This topic covers infections of the middle ear, commonly called ear infections. For information on outer ear infections, see the topic Ear Canal Problems (Swimmer's Ear). For information on inner ear infections, see the topic Labyrinthitis.
The middle ear is the small part of your ear behind your eardrum. It can get infected when germs from the nose and throat are trapped there.
A small tube connects your ear to your throat. These two tubes are called eustachian tubes (say "yoo-STAY-shee-un"). A cold can cause this tube to swell. When the tube swells enough to become blocked, it can trap fluid inside your ear. This makes it a perfect place for germs to grow and cause an infection.
Ear infections happen mostly to young children, because their tubes are smaller and get blocked more easily.
The main symptom is an earache. It can be mild, or it can hurt a lot. Babies and young children may be fussy. They may pull at their ears and cry. They may have trouble sleeping. They may also have a fever.
You may see thick, yellow fluid coming from their ears. This happens when the infection has caused the eardrum to burst and the fluid flows out. This is not serious and usually makes the pain go away. The eardrum usually heals on its own.
When fluid builds up but does not get infected, children often say that their ears just feel plugged. They may have trouble hearing, but their hearing usually returns to normal after the fluid is gone. It may take weeks for the fluid to drain away.
Your doctor will talk to you about your child's symptoms. Then he or she will look into your child's ears. A special tool with a light lets the doctor see the eardrum and tell whether there is fluid behind it. This exam is rarely uncomfortable. It bothers some children more than others.
Most ear infections go away on their own, although antibiotics are recommended for children under the age of 2 and for children at high risk for complications. You can treat your child at home with an over-the-counter pain reliever like acetaminophen (such as Tylenol), a warm washcloth or heating pad on the ear, and rest. Do not give aspirin to anyone younger than 20. Your doctor may give you eardrops that can help your child's pain.
Sometimes after an infection, a child cannot hear well for a while. Call your doctor if this lasts for 3 to 4 months. Children need to be able to hear in order to learn how to talk.
Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you use them will depend on how old your child is and how bad the infection is.
Minor surgery to put tubes in the ears may help if your child has hearing problems or repeat infections.
There are many ways to help prevent ear infections. Do not smoke. Ear infections happen more often to children who are around cigarette smoke. Even the fumes from tobacco smoke on your hair and clothes can affect them. Hand-washing and having your child immunized can help, too.
Also, make sure your child does not go to sleep while sucking on a bottle. And try to limit the use of group child care.
Learning about ear infections:
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|Ear Infection: Should I Give My Child Antibiotics?|
|Ear Problems: Should My Child Be Treated for Fluid Buildup in the Middle Ear?|
Middle ear infections are caused by bacteria and viruses.
During a cold, sinus or throat infection, or an allergy attack, the eustachian tubes, which connect the middle ears to the throat, can become blocked. This stops fluid from draining from the middle ear. This fluid is a perfect breeding ground for bacteria or viruses to grow into an ear infection.
When swelling from an upper respiratory infection or allergy blocks the eustachian tube, air can't reach the middle ear. This creates a vacuum and suction, which pulls fluid and germs from the nose and throat into the middle ear. The swollen tube prevents this fluid from draining. An ear infection begins when bacteria or viruses in the trapped fluid grow into an infection.
Inflammation and fluid buildup can occur without infection and cause a feeling of stuffiness in the ears. This is known as otitis media with effusion.
Symptoms of a middle ear infection (acute otitis media) often start 2 to 7 days after the start of a cold or other upper respiratory infection. Symptoms of an ear infection may include:
Symptoms of fluid buildup may include:
Some children don't have any symptoms with this condition.
Middle ear infections usually occur along with an upper respiratory infection (URI), such as a cold. During a URI, the lining of the eustachian tube can swell and block the tube. Fluid builds up in the middle ear, creating a perfect breeding ground for bacteria or viruses to grow into an ear infection.
