What is ear infections?

An ear infection is an infection behind the eardrum, in the middle ear. This type of infection is called otitis media. It can be caused by a virus or bacteria.

An ear infection usually starts with a cold. A cold can cause swelling in the small tube that connects each ear to the throat. These two tubes are called eustachian (say "yoo-STAY-shun") tubes. Swelling can block the tube and trap fluid inside the ear. This makes it a perfect place for bacteria or viruses to grow and cause an infection.

Ear infections happen mostly to young children. This is because their eustachian tubes are smaller and get blocked more easily.

An ear infection can be painful. 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.

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.

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.

Most ear infections go away on their own. You can treat them 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 with pain.

Your doctor may prescribe antibiotics. Antibiotics are recommended for children under 6 months old and for children at high risk for complications. But ear infections often get better without them. Talk with your doctor. Whether you use antibiotics will depend on how bad the infection is. For children, it also will depend on the child's age.

Follow up with your doctor if your symptoms don't get better. Sometimes children need to follow up if they are younger than 6 months old or if their infection is severe.

Minor surgery to put tubes in the ears may help for repeat infections or hearing problems.

• 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.