Ear infections

An ear infection, also called otitis media (OM), is an inflammation of the middle ear, the space behind your eardrum where the small vibrating bones of your ear help you to hear. Typically ear infections are caused by bacteria or a virus. The infection results in fluid collecting behind the eardrum, causing symptoms like ear pain and trouble hearing.

Find primary care locations
Find urgent care locations
Woman holding young childWoman holding young childFamily having fun at the pool

Causes and types of ear infections

A middle ear infection is usually caused by a bacterium like Streptococcus pneumoniae or Haemophilus influenza, or a virus like those that cause a common cold or the flu. These illnesses can also cause congestion and swelling of the nasal passages, throat, ear canal and eustachian tubes.

This results in three basic types of ear infections according to the Centers for Disease Control and Prevention (CDC):

  • Acute otitis media (AOM). The most common type of ear infection, where the middle ear is infected and inflamed, and fluid is trapped behind the eardrum.
  • Otitis media with effusion (OME). Occurs when fluid builds up in the middle ear without being infected and without causing fever, ear pain or pus build-up. A child with OME may have no symptoms, but your provider will be able to see the fluid behind the eardrum with a special instrument.
    • Chronic otitis media with effusion (COME) is a sub-type that happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.
  • Otitis externa, or “swimmer’s ear.” Occurs when the outer ear canal is infected, different from a middle ear infection.

The role of secondhand smoke. According to the CDC, secondhand smoke is a proven risk factor for causing more frequent ear infections in infants and children, among other health problems. If you need help quitting smoking, your primary care provider can help.

Common signs and symptoms of ear infections

(and when to see your primary care provider for your child)

You

For adults, the common signs and symptoms include:

You should see your primary care provider if your symptoms aren’t going away, are worsening or you develop a fever.

In addition, if you are prone to having multiple ear infections, see your provider because this can cause hearing problems and other serious complications if left untreated.

Your child

For children, ear infections are much more common—according to the National Institute of Health, ear infections are the most common reason parents bring their child to a primary care provider.

Common signs and symptoms in children include:

  • Crying more than usual.
  • Drainage of fluid from the ear.
  • Ear pain, especially when lying down.
  • Fussiness.
  • Headache.
  • Loss of appetite.
  • Loss of balance.
  • Trouble hearing or responding to sounds.
  • Trouble sleeping.
  • Tugging or pulling at an ear.

When to see your provider

See your primary care provider right away if your child has:

  • A fever of 102.2° F (39° C) or higher.
  • Hearing loss.
  • Pus, discharge or bloody fluid coming from the ear.
  • Symptoms of a middle ear infection that last for more than 2–3 days.
  • Worsening symptoms.

For very young children

If your child is younger than 3 months old, get immediate medical attention if he/she has:

  • A fever of 100.4 F° (38° C) or higher.
  • A cold or other upper respiratory infection and is sleepless or irritable.
  • Pus, discharge or bloody fluid coming from the ear.
  • Showing signs of severe ear pain.

Treatment options for ear infections

Adults

Adults can try these methods to feel better at home while a common middle ear infection runs its course:

  • Anesthetic ear drops to relieve pain, as long as your eardrum doesn’t have a hole or tear in it.
  • Drinking extra water or other fluids.
  • Rest.
  • Pain relievers like acetaminophen or ibuprofen.

These home remedies might work for your child as well, as part of a treatment plan that your primary care provider will develop based on the type of ear infection and symptoms.

Kids

For a mild case of middle ear infection, this plan might start with:

  • A wait-and-see approach. Symptoms of ear infections usually improve within 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 as one option for:
    • Children 6 – 23 months with mild middle ear 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 middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2° F (39° C).
  • Delayed prescribing. Your child’s doctor may prescribe an antibiotic such as amoxicillin, but suggests that you wait two to three days to see if your child is still sick before filling it.

After the wait-and-see period

After the wait-and-see period, your doctor may prescribe antibiotics for your child, based on these guidelines:

  • 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 6–23 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).

Even after symptoms have improved, be sure to use the antibiotic as directed. Failing to take all the medicine can lead to recurring infection and resistance of bacteria to antibiotic medications. Talk with your doctor or pharmacist about what to do if you accidentally miss a dose.

References

Center for Disease Control and Prevention (CDC). Ear Infection (https://www.cdc.gov/antibiotic-use/ear-infection.html)

National Institute on Deafness and Other Communication Disorders. Ear Infections in Children (https://www.nidcd.nih.gov/health/ear-infections-children)

MedlinePlus: National Library of Medicine. Ear infection – acute (https://medlineplus.gov/ency/article/000638.htm)