Ear Infection

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is ear infection?

An ear infection occurs when bacteria, viruses, or other microorganisms enter the ear and begin multiplying. When the disease-causing organism enters your body, your immune system will mount a vigorous response, producing antibodies and releasing chemical substances that cause inflammation. An increased number of white blood cells are typically present, as well. During this inflammatory reaction, you may experience pain, swelling, inflammation, redness and fever. These are the symptoms that signal to you and your body that you have an infection.

Many different factors can contribute to the development of ear infection. For example, flying in an airplane, swimming, or having a common cold are some of the conditions that lead to congestion of the ear and may predispose you to an ear infection.

A common ear infection in children is otitis media with effusion, in which the Eustachian tube in the middle ear becomes blocked and infected. The Eustachian tube connects your ear to your throat, and it permits the drainage of fluid from your middle ear. If fluid builds up, it can cause the middle ear to become infected with bacteria or viruses, causing pain and swelling.

Itching accompanied by redness on the outer ear and the skin around your ear can be other indications of an ear infection. If you experience tenderness in the bone behind your ear, along with pain and swelling, you could have mastoiditis (infection of the mastoid bone) or a lymph node infection.

Although most ear infections either resolve on their own or with antibiotics, some symptoms warrant immediate medical attention, as they can point to an infection of the bone behind the ear or a ruptured eardrum. Seek immediate medical care (call 911) if you, or someone you are with, have the following symptoms, including high fever (higher than 101 degrees Fahrenheit) for more than 48 hours; severe pain; severe headache; swelling or redness of the skin around the ear; throbbing or tenderness behind the ear, especially over the bone; or facial twitching.

What are the symptoms of ear infection?

Symptoms of ear infection include pain and swelling. Typically, these symptoms are localized (occurring near the area of infection), but they can also be accompanied by flu-like symptoms, such as fever or headache.

Common symptoms of ear infection

  • Discharge or drainage from the ear
  • Distorted or muffled hearing
  • Ear pain, which young children may indicate by tugging on their ears
  • Feeling of fullness or fluid in the ears
  • Fever and/or chills
  • Headache

Symptoms that might indicate a serious condition

Although most ear infections either resolve on their own or with antibiotics, some symptoms warrant immediate medical attention, as they may indicate an infection of the bones behind the ear or a ruptured eardrum. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following serious symptoms including:

  • Facial twitching
  • High fever (higher than 101 degrees Fahrenheit) for 48 hours or more
  • Severe headache
  • Severe pain
  • Swelling and redness of the skin surrounding the ear
  • Throbbing or tenderness behind the ear, especially over the bone
  • Twitching of the face
  • Worsening symptoms

What causes ear infection?

An ear infection is commonly caused by a buildup of fluid in the Eustachian tube, allowing microorganisms to grow. This tube links the middle ear to the throat and maintains normal air pressure between the nose and the ear. Normally, this tube is clear, permitting the drainage of fluid out of the middle ear. Bacterial growth can involve the fluid of the middle ear, causing acute otitis. This infection causes extreme pain and swelling and requires antibiotics.

What are the risk factors for ear infection?

Ear infections are very common in children. Most children will have an ear infection at some time as they are growing up. The risk factors that predispose children to ear infection include:

  • Being exposed to children with upper respiratory infections, such as a cold or the flu
  • Being put to bed with a bottle (infants or toddlers)
  • Living in cold climates
  • Not being immunized against the flu
  • Smoking or exposure to smokers

Reducing your risk of ear infection

Although ear infections are fairly common in children, you can take measures to avoid them. You may be able to lower your own or your child’s risk of ear infection by:

  • Avoiding exposure to cigarette smoke
  • Being immunized with the influenza vaccine
  • Breastfeeding, which strengthens a child’s immune system
  • Limiting exposure to children with upper respiratory infections
  • Limiting use of antibiotics
  • Washing hands frequently

How is ear infection treated?

The treatment of ear infections depends on the extent of the infection. For most infections, treating the symptoms of pain and fever with over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen (Advil), is sufficient. Children with infections should not be given aspirin.

If the fluid of the middle ear has become infected (acute otitis), your health care provider will most likely prescribe an antibiotic, such as ampicillin. All children under six months of age are given antibiotics for an ear infection.

Antibiotics for ear infection

Antibiotics commonly used for ear infection include:

  • Ampicillin (Omnipen)
  • Azithromycin (Zithromax)
  • Clarithromycin (Biaxin)
  • Trimethoprim/sulfamethoxazole (Bactrim)

If antibiotics are prescribed for your child, it is essential to make sure that your child takes them exactly as directed by your health care provider and keeps taking the entire course of antibiotics, even if he or she feels better.
If fluid remains in the ears despite other treatment, surgery may be considered. In this type of surgery, tubes are inserted into the ears to help drain them.

What you can do to improve your ear infection

Self-care measures can be taken at home for ear infections that are not complicated or recurring. These include:

  • Taking or giving your child over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen (Advil) for the pain
  • Using a warm, damp cloth to soothe the ear pain

What are the potential complications of ear infection?

If caught and treated early, ear infections usually resolve without causing complications. However, symptoms should be evaluated and treated immediately to prevent complications. Complications of ear infection include:

  • Cholesteatoma (noncancerous tumor or cyst most commonly found in the middle ear and area of the mastoid bone)
  • Enlargement of tonsils or adenoids
  • Mastoiditis (inflammation of the bone behind the ear)
  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)
  • Permanent hearing loss
  • Recurring ear infections
  • Speech or language impairment
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 20
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  2. Ear infections in children. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/hearing/earinfections.
  3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2013.