Ear Infections: Symptoms, Treatment, & Prevention

By Howard Jeffries, MD
Medically reviewed checkmarkMedically reviewed
March 26, 2020

Anyone can get an ear infection, but they are incredibly common in children. In fact, five out of six children will have at least one ear infection by the time they’re three. That’s why they’re the most common reason for pediatrician visits. The good news is, ear infections are easily treatable. Most kids outgrow ear infections and go on to have undamaged, perfect ears with normal hearing.

What Is an Ear Infection?

An ear infection is an infection or inflammation of the outer, inner, or middle ear. When pediatricians refer to ear infections, they are most often referring to middle ear infections. The middle ear is the air-filled space behind the eardrum. It holds the ear’s tiny vibrating bones. A middle ear infection is caused by bacteria and viruses and is very common in children.

An inner ear infection is inflammation or irritation of the parts of the ear responsible for hearing and balance. An inner ear infection is most commonly caused by a virus.

An outer ear infection, also known as swimmer’s ear, is often caused by water that stays in your ears after swimming. The moist area promotes bacterial growth. You can also get swimmer’s ear by putting cotton swabs, fingers, or other objects in your ear.

For the purpose of this article, I’ll mainly be discussing middle ear infections unless otherwise noted.

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Symptoms of Ear Infections

Ear infection symptoms usually come on quickly for kids. Middle ear infection symptoms include:

  • Fever of 100° F (37.8° C) or higher (especially in infants and younger children)
  • Ear pain, especially when lying down
  • Difficulty falling or staying sleeping
  • More crying and irritability than usual
  • Fluid drainage from the ear
  • Fussiness
  • Pulling or tugging at an ear or ears
  • Headache
  • Loss of appetite
  • Difficulty hearing or responding to sounds (even quiet ones)
  • Loss of balance or clumsiness
  • Clinginess
  • Lack of energy

What Causes Ear Infections?

Typically, a middle ear infection is caused by bacteria or viruses. The majority of infections are caused by viruses.

The eustachian tube is a passage between your middle ear and throat. These tubes (you have one near each ear) let air move in and out of the middle ear, preventing pressure from building up. The tubes are small, short, and flat (horizontal). They get longer and work better as you get older which is why kids typically tend to outgrow ear infections around seven years old.

The eustachian tube can sometimes become blocked which causes an infection. Often this occurs after a child has a cold, respiratory infection, or sore throat. Ear infections aren’t contagious; they can’t be passed from one person to another. However, you may catch a cold or viral illness that leads to an ear infection.

An inner ear infection is most commonly caused by a virus. Herpes virus, polio, Epstein-Barr virus, and influenza are some viruses associated with inner ear infection. A bacterial infection may also cause an inner infection, although this occurs less frequently.

An outer ear infection is often caused by water that stays in your ears after swimming. The moist area promotes bacterial growth. You can also get it by putting cotton swabs, fingers, or other objects in your ear. Outer ear infections are less commonly caused by a virus.

Diagnosing Ear Infections

If you suspect your child has an ear infection, you should visit the pediatrician. Your child’s doctor will ask about their symptoms. Specifically, he or she will ask if your child recently had a sore throat or cold, is having difficulty sleeping, or has been pulling at his or her ears.

The doctor will also do a physical examination to examine the ear. This will include looking into the eardrum (the thin membrane between your middle and outer ear) as well as the throat and nasal passages with a special flashlight called an otoscope. The doctor may use the otoscope to blow a puff of air into the ear to see if the air makes the eardrum move like a healthy one. An infection can make the eardrum move improperly since pus and fluid pressing against it can make it bulge. The eardrum may also be red from an infection.

If your child has frequent ear infections or your doctor is uncertain on a diagnosis, he or she may need to order some additional tests. They can include:

  • Tympanometry: This test checks if the eardrum moves normally. The test is done using a soft, small plug with a small microphone and speaker plus a tool that changes ear pressure. It seals off the ear canal and adjusts the canal’s air pressure. That assesses the eardrum’s flexibility at different pressures.
  • Acoustic reflectometry: To get an indirect measure of middle ear fluids, this test measures how much sound is reflected back from the eardrum. The eardrum normally absorbs most of the sound. But, when there is more pressure from fluid in the middle ear, the eardrum reflects more sound.
  • Tymapnocentesis: In this rarely used test, a doctor pierces the eardrum with a small tube. That drains fluid from the middle ear. Fluid is tested for bacteria and viruses, which can be helpful if an ear infection has been unresponsive to treatments.

Earwax in kids

Earwax can help prevent outer ear infections. Earwax is made in the outer ear canal, the area between the middle ear and the fleshy part of the ear on the outside of the head, and traps particles like dust and dirt so they don’t irritate or injure the eardrum. Earwax also protects the ear canal and eardrum from infection-causing germs.

Wax goes from the outer ear canal to the ear opening. Since earwax comes out during bathing or falls out naturally, you don’t typically have to remove it. Kids’ ears rarely make too much earwax. However, it’s possible for earwax to build up and block the ear canal. If you can visibly see earwax in your child’s ear, you can use a washcloth to wipe the outside of the ear. However, don’t use something to poke inside the ear like a finger or cotton swab as this can damage the eardrum or canal, or further pack in the wax.