Pus develops as the body tries to fight the ear infection. More fluid collects and pushes against the eardrum, causing pain and sometimes problems hearing. Fever generally lasts a few days. And pain and crying usually last for several hours. After that, most children have some pain on and off for several days, although young children may have pain that comes and goes for more than a week. Antibiotic treatment may shorten some symptoms. But most of the time the immune system can fight infection and heal the ear infection without the use of these medicines. Children under 2 are treated with antibiotics, because they are more likely to have complications from the ear infection.
In severe cases, too much fluid can increase pressure on the eardrum until it ruptures, allowing the fluid to drain. When this happens, fever and pain usually go away and the infection clears. The eardrum usually heals on its own, often in just a couple of weeks.
Sometimes complications, such as a condition called chronic suppurative otitis media (an ear infection with chronic drainage), can arise from repeat ear infections.
Most children who have ear infections still have some fluid behind the eardrum a few weeks after the infection is gone. For some children, the fluid clears in about a month. And a few children still have fluid buildup (effusion) several months after an ear infection clears. This fluid buildup in the ear is called otitis media with effusion. Hearing problems can result, because the fluid affects how the middle ear works. Usually, infection does not occur.
Otitis media with fluid buildup (effusion) may occur even if a child has not had an obvious ear infection or upper respiratory infection. In these cases, something else has caused eustachian tube blockage.
In rare cases, complications can arise from middle ear infection or fluid buildup. Examples include hearing loss and ruptured eardrum.
Some factors that increase the risk for middle ear infection (acute otitis media) are out of your control. These include:
Other factors that increase the risk for ear infection include:
Factors that increase the risk for repeated ear infections also include:
Call your doctor immediately if:
Call your doctor if:
Watchful waiting is when you and your doctor watch symptoms to see if the health problem improves on its own. If it does, no treatment is necessary. If the symptoms don't get better or get worse, then it’s time to take the next treatment step.
Your doctor may recommend watchful waiting if your child is 2 years of age or older, has mild ear pain, and is otherwise healthy. Most ear infections get better without antibiotics. But if your child's pain doesn't get better with nonprescription children's pain reliever (such as acetaminophen) or the symptoms continue after 48 hours, call a doctor.
Health professionals who can diagnose and treat ear infections (acute otitis media) include:
Children who have ear infections often may need to see one of these specialists:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Middle ear infections are usually diagnosed using a health history, a physical exam, and an ear exam.
With a middle ear infection, the eardrum, when seen through a pneumatic otoscope, is red or yellow and bulging. In the case of fluid buildup without infection (otitis media with effusion), the eardrum can look like it's bulging or sucking in. In both cases, the eardrum doesn't move freely when the pneumatic otoscope pushes air into the ear.
Other tests can include:
Treatment for middle ear infections (acute otitis media) involves home treatment for symptom relief.
Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you use antibiotics will depend on how old your child is and how bad the infection is.
Follow-up exams with a doctor are important to check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections.
The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess your child for any risk of complications.
If your child has an ear infection and appears very ill, is younger than 2, or is at risk for complications from the infection, your doctor will likely give antibiotics right away.
If your child has cochlear implants, your doctor will probably prescribe antibiotics, because bacterial meningitis is more common in children who have cochlear implants than in children who do not have cochlear implants.
For children ages 2 and older, more options are available. Some doctors prescribe antibiotics for all ear infections, because it's hard to tell which ear infections will clear up on their own. Other doctors ask parents to watch their child's symptoms for a couple of days, since most ear infections get better without treatment. Antibiotic treatment has only minimal benefits in reducing pain and fever. The cost of medicine and possible side effects are factors doctors consider before giving antibiotics. Also, many doctors are concerned about the growing number of bacteria that are becoming resistant to antibiotics because of frequent use of antibiotics.
If your child's condition improves in the first couple of days, treating the symptoms at home may be all that is needed. Some steps you can take at home to treat ear infection include:
If your child isn't better after a couple of days of home treatment, call your doctor. He or she may prescribe antibiotics.
