What is ear infections?

A frequent kind of ear infection in children is called otitis media. This is an infection in the middle ear, behind the eardrum. It usually starts with a cold. Ear infections can hurt a lot. Children with ear infections often fuss and cry, pull at their ears, and sleep poorly. Older children will often tell you that their ear hurts.

Most children will have at least one ear infection. Fortunately, children usually outgrow them, often about the time they enter grade school.

Your doctor may prescribe antibiotics to treat ear infections. Antibiotics aren't always needed, especially in older children who aren't very sick. Your doctor will discuss treatment with you based on your child and the symptoms. Regular doses of pain medicine are the best way to reduce fever and help your child feel better.

Middle ear infections usually occur with upper respiratory infections, such as colds. Fluid builds up behind the eardrum, where bacteria or viruses can grow into an infection. Pain and sometimes hearing loss happen as the fluid collects. Usually there is a fever. Sometimes the eardrum ruptures, the fluid drains, and the infection clears.

The main symptom is an earache. It can be mild, or it can hurt a lot. A fever may be present. Babies and young children may be fussy. They may pull at their ears and cry. They may have trouble sleeping.

Symptoms of a middle ear infection often start a few days after the start of a cold or other upper respiratory infection. Some people don't have any symptoms.

If the eardrum ruptures, you may see thick, yellow fluid coming from the ears. This usually makes the pain go away. The eardrum usually heals on its own.

When fluid builds up but doesn't get infected, the ears may just feel plugged. This can affect hearing, but hearing usually goes back to normal after the fluid is gone. It may take weeks for the fluid to drain away.

Most ear infections go away on their own. But antibiotics are recommended for children under the age of 6 months 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 on the ear, and rest. Your doctor may give you eardrops that can help your child's pain.

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.

If your child has cochlear implants, your doctor will probably prescribe antibiotics. That's because serious complications of ear infections, including bacterial meningitis, are more common in children who have cochlear implants than in children who don't have these implants.

Follow-up exams with a doctor are important if your child isn't getting better. The doctor will check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections.

Fluid buildup and surgery

Doctors may consider surgery for children who have repeat ear infections or who keep getting fluid behind the eardrum. Procedures include inserting ear tubes or removing adenoids and, in rare cases, the tonsils.

Fluid behind the eardrum after an ear infection is normal. And, in most children, the fluid clears up within 3 months without treatment. If your child has fluid buildup without infection, you may try watchful waiting.

Have your child's hearing tested if the fluid lasts longer than 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, then treatment is needed. Sometimes short-term hearing loss occurs. This is especially a concern in children ages 2 and younger. Normal hearing is very important when young children are learning to talk.

If your child is younger than 2, your doctor may not wait 3 months to start treatment. Hearing problems at this age could affect how well your child can speak. This is also why children in this age group are closely watched when they have ear infections.

Repeat ear infections

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 think about treatment to prevent future infections.

Ear tube surgery may be an option if your child has repeat ear infections. Ear tubes are plastic and are shaped like a hollow spool. They help to clear fluid from your child's middle ear. Allowing the fluid to drain prevents the growth of bacteria that cause ear infections. Your doctor can help you decide if ear tubes are the right choice for your child.

A doctor will diagnose a middle ear infection by doing a physical exam and an ear exam and by asking questions about past health.

The doctor uses a tool called a pneumatic otoscope to look at the eardrum for signs of an ear infection or fluid buildup. For example, the doctor can see if the eardrum moves freely when the otoscope pushes air into the ear.

Other tests may include:

• Hearing tests. These tests are recommended for children who have had fluid in one or both ears for 3 months or if hearing loss is suspected.
• Tympanometry. It measures how the eardrum responds to a change of air pressure inside the ear.
• Tympanocentesis. This test can remove fluid if it has stayed behind the eardrum (chronic otitis media with effusion) or if infection continues even with antibiotics.
• Blood tests. These are done if there are signs of immune problems and a severe infection.

Antibiotics can treat ear infections caused by bacteria. But most children with ear infections get better without them.

Your doctor will likely give antibiotics if:

• Your child has an ear infection and seems very ill.
• Your child is younger than 2 and has an infection in both ears or has more than mild pain or fever.
• Your child is at risk for complications from the infection, such as trouble hearing.

Other medicines

Other medicines that can treat symptoms of an ear infection include:

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain. Do not use ibuprofen if your child is less than 6 months old unless the doctor gave you instructions to use it. Be safe with medicines. Read and follow all instructions on the label.
• Some eardrops. They may help with severe earache. But don't use them if the eardrum is ruptured.

Most studies find that decongestants, antihistamines, and other nonprescription cold remedies usually don't help prevent or treat ear infections or fluid behind the eardrum.

• Give your child acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever, pain, or fussiness. Do not use ibuprofen if your child is less than 6 months old unless the doctor gave you instructions to use it. Be safe with medicines. Read and follow all instructions on the label. Do not give aspirin to anyone younger than 20. It has been linked to Reye syndrome, a serious illness.
• If the doctor prescribed antibiotics for your child, give them as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of antibiotics.
• Place a warm washcloth on your child's ear for pain.
• Encourage rest. Resting will help the body fight the infection. Arrange for quiet play activities.

Some things that increase your child's risk of a middle ear infection are out of your control. These include:

• Being 3 years old or younger.
• Birth defects or other medical conditions, such as cleft palate or Down syndrome.
• A weakened immune system.
• A family history of ear infections.
• Allergies that cause long-term stuffiness in the nose and can block one or both eustachian tubes.
• Repeated colds and upper respiratory infections.

Other things can increase your child's risk of ear infection. They include:

• Being exposed to cigarette smoke.
• Lying flat while bottle feeding.
• Using a pacifier.
• Using a bottle instead of breastfeeding.

Things that increase the risk of repeated ear infections include:

• Being in a childcare center with many other children.
• Getting the first ear infection before 6 months of age.
• Having persistent fluid behind the eardrum.
• Having an ear infection in the last 3 months, especially if it was treated with antibiotics.

Complications from ear infections are rare. But some problems that can occur include:

• Trouble hearing. Hearing problems are usually temporary and mild to moderate. Long-lasting hearing loss is rare. But some children may have problems learning to talk and understand speech if they have repeat ear infections.
• Rupture of the eardrum. If fluid continues to build up in the middle ear, the eardrum may burst. This leaves a small hole that often heals within 2 weeks.

Another complication is ongoing inflammation of the middle ear. The major symptom is repeat or ongoing drainage of pus from the ear through a small hole in the eardrum. Many children with this problem have some hearing loss.

Other complications may develop if there are repeat ear infections:

• Tissue growth behind the eardrum.
• Damage to the tiny bones in the middle ear.

Rare complications include mastoiditis and meningitis.

Middle ear infections are caused by bacteria and viruses. A small tube (eustachian tube) connects your ear to your throat. A cold can cause this tube to swell, blocking it and trapping fluid inside your ear. This makes it a perfect place for germs to grow and cause an infection.