varying frequencies into the ear. How the sounds are reflected off the insides of the ear can tell the doctor how much fluid is inside the ear.
Based on the test results, you or your child may be diagnosed with:
- Acute otitis media (AOM). In AOM, parts of the ear are infected and swollen, and fluid and mucus are trapped inside the ear.
- Otitis media with effusion (OME). Effusion refers to fluid. In OME, fluid stays in the ear after the infection has cleared up. The presence of fluid increases the risk of a new infection, and you or your child may need additional treatments to clear the fluid from the ear.
Treatments and drugs
Most ear infections don't need treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve with the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 48 to 72 hours for anyone who is otherwise healthy and who is:
- Six months to 2 years of age with mild symptoms and an uncertain diagnosis
- More than 2 years old with mild symptoms or an uncertain diagnosis
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
- A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
- Pain medication. Your doctor may advise the use of over-the-counter paracetamol or ibuprofen to relieve pain. Use the drugs as directed on the label. Because aspirin has been linked with Reye's syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
- Eardrops. Prescription eardrops may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up.
Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
- Children under 6 months old with a probable diagnosis of ear infection
- Children 6 months to 2 years old with a certain diagnosis of ear infection
- Anyone with a probable ear infection and moderate to severe ear pain
- Anyone with a probable ear infection and a fever over 102.2 F (39 C) or higher
Even after symptoms have improved, be sure to use all of the antibiotic pills as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose.
If your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops.
Children with frequent or persistent infections or with persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
The following tips may reduce the risk of developing ear infections:
- Prevent common colds and other illnesses. Teach your child to wash his or her hands frequently and thoroughly, and teach your child not to share eating and drinking utensils. If possible, limit the time your child spends in group child care. A child care setting with fewer children may help.
- Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.
- Breast-feed your baby. If possible, breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.
- If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby's mouth while he or she is lying down.
- Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child. Seasonal flu shots and pneumococcal vaccines may help prevent ear infections.