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Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

The term "acute" refers to a short and painful episode. An ear infection that lasts a long time or comes and goes is called chronic otitis media.

For links to other types of ear infections, see otitis.

Otitis media - acute; Infection - inner ear; Middle ear infection - acute

For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection.

Ear infections are common in infants and children, in part because the eustachian tubes become easily clogged. Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:

• Colds and sinus infections
• Allergies
• Tobacco smoke or other irritants
• Infected or overgrown adenoids
• Excess mucus and saliva produced during teething

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.

Ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.

Risk factors for ear infections include the following:

• Not being breastfed
• Recent ear infection
• Recent illness of any type (lowers resistance of the body to infection)
• Day care (especially with more than 6 children)
• Pacifier use
• Genetic factors (susceptibility to infection may run in families)
• Changes in altitude or climate
• Cold climate

Adults can also have ear infections, although they are less common than in children.

In infants, the clearest sign is often irritability and inconsolable crying. Many infants and children develop a fever or have trouble sleeping. Parents often think that tugging on the ear is a symptom of an ear infection, but studies have shown that the same number of children going to the doctor tug on the ear whether or not the ear is infected.

Symptoms in older children or adults include:

• Ear pain or earache
• Fullness in the ear
• Feeling of general illness
• Vomiting
• Diarrhea
• Hearing loss in the affected ear

The child may have symptoms of a cold, or the ear infection may start shortly after having a cold.

All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.

The doctor will ask questions about whether your child (or you) have had ear infections in the past and will want you to describe the current symptoms, including whether your child has had any symptoms of a cold or allergies recently. Your doctor will examine your child's throat, sinuses, head, neck, and lungs.

Using an instrument called an otoscope, the doctor will look inside your child's ears. If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or purulent (filled with pus). The physician will also check for any sign of perforation (hole or holes) in the eardrum.

A hearing test may be recommended if your child has had persistent (chronic and recurrent) ear infections.

Ear infections are curable with treatment but may recur. They are not life threatening but may be quite painful.

Generally, an ear infection is a simple, nonserious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.

Fluid can remain behind the eardrums even after the infection has cleared.

See also: Otitis media with effusion

Other potential complications from otitis media include:

• Ruptured or perforated eardrum
• Chronic, recurrent ear infections
• Enlarged adenoids or tonsils
• Mastoiditis (an infection of the bones around the skull)
• Meningitis (an infection of the brain)
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

Call your child's doctor if:

• Pain, fever, or irritability do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

You can reduce your child's risk of ear infections with the following practices:

• Wash hands and toys frequently. Also, day care with 6 or fewer children can lessen your child's chances of getting a cold or similar infection. This leads to fewer ear infections.
• Avoid pacifiers, especially at day care.
• Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
• Don't expose your child to secondhand smoke.
• The pneumococcal vaccine prevents infections from the organism that most commonly causes acute ear infections and many respiratory infections.
• Some evidence suggests that xylitol, a natural sweetener, may reduce ear infections.
• Avoid overusing antibiotics.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1465.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76:1650-1656.

Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008;134:128-132.