Ear Infection (Otitis Media)

Overview

An ear infection (otitis media) is a swelling or infection of the middle ear, the space behind the eardrum. It often happens when a cold, flu, or allergy causes fluid to build up and germs to grow. This can be painful but usually gets better on its own or with simple care.

Yes, ear infections are very common in young children. Most children will have at least one by the time they start school.

Ear infections most often affect infants and young children, especially those between 6 months and 3 years old. Boys are slightly more likely to get them than girls. Children who attend daycare, use pacifiers, or are around cigarette smoke have a higher risk.

Symptoms

Common symptoms

• Ear pain, especially when lying down
• Tugging or pulling at the ear
• Trouble sleeping
• Fussiness or crying more than usual
• Trouble hearing or responding to sounds
• Fever (temperature above 100.4°F or 38°C)
• Fluid draining from the ear

Symptoms in children

• Children may have the same symptoms as above, but also show signs like being irritable, crying more, or having trouble feeding because sucking and swallowing hurts the ear.

Symptoms in older adults

• Ear infections are less common in older adults. If they occur, symptoms may include ear pain, hearing loss, dizziness, or ringing in the ear (tinnitus).

Causes

Main causes

• Viruses or bacteria from a cold, flu, or sinus infection that travel into the middle ear
• Congestion from allergies or smoke that blocks the small tube (eustachian tube) connecting the ear to the throat
• Fluid buildup in the middle ear that becomes infected

Risk factors

• Being younger than 5 years old, especially between 6 months and 2 years
• Attending group childcare or daycare
• Using a pacifier, especially after 12 months
• Being around secondhand tobacco smoke
• Having a family history of ear infections
• Having a weak immune system or conditions like cleft palate

When to see a doctor

See a doctor urgently if:

• Symptoms that last more than 2-3 days without improvement
• Severe ear pain that makes it hard to sleep or eat
• Fluid draining from the ear
• Fever of 102°F (39°C) or higher, especially in a baby under 6 months
• Hearing loss that is getting worse

Book a routine appointment if:

• Mild symptoms that are getting better on their own after a few days
• For a check-up if your child has had many ear infections (3 or more in 6 months, or 4 in a year)
• If you are worried about hearing or speech development

Diagnosis

A doctor will look inside your child's ear with a small tool called an otoscope. This lets them see if the eardrum is red, swollen, or bulging. They may also use a pneumatic otoscope to puff a little air into the ear to check the eardrum's movement.

Tests that may be done

• Otoscopy (looking inside the ear with a light)
• Tympanometry (a test that checks how the eardrum moves)
• Hearing test if infections are frequent or hearing loss is suspected

What to expect at your appointment

The doctor will ask about symptoms, examine the ear, and may suggest home care or medicine. Most visits are quick and painless. For children with many infections, the doctor may recommend seeing an ear, nose, and throat specialist (ENT).

Treatment

Treatment for ear infection depends on the child's age, severity of symptoms, and how many infections they have had. Many mild infections clear up on their own. The goal is to relieve pain and help the body fight the infection. Antibiotics are not always needed.

Self-care at home

• Give your child plenty of fluids and rest
• Use over-the-counter pain relief like paracetamol or ibuprofen — always follow the dose instructions for your child's age and weight
• Apply a warm (not hot) cloth to the painful ear for comfort
• Keep your child upright when they are awake to help drain fluid
• Avoid putting anything in the ear, including cotton swabs or drops, unless a doctor tells you

Medical treatments

If the infection does not get better after a few days, or if your child is very young or has a high fever, a doctor may prescribe an antibiotic. Antibiotics are usually given by mouth for 7 to 10 days. Sometimes ear drops are used if there is a hole in the eardrum. The doctor will decide what is best. It is important to finish the full course of antibiotics if prescribed.

When is surgery considered?

If your child has many ear infections (more than 4 in 6 months), or if fluid stays in the ear for a long time and causes hearing loss or speech delay, a doctor may suggest tiny tubes (grommets) placed in the eardrum. This surgery is called myringotomy and helps drain fluid. It is minor and usually done under general anaesthetic.

Living with this condition

Most children recover fully from ear infections without long-term problems. While your child has an infection, keep them comfortable, watch for worsening symptoms, and keep them home from school or daycare if they have a fever or are in pain. Make sure they rest and drink enough.

Lifestyle tips

• Avoid exposing your child to cigarette smoke — it increases the risk of infections
• If your child uses a pacifier, try to stop after 6 to 12 months to reduce infection risk
• Breastfeed your baby if possible — it helps protect against infections
• Keep your child up to date with vaccinations

Diet and exercise

Encourage a healthy diet with plenty of fruits and vegetables to support the immune system. For babies, breast milk is best. There are no special diet restrictions. Gentle play and activity are fine as long as your child feels well enough.

Mental health and emotional wellbeing

Frequent ear infections can be frustrating for both child and parents. The pain and hearing problems may affect your child's mood, sleep, and behaviour. If you notice your child is sad, withdrawn, or not talking as much, talk to your doctor. Reassure your child that the pain will pass and that you are there to help.

Prevention

You cannot prevent every ear infection, but you can lower the risk. Keeping your child away from cigarette smoke, breastfeeding, and avoiding pacifier use after 12 months help. Good hand washing and keeping your child away from sick people also reduce colds that can trigger ear infections.

Vaccines

The pneumococcal vaccine (PCV) and the annual flu vaccine can help prevent some ear infections caused by the bacteria and viruses they target. Make sure your child gets all routine childhood vaccinations.

Screening programmes

There is no routine screening for ear infections. However, if your child has had many infections or if you notice hearing problems, the doctor may do hearing tests. Regular check-ups are important to catch any problems early.

Complications

If left untreated

• Hearing loss that may be temporary or, rarely, permanent
• Fluid in the ear that lasts for months (glue ear)
• A hole in the eardrum that does not heal on its own
• Spread of infection to nearby areas, like the mastoid bone behind the ear (mastoiditis) or, very rarely, to the brain

Long-term outlook

The large majority of children with ear infections recover fully without any lasting problems. Even if complications like hearing loss occur, they often get better once the infection is treated. With good care and regular follow-up, most children grow up with normal hearing and development. Remember, your doctor is there to help you and your child every step of the way.

Find support

International organisations

• NHS (UK) ↗
• World Health Organization (WHO) – Hearing Loss ↗

Local organisations

• NHS 111 ↗ · United Kingdom
• NHS Inform (Scotland) ↗ · Scotland
• Healthdirect (Australia) ↗ · Australia

Helplines

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