Decongestants, antihistamines, and other over-the-counter cold remedies do not often work for treating or preventing ear infection. Antihistamines that cause sleepiness may thicken fluids, which can make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.
If your child with an ear infection must take an airplane trip, talk with your doctor about how to cope with ear pain during the trip.
Fluid behind the eardrum after an ear infection is normal. And in most children, the fluid clears up within 3 months without treatment. Test your child's hearing if the fluid persists past that point. If hearing is normal, you may choose to continue monitoring your child without treatment.
If a child has repeat ear infections (three or more ear infections in a 6-month period or four in 1 year), you may want to consider treatment to prevent future infections.
One option used a lot in the past is long-term oral antibiotic treatment. There is debate within the medical community about using antibiotics on a long-term basis to prevent ear infections. Many doctors don't want to prescribe long-term antibiotics, because they are not sure that they really work. Also, when antibiotics are used too often, bacteria can become resistant to antibiotics. Having tubes put in the ears is another option for treating repeat ear infections.
If your child has fluid buildup without infection, you may try watchful waiting. Fluid behind the eardrum after an ear infection is normal. In most children, the fluid clears up within a few months without treatment. Have your child's hearing tested if the fluid persists past 3 months. If hearing is normal, you may choose to keep watching your child without treatment.
If a child has fluid behind the eardrum for more than 3 months and has significant hearing problems, treatment is needed. Sometimes short-term hearing loss occurs, which is especially a concern in children ages 2 and younger. Normal hearing is very important when young children are learning to talk.
Doctors may consider surgery for children with repeat ear infections or those with persistent fluid behind the eardrum. Procedures include inserting ear tubes or removing adenoids and, in rare cases, the tonsils.
Inserting tubes into the eardrum (myringotomy or tympanostomy with tube placement) allows fluid to drain from the middle ear. The tubes keep fluid from building up and may prevent repeat ear infections. These tubes stay in place for 6 to 12 months and then fall out on their own. If needed, tubes are inserted again if more fluid builds up. About 8 out of 10 children need no further treatment after tubes are inserted for otitis media with effusion.3
You can use antibiotic eardrops for ear infections while tubes are in place. In some cases, antibiotic eardrops seem to work better than antibiotics by mouth when tubes are present.4
While tubes are in place, your doctor will recommend ear protection, including caution with water. The ear could get infected if any germs in the water get into the ear.
As a treatment for chronic ear infections, experts recommend removing adenoids and tonsils only after tubes and antibiotics have failed. Removing adenoids may improve air and fluid flow in nasal passages. This may reduce the chance of fluid collecting in the middle ear, which can lead to infection. Tonsils are removed if they are frequently infected. Experts do not recommend tonsil removal alone as a treatment for ear infections.5
If your child has a ruptured eardrum, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.
If a ruptured eardrum hasn't healed in 3 to 6 months, your child may need surgery (myringoplasty or tympanoplasty) to close the hole. This surgery is rarely done, because the eardrum usually heals on its own within a few weeks. If a child has had many ear infections, you may delay surgery until the child is 6 to 8 years old to allow time for eustachian tube function to improve. At this point, there is a better chance that surgery will work.
If amoxicillin—the most commonly used antibiotic for ear infections—does not improve symptoms in 48 hours, your doctor may try a different antibiotic.
When taking antibiotics for ear infection, it is very important that your child take all of the medicine as directed, even if he or she feels better. Do not use leftover antibiotics to treat another illness. Misuse of antibiotics can lead to drug-resistant bacteria.
Most studies find that decongestants, antihistamines, and other nonprescription cold remedies usually do not help prevent or treat ear infections or fluid behind the eardrum.