It’s best to have your doctor remove wax buildup. The doctor can use special instruments to pull, suction, or scoop wax out, or he may flush out wax with warm water. Your doctor may need to remove earwax in order to better see the eardrum if there is a concern for a middle ear infection.

Treatment Options

Ear infections often improve within a few days and most clear in one to two weeks without treatment. As a result, your doctor may take a wait-and see-approach. That will especially be the case if your child is 24 months and older with mild middle ear pain in one or both ears, has had the pain for less than 48 hours, and has a temperature less than 102.2° F (39° C).

Your child’s doctor may manage their pain with over-the-counter (OTC) pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol). They may also be given topical, OTC anesthetic drops to help relieve pain, as long as there is no hole or tear in the eardrum. These drops are applied into the ear canal, essentially numbing the inflamed eardrum.

Ear infections may also be treated with antibiotics. The pediatrician might prescribe an antibiotic, such as amoxicillin, if the ear infection is caused by a bacterial infection. However, overuse of antibiotics can make infections resistant to medication. Ask your child’s doctor about the risks and benefits of antibiotics. What’s best for your child depends on factors including the severity of their symptoms, their age, how often your child has had ear infections, how long your child has had the infection, and other medical conditions your child may have.

Your child’s symptoms should improve within 24-48 hours, whether prescribed antibiotics or not. If your child doesn’t get better after 48 hours or gets worse, call their doctor.

Home remedies for ear infections

A number of home remedies for ear infections may help ease your child’s pain. Ear infection home remedies include:

  • Warm oil: Place a few drops of room temperature or slightly warmed sesame or olive oil in the affected ear. You should not do this if your child has a ruptured eardrum or has fluid draining from their ear.
  • Warm compress: Place a moist and warm compress over your child’s ear for 10-15 minutes to help reduce pain.
  • Head elevation: If the ear infection is accompanied by a cold, you can improve your child’s sinus drainage and promote ear fluid drainage by slightly elevating their crib or bed. Do so by placing a pillow or two beneath the mattress.
  • Hydration: Swallowing helps open the eustachian tube, allowing drainage of the trapped fluid.
  • Thin out mucus: Run a humidifier to add moisture to the air.You may also spray saline mist directly in your child’s nose to help mucus flow and drain more easily.

Prevention Tips

To help lower your child’s risk for ear infections, take the following measures:

  • If possible, stay away from people who have colds.
  • Discourage your child from touching his or her eyes, mouth, and nose.
  • Don’t go near people who are smoking. Smoke from cigarettes can prevent the eustachian tubes from properly functioning. Even if you smoke outside, your child can be exposed to dust particles on your clothing or hair.
  • Limit use of pacifiers. They introduce bacteria in the mouth, which can then travel to the ear.
  • Keep your children home from school or daycare when they’re sick. Also try to limit their exposure to sick playmates.
  • Regularly wash your child’s hands or encourage good hand hygiene. That will prevent the spread of germs and reduce your child’s risk of catching the flu or a cold.
  • Be sure your child’s vaccines are up to date. Both you and your child should get the flu shot yearly. Your child should also get vaccinated against pneumococcal disease. The primary reason for vaccinating against this disease is to prevent meningitis, pneumonia, and other serious conditions. However, the vaccine also has been shown to reduce chronic ear infection frequency and the need for ear tube surgery.
  • Don’t have your baby sleep alongside a bottle. Doing so increases the chance for acute infection due to a child’s positioning when bottle feeding while sleeping.
  • Consider breastfeeding your baby. Breastfed babies are less likely to get ear infections. If you can’t breastfeed or prefer to bottle feed, your baby should be bottle fed in a sitting position. Milk is more likely to flow into the middle ear if your baby drinks a bottle lying down.

Risk Factors and Complications

Despite taking precautions, some kids still experience frequent middle ear infections. Sometimes fluids build behind the eardrum, even after the infection is gone, if the ear doesn’t properly drain these fluids. If you have recurrent ear infections, your doctor may refer you to an ear, nose, and throat (ENT) doctor to consider ear-tube surgery. With ear tubes, a small ventilation tube is put in the eardrum. This allows for better air flow and prevents fluid from backing up in the middle ear.

  • Some rare but serious complications from ear infections include:
  • Language or speech delay
  • Hearing loss
  • Ruptured eardrum
  • Meningitis (bacterial infection of the membranes covering the spinal cord and brain)
  • Mastoiditis (infection of the mastoid bone in the skull)
  • Eardrum perforation (hole in the eardrum)

When to See a Doctor

You want to get an ear infection accurately diagnosed so it can be treated. Your doctor will decide what approach to take. Call your child’s doctor if:

  • Ear pain is severe
  • Your child is under six months old
  • You see fluid discharge or blood fluid or pus in the ear
  • Symptoms persist for more than a day
  • Your toddler had a cold or upper respiratory infection and is irritable or sleepless
  • Fever doesn’t go away after 24-48 hours

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Howard Jeffries, MD

A pediatric cardiac intensivist at Seattle Children's Hospital, Dr. Jeffries is also Senior Medical Director, Regional Network. He completed a residency in pediatrics and a fellowship in pediatric intensive care. He has published chapters and peer-reviewed articles, with an emphasis on cardiac intensive care, informatics, outcomes assessment and quality improvement.