Ear Infections (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.
Ear infections are often painful because of inflammation and buildup of fluids in the middle ear.
Because ear infections often clear up on their own, treatment often begins with managing pain and monitoring the problem. Ear infection in infants and severe cases in general 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.
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
- Sore throat
When to see a doctor
Signs and symptoms of an ear infection can indicate a number of different 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
- 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.
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others) to relieve pain. Use the drugs as directed on the label. Because aspirin has been linked with Reye’s syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
Eardrops. Prescription eardrops such as antipyrine-benzocaine (Aurodex) may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child’s ear while he or she lies on a flat surface with the infected ear facing up. Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don’t use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you’re an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.
Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
- Children under 6 months old with a probable diagnosis of ear infection
- Children 6 months to 2 years old with a certain diagnosis of ear infection
- Anyone with a probable ear infection and moderate to severe ear pain
- Anyone with a probable ear infection and a fever over 102.2 F (39 C) or higher
Even after symptoms have improved, be sure to use all of the antibiotic pills as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose.
If your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It’s often treated with antibiotics administered as drops. You’ll receive instructions on how to suction fluids out through the ear canal before administering drops.