Children who have fluid behind the eardrum longer than 3 months (chronic otitis media with effusion) may have trouble hearing and need a hearing test. If there is a hearing problem, your doctor may also prescribe antibiotics to help clear the fluid. But that usually doesn't help. The doctor might also suggest placing tubes in the ears to drain the fluid and improve hearing.
If your child is younger than 2, your doctor may not wait 3 months to start treatment because hearing problems at this age could affect your child's speaking ability. This is also why children in this age group are closely watched when they have ear infections.
Children who get rare but serious problems from ear infections, such as infection in the tissues around the brain and spinal cord (meningitis) or infection in the bone behind the ear (mastoiditis), need treatment right away.
You may be able to prevent your child from getting middle ear infections by:
Rest and care at home is often all children 2 years of age or older with ear infections need. Most ear infections get better without treatment. If your child is mildly ill and home treatment takes care of the earache, you may choose not to seek treatment for the ear infection.
At home, try:
Decongestants, antihistamines, expectorants, and other over-the-counter cold remedies usually do not work for treating or preventing ear infections. Antihistamines that cause sleepiness may thicken fluids, which can make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than age 2.
If your child with an ear infection must take an airplane trip, talk with your doctor about how to help your child cope with ear pain during the trip.
If your child isn't better after a few days of home treatment, call your doctor.
If your child has a ruptured eardrum or has ear tubes in place, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.
Antibiotics can treat ear infections. But most children with ear infections get better without them. If the care you give at home relieves pain, and a child's symptoms are getting better after a few days, you may not need antibiotics.
If your child has an ear infection and appears very ill, is younger than 2, or is at risk for complications from the infection, your doctor will likely give antibiotics right away. For children ages 2 and older, many doctors wait for a few days to see if the ear infection will get better on its own. When doctors do prescribe antibiotics, they most often use amoxicillin because it works well and costs less than other brands.
Experts suggest a hearing test if a child has had fluid behind his or her eardrum longer than 3 months. Normal hearing is critical during the first 2 years when your child is learning to talk. Your doctor may prescribe antibiotics to help clear the fluid. But that usually doesn't help. The doctor may also suggest placing tubes in the ears to drain fluid and improve hearing.
Other medicines that can treat symptoms of ear infection include:
Decongestants, antihistamines, expectorants, and other over-the-counter cold remedies usually do not work well for treating or preventing ear infections. Antihistamines that may make your child sleepy can thicken fluids and may actually make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.
Antibiotics may help cure ear infections caused by bacteria.
Some doctors prefer to treat all ear infections with antibiotics. Some things to consider before your child takes antibiotics include:
If your child still has symptoms (fever and earache) longer than 48 hours after starting an antibiotic, a different antibiotic may work better. Call your doctor if your child isn't feeling better after 2 days of antibiotic treatment.
Surgery for middle ear infections (acute otitis media) often means placing a drainage tube into the eardrum of one or both ears. It's one of the most common childhood operations. While the child is under general anesthesia, the surgeon cuts a small hole in the eardrum and inserts a small plastic tube in the opening (myringotomy or tympanostomy with tube placement).
The tubes will ventilate the middle ear after the fluid is gone. And they help relieve hearing problems.
Doctors consider tube placement for children who have had repeat infections or fluid behind the eardrum in both ears for 3 to 4 months and have trouble hearing. Sometimes they consider tubes for a child who has fluid in only one ear but also has trouble hearing.
Inserting ear tubes (myringotomy or tympanostomy with tube placement) often restores hearing and helps prevent buildup of pressure and fluid in the middle ear.
Adenoid removal (adenoidectomy) or adenoid and tonsil removal (adenotonsillectomy) may help some children who have repeat ear infections or fluid behind the eardrum. Children younger than 4 don't usually have their adenoids taken out unless they have severe nasal blockage. Taking out the tonsils alone is not usually done unless a child has another reason to have them removed.
Most tubes stay in place for about 6 to 12 months, after which they usually fall out on their own. After the tubes are out, the hole in the eardrum usually closes in 3 to 4 weeks. Some children need tubes put back in their ears because fluid behind the eardrum returns.
