Ear Infection

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. 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 the 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 makes more fluid build up in the middle ear behind the eardrum.

Risk factors for 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
  • Pacifier use
  • Recent ear infection
  • Recent illness of any type (because illness lowers the body's resistance to infection)

Some causes are

  • Allergies
  • Colds and sinus infections
  • Excess mucus and saliva produced during teething
  • Infected or overgrown adenoids (lymph tissue in the upper part of the throat)
  • Tobacco smoke

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. Getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole in it.

Acute ear infections most often occur in the winter. You cannot catch an ear infection from someone else. But a cold that spreads among children may cause some of them to get ear infections.

The provider will look inside the ears using an instrument called an otoscope.

This may show

  • Areas of dullness or redness
  • Air bubbles or fluid behind the eardrum
  • Bloody fluid or pus inside the middle ear
  • A hole (perforation) in the eardrum

The provider might recommend a hearing test if the person has a history of ear infections.

Some ear infections clear 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 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 the provider to determine whether antibiotics are needed.

Anitibiotics

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 health care provider is more likely to prescribe antibiotics if your child:
  • Is under age 2
  • Has a fever
  • Appears sick
  • Does not improve in 24 to 48 hours

If antibiotics are prescribed, it is important to take them every day and to take all of the medicine. 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. Although rare, serious allergic reactions 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:
  • 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.
  • Usually the tubes fall out by themselves. Those that don't fall out may be removed in the 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.