Ear infection - acute
Otitis media - acute; Infection - inner ear; Middle ear infection - acute
Ear infections are one of the most common reasons parents take their children to the doctor. The most common type of ear infection is called otitis media. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum.
An acute ear infection starts over a short period and is painful. Ear infections that last a long time or come and go are called chronic ear infections .
Chronic ear infections
Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back. It causes long-term or perm...
Causes
The eustachian tube runs from the middle of each ear to the back of the throat. Normally, this tube drains fluid that is made in the middle ear. If this tube gets blocked, fluid can build up. This can lead to infection.
- Ear infections are common in infants and children because the eustachian tubes are easily clogged.
- Ear infections can also occur in adults, although they are less common than in children.
Anything that causes the eustachian tubes to become swollen or blocked makes more fluid build up in the middle ear behind the eardrum. Some causes are:
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Allergies
Allergies
An allergy is an immune response or reaction to substances that are usually not harmful.
- Colds and sinus infections
- Excess mucus and saliva produced during teething
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Infected or
overgrown adenoids
(lymph tissue in the upper part of the throat)
Overgrown adenoids
The adenoids are lymph tissues that sit in your upper airway between your nose and the back of your throat. They are similar to the tonsils. Enlarge...
- Tobacco smoke
Ear infections are also more likely in children who spend a lot of time drinking from a sippy cup or bottle while lying on their back. Getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole in it.
Acute ear infections most often occur in the winter. You cannot catch an ear infection from someone else. But a cold that spreads among children may cause some of them to get ear infections.
Risk factors for acute ear infections include:
- Attending day care (especially centers with more than 6 children)
- Changes in altitude or climate
- Cold climate
- Exposure to smoke
- Family history of ear infections
- Not being breastfed
- Pacifier use
- Recent ear infection
- Recent illness of any type (because illness lowers the body's resistance to infection)
Symptoms
In infants, often the main sign of an ear infection is acting irritable or crying that cannot be soothed. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
Symptoms of an acute ear infection in older children or adults include:
- Ear pain or earache
- Fullness in the ear
- Feeling of general illness
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Vomiting
Vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...
- Diarrhea
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Hearing loss
in the affected ear
Hearing loss
Hearing loss is being partly or totally unable to hear sound in one or both ears.
The ear infection may start shortly after a cold. Sudden drainage of yellow or green fluid from the ear may mean the eardrum has ruptured.
All acute ear infections involve fluid behind the eardrum. At home, you can use an electronic ear monitor to check for this fluid. You can buy this device at a drugstore. You still need to see a health care provider to confirm an ear infection.
Exams and Tests
The provider will look inside the ears using an instrument called an otoscope. This may show:
- Areas of dullness or redness
- Air bubbles or fluid behind the eardrum
- Bloody fluid or pus inside the middle ear
- A hole (perforation) in the eardrum
The provider might recommend a hearing test if the person has a history of ear infections.
Treatment
Some ear infections clear on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:
- Apply a warm cloth or warm water bottle to the affected ear.
- Use over-the-counter pain relief drops for ears. Or, ask the provider about prescription eardrops to relieve pain.
- Take over-the-counter medicines such as ibuprofen or acetaminophen for pain or fever. DO NOT give aspirin to children.
All children younger than 6 months with a fever or symptoms of an ear infection should see a provider. Children who are older than 6 months may be watched at home if they DO NOT have:
- A fever higher than 102°F (38.9°C)
- More severe pain or other symptoms
- Other medical problems
If there is no improvement or if symptoms get worse, schedule an appointment with the provider to determine whether antibiotics are needed.
ANTIBIOTICS
A virus or bacteria can cause ear infections. Antibiotics will not help an infection that is caused by a virus. Most providers don't prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.
Your provider is more likely to prescribe antibiotics if your child:
- Is under age 2
- Has a fever
- Appears sick
- Does not improve in 24 to 48 hours
If antibiotics are prescribed, it is important to take them every day and to take all of the medicine. DO NOT stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your provider. You may need to switch to a different antibiotic.
Side effects of antibiotics may include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.
Some children have repeat ear infections that seem to go away between episodes. They may receive a smaller, daily dose of antibiotics to prevent new infections.
SURGERY
If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the provider may recommend ear tubes :
Ear tubes
Ear tube insertion involves placing tubes through the eardrums. The eardrum is the thin layer of tissue that separates the outer and middle ear. ...
