An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear. Children are more likely than adults to get ear infections.
Ear infections frequently are painful because of inflammation and buildup of fluids in the middle ear.
Because ear infections often clear up on their own, treatment may begin with managing pain and monitoring the problem. Ear infection in infants and severe cases in general often require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications.
Symptoms and causes
The onset of signs and symptoms of ear infection is usually rapid.
Signs and symptoms common in children include:
- Ear pain, especially when lying down
- Tugging or pulling at an ear
- Difficulty sleeping
- Crying more than usual
- Acting more irritable than usual
- Difficulty hearing or responding to sounds
- Loss of balance
- Fever of 100 F (38 C) or higher
- Drainage of fluid from the ear
- Loss of appetite
Common signs and symptoms in adults include:
- Ear pain
- Drainage of fluid from the ear
- Diminished hearing
When to see a doctor
Signs and symptoms of an ear infection can indicate a number of conditions. It’s important to get an accurate diagnosis and prompt treatment. Call your child’s doctor if:
- Symptoms last for more than a day
- Symptoms are present in a child less than 6 months of age
- Ear pain is severe
- Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection
- You observe a discharge of fluid, pus or bloody discharge from the ear
An adult with ear pain or discharge should see a doctor as soon as possible.
An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.
Risk factors for ear infections include:
- Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their eustachian tubes and because of their poorly developed immune systems.
- Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home because they’re exposed to more infections, such as the common cold.
- Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.
- Seasonal factors. Ear infections are most common during the fall and winter when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.
- Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.
Most ear infections don’t cause long-term complications. Frequent or persistent infections and persistent fluid buildup can result in some serious complications:
- Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was before the infection after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
- Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
- Spread of infection. Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).
- Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.