Ear infection - acute
Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.
The term "acute" refers to a short and painful episode. An ear infection that lasts a long time or comes and goes is called chronic otitis media.
For links to other types of ear infections, see otitis.
Otitis media - acute; Infection - inner ear; Middle ear infection - acute
Causes, incidence, and risk factors
For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection.
Ear infections are common in infants and children, in part because the eustachian tubes become easily clogged.
Ear infections may also occur in adults, although they are less common than in children.
Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:
- Colds and sinus infections
- Excess mucus and saliva produced during teething
- Infected or overgrown adenoids
- Tobacco smoke or other irritants
Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.
Ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.
Risk factors for ear infections include the following:
- Attending daycare (especially those with more than 6 children)
- Changes in altitude or climate
- Cold climate
- Exposure to smoke
- Genetic factors (susceptibility to infection may run in families)
- Not being breastfed
- Pacifier use
- Recent ear infection
- Recent illness of any type (lowers resistance of the body to infection)
In infants, the clearest sign is often irritability and inconsolable crying. Many infants and children develop a fever or have trouble sleeping. Parents often think that tugging on the ear is a symptom of an ear infection, but studies have shown that the same number of children going to the doctor tug on the ear whether or not the ear is infected.
Symptoms 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 child may have symptoms of a cold, or the ear infection may start shortly after having a cold.
All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.
Signs and tests
You will be asked if there have been any ear infections in the past, and whether your child (or you, if you are the patient) have had any recent cold or allergy symptoms.
The health care provider will perform a physical exam. This will include an examination of the throat, sinuses, head, neck, lungs, and ears. The health care provider looks inside the ears using an instrument called an otoscope. If infected, there may be areas of dullness or redness, or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or filled with pus. The health care provider will also check for any signs of perforation (a hole) in the eardrum.
A hearing test may be recommended if there is a history of persistent (chronic and recurrent) ear infections.
Some ear infections will safely clear up 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 doctor about prescription ear drops to relieve pain.
- Take over-the-counter medications for pain or fever, such as ibuprofen or acetaminophen. Do NOT give aspirin to children.
All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:
- A fever higher than 102 °F
- More severe pain or other symptoms
- Other medical problems
If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.
A virus or bacteria can cause ear infections. Antibiotics will not help an infection caused by a virus. Many health care providers no longer prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.
Your health care provider is more likely to prescribe antibiotics if:
- Your child is under age 2
- Has a fever
- Appears sick
- Is not improving over 24 to 48 hours
Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.
Amoxicillin is commonly the first choice. Other antibiotics that may be given are azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.
Side effects of antibiotics include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.
Some children who have repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.
If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.
- In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily. Tympanostomy tube insertion is done under general anesthesia.
- Usually the tubes fall out by themselves. Those that don't fall out may be removed in your doctor's office.
If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.
Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all your medication as instructed.
Generally, an ear infection is a simple, nonserious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.
Fluid can remain behind the eardrums even after the infection has cleared.
See also: Otitis media with effusion
Other potential complications from otitis media include:
- Ruptured or perforated eardrum
- Chronic, recurrent ear infections
- Enlarged adenoids or tonsils
- Mastoiditis (an infection of the bones around the skull)
- Meningitis (an infection of the brain)
- Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
- Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections
Calling your health care provider
Call your child's doctor if:
- Pain, fever, or irritability do not improve within 24 to 48 hours
- At the start, the child seems sicker than just an ear infection
- Your child has a high fever or severe pain
- Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
- Symptoms worsen
- New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles
For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.
You can reduce your child's risk of ear infections with the following practices:
- Wash hands and toys frequently.
- If possible, choose a daycare that has a class with 6 or fewer children. This can reduce your child's chances of getting a cold or similar infection, and leads to fewer ear infections.
- Avoid pacifiers.
- Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
- Do not expose your child to secondhand smoke.
- Make sure your child's immunizations are up-to-date. The pneumococcal vaccine prevents infections from the bacteria that most commonly causes acute ear infections and many respiratory infections.
- Avoid overusing antibiotics. Overusing antibiotics can lead to antibiotic resistance.
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1465.
Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.
Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76:1650-1656.
Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008;134:128-132.
Advisory Committee on Immunization Practices (ACIP). Licensure of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children. MMWR. 2010 Mar 12;59(09):258-261.
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.