Ear infection - acute
Otitis media - acute; Infection - inner ear; Middle ear infection - acuteSuspected ear infections are one of the most common reasons parents take their children to the health care provider. The most common type of ear infection is called otitis media. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum.
An acute ear infection starts over a short period and is painful. Ear infections that last a long time or come and go are called chronic ear infections.
Chronic ear infections
Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back. It causes long-term or perm...
Read Article Now Book Mark ArticleCauses
The eustachian tube runs from the middle of each ear to the back of the throat. Normally, this tube drains fluid that is made in the middle ear. If this tube gets blocked, fluid can build up. This can lead to infection.
- Ear infections are common in infants and children because their eustachian tubes are easily clogged.
- Ear infections can also occur in adults, although they are less common than in children.
Anything that causes the eustachian tubes to become swollen or blocked leads to more fluid buildup in the middle ear behind the eardrum. Some causes are:
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Allergies
Allergies
An allergy is an immune response or reaction to substances that are usually not harmful.
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Colds and sinus infections
Colds
The common cold most often causes a runny nose, nasal congestion, and sneezing. You may also have a sore throat, cough, headache, or other symptoms....
Read Article Now Book Mark ArticleSinus infections
Sinusitis is present when the tissue lining the sinuses become swollen or inflamed. It occurs as the result of an inflammatory reaction or an infect...
Read Article Now Book Mark Article - Excess mucus and saliva produced during teething
Teething
Teething is the growth of teeth through the gums in the mouth of infants and young children.
Read Article Now Book Mark Article - Infected or overgrown adenoids (lymph tissue in the upper part of the throat)
Overgrown adenoids
The adenoids are lymph tissues that sit in your upper airway between your nose and the back of your throat. They are similar to the tonsils. Enlarge...
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Ear infections are also more likely in children who spend a lot of time drinking from a sippy cup or bottle while lying on their back. Milk may enter the eustachian tube, which may increase the risk of an ear infection. Getting water in the ears will not cause an acute ear infection unless the eardrum has a hole in it.
Other risk factors for acute ear infections include:
- Attending day care (especially centers with more than 6 children)
- Changes in altitude or climate
- Cold climate
- Exposure to smoke
- Family history of ear infections
- Not being breastfed
- Pacifier use
- Recent ear infection
- Recent illness of any type (because illness lowers the body's resistance to infection)
- Birth defect, leading to deficiency in eustachian tube function
Symptoms
In infants, often the main sign of an ear infection is acting irritable or crying that cannot be soothed. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
Read Article Now Book Mark ArticleSymptoms of an acute ear infection in older children or adults include:
- Ear pain
- Fullness in the ear
- Feeling of general illness
- Nasal congestion
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Cough
Cough
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...
Read Article Now Book Mark Article - Lethargy
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Vomiting
Vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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Hearing loss in the affected ear
Hearing loss
Hearing loss is being partly or totally unable to hear sound in one or both ears.
Read Article Now Book Mark Article - Drainage of fluid from the ear
- Loss of appetite
The ear infection may start shortly after a cold. Sudden drainage of yellow or green fluid from the ear may mean the eardrum has ruptured.
All acute ear infections involve fluid behind the eardrum. At home, you can use an electronic ear monitor to check for this fluid. You can buy this device at a drugstore. You still need to see a provider to confirm an ear infection.
Exams and Tests
Your provider will take your medical history and ask about symptoms.
Your provider will look inside the ears using an instrument called an otoscope. This exam may show:
- Areas of marked redness
- Bulging of the tympanic membrane
- Discharge from the ear
- Air bubbles or fluid behind the eardrum
- A hole (perforation) in the eardrum
Your provider might recommend a hearing test if the person has a history of ear infections.
Treatment
Some ear infections clear on their own without antibiotics. Treating the pain and allowing the body time to heal itself is often 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 your provider about prescription eardrops to relieve pain.
- Take over-the-counter medicines such as ibuprofen or acetaminophen for pain or fever. Do not give aspirin to children.
All children younger than 6 months with a fever or symptoms of an ear infection should see a provider. Children who are older than 6 months may be watched at home if they do not have:
- A fever higher than 102°F (38.9°C)
- More severe pain or other symptoms
- Other medical problems
If there is no improvement or if symptoms get worse, schedule an appointment with your provider to determine whether antibiotics are needed.
ANTIBIOTICS
A virus or bacteria can cause ear infections. Antibiotics will not help an infection that is caused by a virus. Most providers don't prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.
Your provider is more likely to prescribe antibiotics if your child:
- Is under age 2 years
- Has a fever
- Appears sick
- Does not improve in 24 to 48 hours
If antibiotics are prescribed, it is important to take them as directed and to take all of the medicines. Do not stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your provider. You may need to switch to a different antibiotic.
Side effects of antibiotics may include nausea, vomiting, and diarrhea. Serious allergic reactions are rare, but may also occur.
Some children have repeat ear infections that seem to go away between episodes. They may receive a smaller, daily dose of antibiotics to prevent new infections.
SURGERY
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 provider may recommend ear tubes:
Ear tubes
Ear tube insertion involves placing tubes through the eardrums. The eardrum is the thin layer of tissue that separates the outer and middle ear. No...
Read Article Now Book Mark Article- If a child more than 6 months old has had 3 or more ear infections within 6 months or more than 4 ear infections within a 12-month period
- If a child less than 6 months old has had 2 ear infections in a 6- to 12-month period or 3 episodes in 24 months
- If the infection does not go away with medical treatment
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 (myringotomy).