- A tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily.
- Usually the tubes fall out by themselves. Those that don't fall out may be removed in the provider's office.
If the adenoids are enlarged, removing them with surgery may be considered if ear infections continue to occur. Removing tonsils does not seem to help prevent ear infections.
Outlook (Prognosis)
Most often, an ear infection is a minor problem that gets better. Ear infections can be treated, but they may occur again in the future.
Most children will have slight short-term hearing loss during and right after an ear infection. This is due to fluid in the ear. Fluid can stay behind the eardrum for weeks or even months after the infection has cleared.
Fluid can stay behind the eardrum
Otitis media with effusion (OME) is thick or sticky fluid behind the eardrum in the middle ear. It occurs without an ear infection.
Speech or language delay is uncommon. It may occur in a child who has lasting hearing loss from many repeated ear infections.
Possible Complications
In rare cases, a more serious infection may develop, such as
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Mastoiditis
(an infection of the bones around the skull)
Mastoiditis
Mastoiditis is an infection of the mastoid bone of the skull. The mastoid is located just behind the ear.
-
Meningitis
(an infection of the brain)
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
When to Contact a Medical Professional
Call your child's provider if:
- Pain, fever, or irritability do not improve within 24 to 48 hours
- At the start, the child seems sicker than you would expect from an ear infection
- Your child has a high fever or severe pain
- Severe pain suddenly stops -- this may indicate a ruptured eardrum
- Symptoms get worse
- New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles
Let the provider know right away if a child younger than 6 months has a fever, even if the child doesn't have other symptoms.
Prevention
You can reduce your child's risk of ear infections with the following measures:
- Wash hands and toys often.
- If possible, choose a day care that has 6 or fewer children. This can reduce your child's chances of getting a cold or other infection, and lead to fewer ear infections.
- DO NOT use pacifiers.
- Breastfeed -- this makes a child much less prone to ear infections. If you are bottle feeding, hold your infant in an upright, seated position.
- DO NOT expose your child to secondhand smoke.
- Make sure your child's immunizations are up to date. The pneumococcal vaccine prevents infections from the bacteria that most commonly cause acute ear infections and many respiratory infections.
- DO NOT overuse antibiotics. Doing so can lead to antibiotic resistance.
References
Casselbrandt ML, Mandel EM. Acute otitis media and otitis media with effusion. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 195.
Klein JO. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics . 2013;131(3):e964-e999. PMID: 23439909 www.ncbi.nlm.nih.gov/pubmed/23439909 .
Moreno M, Furtner F, Rivara FP. Parental smoking and childhood ear infections: a dangerous combination. Arch Pediatr Adolesc Med . 2012;166(1):104. PMID: 22213761 www.ncbi.nlm.nih.gov/pubmed/22213761 .
Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg . 2013;149(1 Suppl):S1-S35. PMID: 23818543 www.ncbi.nlm.nih.gov/pubmed/23818543 .
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Ear anatomy - illustration
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
Ear anatomy
illustration
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Middle ear infection (otitis media) - illustration
Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.
Middle ear infection (otitis media)
illustration
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Eustachian tube - illustration
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore.
Eustachian tube
illustration
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Mastoiditis - side view of head - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has drainage from the ear and redness (erythema) behind the ear over the mastoid bone.
Mastoiditis - side view of head
illustration
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Mastoiditis - redness and swelling behind ear - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has noticeable swelling and redness behind his right ear because of mastoiditis.
Mastoiditis - redness and swelling behind ear
illustration
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Ear tube insertion - Series
Presentation
-
Ear anatomy - illustration
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
Ear anatomy
illustration
-
Middle ear infection (otitis media) - illustration
Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.
Middle ear infection (otitis media)
illustration
-
Eustachian tube - illustration
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore.
Eustachian tube
illustration
-
Mastoiditis - side view of head - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has drainage from the ear and redness (erythema) behind the ear over the mastoid bone.
Mastoiditis - side view of head
illustration
-
Mastoiditis - redness and swelling behind ear - illustration
Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has noticeable swelling and redness behind his right ear because of mastoiditis.
Mastoiditis - redness and swelling behind ear
illustration
-
Ear tube insertion - Series
Presentation
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Otitis media
(Alt. Medicine)
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Ear infections
(In-Depth)
Review Date: 4/21/2015
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.