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This topic covers
infections of the middle ear, commonly called
ear infections. For information on outer ear
infections, see the topic
Ear Canal Problems (Swimmer's Ear). For information on inner ear infections,
see the topic
middle ear is the small part of your ear behind your eardrum. It can get
infected when germs from the nose and throat are trapped there.
A small tube
connects your ear to your throat. These two tubes are called eustachian tubes (say "yoo-STAY-shee-un"). A cold can cause this tube to swell. When the
tube swells enough to become blocked, it can trap fluid inside your ear. This
makes it a perfect place for germs to grow and cause an infection.
Ear infections happen mostly to young children, because their tubes are
smaller and get blocked more easily.
The main symptom is an
earache. It can be mild, or it can hurt a lot. Babies and young children may be
fussy. They may pull at their ears and cry. They may have trouble sleeping.
They may also have a fever.
You may see thick, yellow fluid coming
from their ears. This happens when the infection has caused the eardrum to
burst and the fluid flows out. This isn't serious and usually makes the pain
go away. The eardrum usually heals on its own.
When fluid builds
up but doesn't get infected, children often say that their ears just feel
plugged. They may have trouble hearing, but their hearing usually returns to
normal after the fluid is gone. It may take weeks for the fluid to drain away.
doctor will talk to you about your child's symptoms. Then he or she will look
into your child's ears. A special tool with a light lets the doctor see the
eardrum and tell whether there is fluid behind it. This exam is rarely
uncomfortable. It bothers some children more than others.
Most ear infections go away on
their own, although antibiotics are recommended for children under the age of 2 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 or heating pad on the ear, and rest.
Do not give aspirin to anyone younger than 20. 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 them will
depend on how old your child is and how bad the infection is.
Minor surgery to put tubes in the ears may help if your child has hearing
problems or repeat infections.
Sometimes after an infection, a child cannot hear well for a while. Call
your doctor if this lasts for 3 to 4 months. Children need to be able to hear
in order to learn how to talk.
There are many
ways to help prevent ear infections.
Learning about ear infections:
Helping a sick child:
Health Tools help you make wise health decisions or take action to improve your health.
Middle ear infections are caused by bacteria and viruses.
Swelling from an
upper respiratory infection or allergy can block the
eustachian tubes, which connect the middle ears to the
throat. So air can't reach the middle ear. This
creates a vacuum and suction, which pulls fluid and germs from the nose and
throat into the middle ear. The swollen tube prevents this fluid from draining.
The fluid is a perfect breeding ground for bacteria or viruses to grow into an
Inflammation and fluid buildup can occur without
infection and cause a feeling of stuffiness in the ears. This is known as
otitis media with effusion.
Symptoms of a
middle ear infection (acute otitis media) often start
2 to 7 days after the start of a cold or other
upper respiratory infection. Symptoms of an ear
infection may include:
Symptoms of fluid buildup may
Some children don't have any symptoms.
Middle ear infections usually occur along with an
upper respiratory infection (URI), such as a cold.
builds up in the middle ear, creating a perfect breeding ground for bacteria or
viruses to grow into an ear infection.
Pus forms as the body
tries to fight the ear infection. More fluid collects and pushes against the
eardrum, causing pain and sometimes problems hearing. Fever typically lasts
a few days. And pain and crying usually last for several hours. After
that, most children have some pain on and off for several days, although young
children may have pain that comes and goes for more than a week.
Antibiotic treatment may shorten some
symptoms. But most of the time the
immune system can fight infection and heal the ear
infection without the use of these medicines.
In severe cases, too much fluid can increase pressure on the eardrum
ruptures, allowing the fluid to drain. When this
happens, fever and pain usually go away and the infection clears. The eardrum
usually heals on its own, often in just a couple of weeks.
complications, such as an ear infection with chronic drainage, can occur with
repeat ear infections.
Most children who have ear infections still have some fluid behind the
eardrum a few weeks after the infection is gone. For some children, the fluid
clears in about a month. And a few children still have fluid buildup (effusion) several
months after an ear infection clears. This fluid
buildup in the ear is called otitis media with effusion. Hearing problems can
result, because the fluid affects how the middle ear works. Usually, infection
does not occur.
Otitis media with fluid buildup (effusion) may occur even if a child
has not had an obvious ear infection or upper respiratory infection. In these
cases, something else has caused
eustachian tube blockage.
In rare cases,
complications can arise from middle ear infection or fluid buildup. Examples
include hearing loss and ruptured eardrum.
