Ear Infection (Otitis Media)

The scientific name for an ear infection is otitis media (OM).

An ear infection is an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. 3 out of 4 children will have at least one ear infection by their third birthday. In fact, ear infections are the most common reason parents bring their child to a doctor.

Types of Otitis Media

There are three types of otitis media.

  • Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear—commonly called an earache. Your child might also have a fever.
  • Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument.
  • Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.

Cause of Otitis Media

An ear infection usually is caused by bacteria and often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear; if the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary infection. Because of the infection, fluid builds up behind the eardrum.

It is harder for children to fight illness than it is for adults, so children develop ear infections more often. Some researchers believe that other factors, such as being around cigarette smoke, can contribute to ear infections.

What's happening during an ear infection?

When the ears are infected the eustachian tubes become inflamed and swollen. The adenoids can also become infected.

  • The eustachian tubes are inside the ear. They keep air pressure stable in the ear. These tubes also help supply the ears with fresh air.
  • The adenoids are located near the eustachian tubes. Adenoids are clumps of cells that fight infections.

Swollen and inflamed eustachian tubes often get clogged with fluid and mucus from a cold. If the fluids plug the openings of the eustachian tubes, air and fluid get trapped inside the ear. These tubes are smaller and straighter in children than they are in adults. This makes it harder for fluid to drain out of the ear and is one reason that children get more ear infections than adults. The infections are usually painful.

Adenoids are located in the throat, near the eustachian tubes. Adenoids can become infected and swollen. They can also block the openings of the eustachian tubes, trapping air and fluid. Just like the eustachian tubes, the adenoids are different in children than in adults. In children, the adenoids are larger, so they can more easily block the opening of the eustachian tube.

Symptoms of Otitis Media
 
Most ear infections happen to children before they’ve learned how to talk. If your child isn’t old enough to say “My ear hurts,” here are a few things to look for:
  • Tugging or pulling at the ear(s)
  • Fussiness and crying
  • Trouble sleeping
  • Fever (especially in infants and younger children)
  • Fluid draining from the ear
  • Clumsiness or problems with balance
  • Trouble hearing or responding to quiet sounds

A child with an ear infection may show you any of these signs. If you see any of them, call a doctor.

Treatment of Acute Otitis Media (AOM)

Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye’s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.)
 
If your doctor isn’t able to make a definite diagnosis of otitis media and your child doesn’t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can’t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there’s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn’t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics.
 
If your doctor prescribes an antibiotic, it’s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn’t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It’s also important to return for your child’s follow-up visit, so that the doctor can check if the infection is gone.

Recovery from Otitis Media

Your child should start feeling better within a few days after visiting the doctor. If it’s been several days and your child still seems sick, call your doctor. Your child might need a different antibiotic. Once the infection clears, fluid may still remain in the middle ear but usually disappears within three to six weeks.

Giving the Medicine Correctly

If your doctor gives you a prescription for medicine for your child, make sure you understand the directions completely before you leave his or her office. Here are a few suggestions about giving medicine to your child.

1. Read. Make sure the pharmacy has given you printed information about the medicine and clear instructions about how to give it to your child. Read the information that comes with the medicine. If you have any problems understanding the information, ask the pharmacist, your doctor, or a nurse. You should know the answers to the following questions:

  • Does the medicine need to be refrigerated?
  • How many times a day will I be giving my child this medicine?
  • How many days will my child take this medicine?
  • Should it be given with food or without food?

2. Plan. Sometimes it is hard to remember when you have given your child a dose of medicine. Before you give the first dose, make a written plan or chart to cover all of the days of the medication. Some children may require 10 to 14 days of treatment.

Your chart might look like this if your child's prescription is for 3 times a day with food:

Put your chart on the refrigerator so you can check off the doses at every meal. Be sure to measure carefully. Use a measuring spoon or special medicine-measuring cup if one comes with the medicine. Do not use spoons that come with tableware sets because they are not always a standard size.

3. Follow through. Be sure to give all of the medicine to your child. Make sure it is given at the right times. If your doctor asks you to bring your child back for a "recheck", do it on schedule. Your doctor wants to know if the ears are clear of fluid and if the infection has stopped. Write down and ask the doctor any questions you have before you leave his or her office.

Medication use at daycare or school

Even before your child has an ear infection or needs to take medicine, ask the daycare program or school about their medication policy. Sometimes you will need a note from your doctor for the staff at the school. The note can tell the people at your child's school how and when to give your child medicine if it is needed during school hours. Some schools will not give children medicine. If this is the case at your child's school, ask your doctor how to schedule your child's medicine.

Surgery for Otitis Media ("Tubes")

Some children with otitis media need surgery. The most common surgical treatment involves having small tubes placed inside the ear. This surgery is called a myringotomy. It is recommended when fluids from an ear infection stay in the ear for several months. At that stage, fluid may cause hearing loss and speech problems. A doctor called an otolaryngologist (ear, nose, and throat surgeon) will help you through this process if your child needs an operation. The operation will require anesthesia.

In a myringotomy, a surgeon makes a small opening in the ear drum. Then a tube is placed in the opening. The tube works to relieve pressure in the clogged ear so that the child can hear again. Fluid cannot build up in the ear if the tube is venting it with fresh air.

After a few months, the tubes will fall out on their own. In rare cases, a child may need to have a myringotomy more than once.

Another kind of surgery removes the adenoids. This is called an adenoidectomy. Removing the adenoids has been shown to help some children with otitis media who are between the ages of 4 and 8. We know less about whether this can help children under age 4.

Otitis Media and Hearing Loss

An ear infection can cause temporary hearing problems. Temporary speech and language problems can happen, too. If left untreated, these problems can become more serious.

An ear infection affects important parts in the ear that help us hear. Sounds around us are collected by the outer ear. Then sound travels to the middle ear, which has three tiny bones and is filled with air. After that, sound moves on to the inner ear. The inner ear is where sounds are turned into electrical signals and sent to the brain. An ear infection affects the whole ear, but especially the middle and inner ear. Hearing is affected because sound cannot get through an ear that is filled with fluid.

Otitis Media Prevention

Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child’s risk for ear infections.

  • Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated. The vaccine is strongly recommended for children in daycare.
  • Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu.
  • Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections.
  • Never put your baby down for a nap, or for the night, with a bottle.
  • Don’t allow sick children to spend time together. As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick.

__________________________________________________________________

© 2010 Vivacare.  Last updated March 19, 2013.

Reference: National Institute on Deafness and Other Communication Disorders

All rights reserved. Any redistribution or reproduction of part or all of the contents in any form is prohibited. You may not, except with our express written permission, distribute, reproduce, or commercially exploit the content.

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

From Your Doctor service powered by Vivacare.

Additional Resources

Overview
Ear Infection Guide (link to Mayo Clinic)
Medications
En Espanol
Infecciones de los Oidos (link to NIDCD)
This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.
View Content Policy