In rare cases, tubes may scar the eardrum and lead to permanent hearing loss.
Doctors suggest tubes if fluid behind the eardrum or ear infections keep coming back. Learn the pros and cons of this surgery. Before deciding, ask how the surgery can help or hurt your child and how much it will cost.
Surgeons sometimes operate to close a ruptured eardrum that hasn't healed in 3 to 6 months, though this is rare. The eardrum usually heals on its own within a few weeks.
If your child has a ruptured eardrum or has ear tubes in place, your doctor will recommend ear protection, including caution with water. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.
Allergy treatment can help children who have allergies and who also have frequent ear infections. Allergy testing isn't suggested unless children have signs of allergies.
Some people use herbal remedies, such as echinacea and garlic oil capsules, to treat ear infections. There is no scientific evidence that these therapies work. If you are thinking about using these therapies for your child's ear infection, talk with your doctor.
|Centers for Disease Control and Prevention|
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|Atlanta, GA 30333|
The Get Smart Web site at the Centers for Disease Control and Prevention (CDC) provides information for both consumers and health professionals on the appropriate use of antibiotics. The Web site explains the dangers of inappropriate use of antibiotics and gives tips on actions people can take to feel better if they have an infection that cannot be helped by antibiotics. Some materials are available in English and in Spanish.
|American Academy of Family Physicians|
|P.O. Box 11210|
|Shawnee Mission, KS 66207-1210|
The American Academy of Family Physicians offers information on adult and child health conditions and healthy living. Its Web site has topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
|American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)|
|1650 Diagonal Road|
|Alexandria, VA 22314-2857|
The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is the world's largest organization of physicians dedicated to the care of ear, nose, and throat (ENT) disorders. Its Web site includes information for the general public on ENT disorders.
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|Elk Grove Village, IL 60007-1098|
The American Academy of Pediatrics (AAP) offers a variety of educational materials about parenting, general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other organizations are also available.
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This website is sponsored by the Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This website offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly emails about your area of interest.
|National Institute on Deafness and Other Communication DisordersNational Institutes of Health|
|31 Center Drive, MSC 2320|
|Bethesda, MD 20892-2320|
The National Institute on Deafness and Other Communication Disorders, part of the U.S. National Institutes of Health, advances research in all aspects of human communication and helps people who have communication disorders. The website has information about hearing, balance, smell, taste, voice, speech, and language.
- Kelley PE, et al. (2009). Ear, nose, and throat. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 437–470. New York: McGraw-Hill.
- American Academy of Pediatrics and American Academy of Family Physicians (2004). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 113(5): 1451–1465.
- Weinberger PM, Terris DJ (2010). Otitis media section of Otolaryngology-Head and neck surgery. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 228–229. New York: McGraw-Hill.
- Macfadyen CA, et al. (2006). Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
- Rovers MM, et al. (2004). Otitis media. Lancet, 363(9407): 465–473.
- Pneumococcal vaccine (Prevnar) for otitis media (2003). Medical Letter on Drugs and Therapeutics, 45 (W1153B): 27–28.
Other Works Consulted
- Bradley-Stevenson C, et al. (2007). AOM in children (acute), search date January 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Glasziou PP, et al. (2004). Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
- Kerschner JE (2007). Otitis media. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 2632–2646. Philadelphia: Saunders Elsevier.
- Klein JO, Bluestone CD (2009). Otitis media. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 216–236. Philadelphia: Saunders Elsevier.
- Yates PD, Anari S (2008). Otitis media. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, pp. 655–665. New York: McGraw-Hill.
|Primary Medical Reviewer||Michael J. Sexton, MD - Pediatrics|
|Specialist Medical Reviewer||Charles M. Myer, III, MD - Otolaryngology|
|Last Revised||May 9, 2011|
Last Revised: May 9, 2011
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