Some things that increase
the risk for
middle ear infection are out of
your control. These include:
Other things that increase the risk for ear infection
Things that increase the risk for repeated ear infections
Call your doctor immediately if:
Call your doctor if:
Watchful waiting is when you and your doctor
watch symptoms to see if the health problem improves on its own. If it does, no
treatment is needed. If the symptoms don't get better or if they get worse, then
it's time to take the next treatment step.
Your doctor may recommend watchful waiting if your child is 2 years of age or older, has mild ear pain, and is otherwise healthy. Most
ear infections get better without antibiotics. But if your child's pain doesn't
get better with nonprescription children's pain reliever (such as
acetaminophen) or the symptoms continue after 48 hours, call a doctor.
Health professionals who can diagnose and treat
ear infections include:
Children who often get ear infections may need to see
one of these specialists:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Middle ear infections are usually diagnosed using a
health history, a
physical exam, and an
The doctor uses 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 pneumatic otoscope pushes air into the ear.
Other tests may include:
The first treatment of a middle
ear infection focuses on relieving pain. The doctor will also assess your child
for any risk of
If your child's
condition improves in the first couple of days, treating the symptoms at home
may be all that is needed. For more information, see Home Treatment.
If your child isn't better after a couple of days of home
treatment, call your doctor. He or she may prescribe antibiotics.
Follow-up exams with a doctor are important to check
for persistent infection, fluid behind the eardrum
(otitis media with effusion), or repeat
infections. Even if your child seems well, he or she may need a follow-up visit in
about 4 weeks, especially if your child is young.
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. For more information, see Medications.
If your child has cochlear implants, your doctor will probably prescribe antibiotics, because serious complications of ear infections, including bacterial meningitis, are more common in children who have cochlear implants than in children who do not have cochlear implants.
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 consider treatment to prevent future infections.
One option that has been used a lot in the past is long-term oral antibiotic treatment.
There is debate within the medical community about using antibiotics on a
long-term basis to prevent ear infections. Many doctors don't want to prescribe
long-term antibiotics, because they are not sure that they really work. Also,
when antibiotics are used too often, bacteria can become
resistant to antibiotics.
Having tubes put in the ears is another
option for treating repeat ear infections.
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, which 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 your child's speaking ability. This is also why children in this age
group are closely watched when they have ear infections.
If there is a hearing problem, your doctor may also
prescribe antibiotics to help clear the fluid. The doctor might also suggest placing tubes in the ears to drain the fluid and
consider surgery for children who have repeat ear infections or for those who have
persistent fluid behind the eardrum. Procedures include inserting ear tubes or
adenoids and, in rare cases, the tonsils. For more information, see Surgery.
Children who get rare but serious problems from
ear infections, such as infection in the tissues around the brain and spinal
cord (meningitis) or infection in the bone behind the ear
(mastoiditis), need treatment right away.
You may be able to prevent your child from
middle ear infections.
Rest and care at home is often all that children age 2 or older need when they have an ear infection. Most ear infections get better without treatment. If your child is mildly ill and home treatment takes care of the earache, you may choose not to see a doctor.
At home, try these tips:
If your child isn't better after a few days of home treatment, call your doctor.
Ask your doctor about ear protection for your child. He or she can tell you when the hole in the eardrum has healed and when it's okay to go back to regular water activities.
If your child with an ear infection must take an airplane trip, talk with your doctor about how to help your child cope with ear pain during the trip.
Antibiotics can treat ear infections caused by bacteria. But most children with ear infections get better without them. If the care you give at home relieves pain and the symptoms are getting better after a few days, you may not need antibiotics.
Your doctor will likely give antibiotics right away if:
For children ages 2 and older, many doctors wait for a few days to see if the ear infection will get better on its own. When doctors do prescribe antibiotics, they most often use amoxicillin, because it works well and costs less than other brands.
When your child takes
antibiotics for an ear infection, it is very important to take all of
the medicine as directed, even if your child feels better. Do not use leftover
antibiotics to treat another illness. Misuse of antibiotics can lead to
Some doctors prefer to treat all ear infections with antibiotics, because it's hard to tell which ear infections will clear up
on their own. Some things to consider before your child takes antibiotics include:
only minimal benefits in reducing pain and fever.
If your child still has symptoms (fever and earache) longer than 48 hours after starting an antibiotic, a different antibiotic may work better. Call your doctor if your child isn't feeling better after 2 days of antibiotic treatment.
Other medicines that can treat symptoms of ear infection include:
find that decongestants, antihistamines, and other nonprescription cold
remedies usually don't help prevent or treat ear infections or fluid behind
the eardrum. Antihistamines that may make your child sleepy can thicken fluids and may actually make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2 years.