The tubes often eventually fall out by themselves. Those that don't fall out may be removed in your provider's office.
If the adenoids are enlarged, removing them with surgery may be considered if ear infections continue to occur. Removing tonsils does not seem to help prevent ear infections.
Outlook (Prognosis)
Most often, an ear infection is a minor problem that gets better. Ear infections can be treated, but they may occur again in the future.
Most children will have slight short-term hearing loss during and right after an ear infection. This is due to fluid in the ear. Fluid can stay behind the eardrum for weeks or even months after the infection has cleared.
Fluid can stay behind the eardrum
Otitis media with effusion (OME) is thick or sticky fluid behind the eardrum in the middle ear. It occurs without an ear infection.
Read Article Now Book Mark ArticleSpeech or language delay is uncommon. It may occur in a child who has lasting hearing loss from many repeated ear infections.
Possible Complications
In rare cases, a more serious infection may develop, such as:
- Tearing of the eardrum
- Spreading of infection to nearby tissues, such as infection of the bones behind the ear (mastoiditis) or infection of the brain membrane (meningitis)
Mastoiditis
Mastoiditis is an infection of the mastoid bone of the skull. The mastoid bone is located just behind the ear.
Read Article Now Book Mark Article - Chronic otitis media
- Collection of pus in or around the brain (abscess)
When to Contact a Medical Professional
Contact your provider if:
- You have swelling behind the ear.
- Your symptoms get worse, even with treatment.
- You have a high fever or severe pain.
- Severe pain suddenly stops, which may indicate a ruptured eardrum.
- New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles.
Let your provider know right away if a child younger than 6 months has a fever, even if the child doesn't have other symptoms.
Prevention
You can reduce your child's risk of ear infections with the following measures:
- Wash your hands and your child's hands and toys to decrease the chance of getting a cold.
- If possible, choose a day care that has 6 or fewer children. This can reduce your child's chances of getting a cold or other infection.
- Avoid using pacifiers.
- Breastfeed your baby.
- Avoid bottle feeding your child when they are lying down.
- Avoid smoking.
- Make sure your child's immunizations are up to date. The pneumococcal vaccine prevents infections from the bacteria that most commonly cause acute ear infections and many respiratory infections.
References
Haddad J, Dodhia SN. General considerations and evaluation of the ear. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 654.
Kerschner JE, Preciado D. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 658.
Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.
Ranakusuma RW, Pitoyo Y, Safitri ED, et al. Systemic corticosteroids for acute otitis media in children. Cochrane Database Syst Rev. 2018;15;3(3):CD012289. PMID: 29543327 pubmed.ncbi.nlm.nih.gov/29543327/.
Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. PMID: 26832942 pubmed.ncbi.nlm.nih.gov/26832942/.
Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical Practice Guideline: Tympanostomy tubes in children (update).Otolaryngol Head Neck Surg. 2022;166(1_suppl):S1-S55. PMID: 35138954 pubmed.ncbi.nlm.nih.gov/35138954/.
Schilder AGM, Rosenfeld RM, Venekamp RP. Acute otitis media and otitis media with effusion. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 199.
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Ear anatomy - illustration
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
Ear anatomy
illustration
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Middle ear infection (otitis media) - illustration
Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.
Middle ear infection (otitis media)
illustration
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Otoscopic exam of the ear - illustration
An otoscope is an instrument which is used to look into the ear canal. The ear speculum (a cone-shaped viewing piece of the otoscope) is slowly inserted into the ear canal while looking into the otoscope. The speculum is angled slightly toward the person's nose to follow the canal. A light beam extends beyond the viewing tip of the speculum. The otoscope is gently moved to different angles to view the canal walls and eardrum.
Otoscopic exam of the ear
illustration
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Eustachian tube - illustration
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore.
Eustachian tube
illustration
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Mastoiditis - side view of head - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has drainage from the ear and redness (erythema) behind the ear over the mastoid bone.
Mastoiditis - side view of head
illustration
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Mastoiditis - redness and swelling behind ear - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has noticeable swelling and redness behind his right ear because of mastoiditis.
Mastoiditis - redness and swelling behind ear
illustration
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Ear tube insertion - series - Normal anatomy
Presentation
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Ear anatomy - illustration
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
Ear anatomy
illustration
-
Middle ear infection (otitis media) - illustration
Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.
Middle ear infection (otitis media)
illustration
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Otoscopic exam of the ear - illustration
An otoscope is an instrument which is used to look into the ear canal. The ear speculum (a cone-shaped viewing piece of the otoscope) is slowly inserted into the ear canal while looking into the otoscope. The speculum is angled slightly toward the person's nose to follow the canal. A light beam extends beyond the viewing tip of the speculum. The otoscope is gently moved to different angles to view the canal walls and eardrum.
Otoscopic exam of the ear
illustration
-
Eustachian tube - illustration
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore.
Eustachian tube
illustration
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Mastoiditis - side view of head - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has drainage from the ear and redness (erythema) behind the ear over the mastoid bone.
Mastoiditis - side view of head
illustration
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Mastoiditis - redness and swelling behind ear - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has noticeable swelling and redness behind his right ear because of mastoiditis.
Mastoiditis - redness and swelling behind ear
illustration
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Ear tube insertion - series - Normal anatomy
Presentation
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Otitis media
(Alt. Medicine)
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Ear infections - InDepth
(In-Depth)
Review Date: 1/24/2023
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 02/03/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.