Surgery for middle ear infections often means placing a drainage tube into the eardrum of one or both ears. It's one of the most common childhood operations.
Inserting ear tubes (myringotomy or tympanostomy with tube placement):
While the child is under general anesthesia, the surgeon cuts a small hole in the eardrum and inserts a small plastic tube in the opening.
Most tubes stay in place for about 6 to 12 months and then usually fall out on their own. After the tubes are out, the hole in the eardrum usually closes in 3 to 4 weeks. Some children need tubes put back in their ears because fluid behind the eardrum returns.
In rare cases, tubes may scar the eardrum and lead to permanent hearing loss.
Doctors consider tube placement for children who have had repeat infections or fluid behind the eardrum in both ears for 3 to 4 months and have trouble hearing. Sometimes they consider tubes for a child who has fluid in only one ear but also has trouble hearing. Learn the pros and cons of this surgery. Before deciding, ask how the surgery can help or hurt your child and how much it will cost.
You can use antibiotic eardrops for ear infections
while tubes are in place. In some cases, antibiotic eardrops seem to work
better than antibiotics by mouth when tubes are present.1
Adenoid removal (adenoidectomy) or adenoid and tonsil removal (adenotonsillectomy) may help some children who have repeat ear infections or fluid behind the eardrum. Children younger than 4 don't usually have their adenoids taken out unless they have severe nasal blockage.
As a treatment for chronic ear infections, experts
recommend removing adenoids and tonsils only after tubes and antibiotics have
failed. Removing adenoids may improve air and fluid flow in nasal passages.
This may reduce the chance of fluid collecting in the middle ear, which can
lead to infection. When used along with
other treatments, removing adenoids (adenoidectomy) can help some children who have
repeat ear infections. But taking out the tonsils
with the adenoids (adenotonsillectomy) isn't very helpful.2 Tonsils are removed if they are frequently infected. Experts
don't recommend tonsil removal alone as a treatment for ear
Surgeons sometimes operate to close a ruptured eardrum that hasn't healed in 3 to 6 months, though this is rare. The eardrum usually heals on its own within a few weeks. If a child has had many ear infections, you may delay
surgery until the child is 6 to 8 years old to allow time for
eustachian tube function to improve. At this point,
there is a better chance that surgery will work.
Allergy treatment can help children who have allergies and who also have frequent ear infections. Allergy testing isn't suggested unless children have signs of allergies.
Some people use herbal remedies, such as echinacea and garlic oil capsules, to treat ear infections. There is no scientific evidence that these therapies work. If you are thinking about using these therapies for your child's ear infection, talk with your doctor.
The website FamilyDoctor.org is sponsored by the American Academy of Family Physicians. It offers information on adult and child health conditions and healthy living. There are topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
The Get Smart Web site at the Centers for Disease Control and Prevention (CDC) provides information for both consumers and health professionals on the appropriate use of antibiotics. The website explains the dangers of inappropriate use of antibiotics and gives tips on actions people can take to feel better if they have an infection that cannot be helped by antibiotics. Some materials are available in English and in Spanish.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The website has information about hearing,
balance, smell, taste, voice, speech, and language.
CitationsKlein, JO (2011). Infections of the ear. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 973–979. New York: McGraw-Hill.Williamson I (2011). Otitis media with effusion in children, search date March 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.Pai S, Parikh SR (2012). Otitis media. In AK Lalwani, ed., Current Diagnosis and Treatment Otolaryngology Head and Neck Surgery, 3rd ed., pp. 674–681. New York: McGraw-Hill.Other Works ConsultedAn expanded pneumococcal vaccine (Prevnar 13) for infants and children (2010). Medical Letter on Drugs and Therapeutics, 52(1345): 67–68.Damoiseaux RAJM, Rovers MM (2011). AOM in children, search date September 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.Kerschner JE (2011). Otitis media. In RM Kleigman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2199–2213. Philadelphia: Saunders.Klein JO, Bluestone CD (2009). Otitis media. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 216–236. Philadelphia: Saunders Elsevier.Pai S, Parikh SR (2012). Otitis media. In AK Lalwani, ed., Current Diagnosis and Treatment Otolaryngology Head and Neck Surgery, 3rd ed., pp. 674–681. New York: McGraw-Hill.Shekelle PG, et al. (2010). Management of Acute Otitis Media: Update. Evidence Report/Technology Assessment No. 198. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/tp/otitisuptp.htm.
September 10, 2012
Susan C. Kim, MD - Pediatrics & Charles M. Myer, III, MD - Otolaryngology
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