Ear Infections

Overview

An ear infection is an inflammation or infection of the ear, usually caused by germs. It most often occurs in the middle ear, the air-filled space behind the eardrum, which fills with fluid and becomes painful.

Very common, especially in young children. Around 4 out of 5 children will have at least one middle-ear infection by the time they turn 3.

People of any age can develop an ear infection, but it is most common in babies and children aged 6 months to 2 years. It also affects more boys than girls, and is more common in children who attend childcare or who are around tobacco smoke.

Symptoms

Common symptoms

• Ear pain, especially when lying down
• A feeling of pressure or fullness inside the ear
• Muffled hearing or trouble hearing
• Mild fever or dizziness
• Occasionally, fluid leaking from the ear

Symptoms in children

• Tugging or pulling at an ear
• Crying more than usual or showing irritability
• Trouble sleeping
• Fever, especially in babies
• Not responding to quiet sounds
• Loss of appetite, nausea, or vomiting

Symptoms in older adults

• Ear pain or a feeling of blockage
• Hearing loss or a change in hearing
• Dizziness, unsteadiness, or balance problems
• Sometimes only a low-grade fever or no temperature at all
• In some cases, confusion or a general feeling of being unwell

Causes

Main causes

• A bacterial or viral infection in the middle ear
• A blocked Eustachian tube (the tube that connects the middle ear to the back of the throat), often after a cold or flu
• Fluid that collects behind the eardrum and becomes infected

Risk factors

• Being between 6 months and 2 years old
• Attending daycare or a group childcare setting
• Bottle-feeding while lying flat
• Being around secondhand smoke
• Using a pacifier, especially after 6 months
• A recent cold, sinus infection, or allergies

When to see a doctor

See a doctor urgently if:

• Call your local emergency number if you have any of the emergency symptoms listed above
• See a doctor the same day if you or your child has severe ear pain, a high fever, or thick discharge from the ear
• Always see a doctor for a baby under 6 months with a possible ear infection

Book a routine appointment if:

• See a doctor if ear pain or a feeling of fullness lasts more than 2 to 3 days
• If hearing does not return to normal within a few weeks after the infection clears
• If you or your child has frequent ear infections (for example, 3 in 6 months)

Diagnosis

A doctor or nurse will look inside the ear using an instrument with a light called an otoscope. They check for redness, fluid, or a bulging eardrum. They may also puff a small amount of air to see if the eardrum moves normally.

Tests that may be done

• Otoscope examination of the outer ear and eardrum
• Pneumatic otoscope, which tests eardrum movement
• Tympanometry, a quick test using a small probe to measure eardrum function
• Hearing tests, if the infection is severe, repeated, or causing lasting hearing loss

What to expect at your appointment

The examination is quick and painless, though your child may wriggle. You will be given advice on how to manage symptoms and told what to watch for. If needed, a swab or hearing test may be arranged.

Treatment

Most ear infections are caused by viruses and will clear up by themselves. For bacterial infections, a doctor may decide whether antibiotics are needed. In many cases, the best approach is to manage pain and monitor symptoms for 48 to 72 hours.

Self-care at home

• Rest and drink plenty of fluids
• Use simple pain-relief from a pharmacy, as recommended by your pharmacist or doctor
• Place a warm, dry cloth or a covered warm-water bottle over the painful ear for a few minutes
• Sit up or raise the head with extra pillows when resting and sleeping
• Keep the ear dry if there is any discharge, and avoid putting anything inside it

Medical treatments

If the doctor suspects a bacterial infection, they may prescribe a course of antibiotics, usually taken by mouth, over several days. These should be taken exactly as directed, even if you or your child feels better before finishing. Doctors are now more cautious about prescribing antibiotics, so they may advise waiting a couple of days to see if the infection resolves without them. For persistent pain, a doctor may recommend over-the-counter painkillers or, in some cases, special eardrops — only if the eardrum is not perforated.

When is surgery considered?

For a child who has very frequent ear infections (for example, three or more in six months), or who has fluid behind the eardrum for months with hearing trouble, a specialist may suggest inserting tiny ventilation tubes, called grommets, through the eardrum. This helps fluid drain and reduces the number of infections. Rarely, surgery to remove enlarged adenoids may be recommended if they are blocking the Eustachian tube.

Living with this condition

While an ear infection is healing, get plenty of rest and drink extra fluids. Pain can last for a few days, but it should gradually improve. Finish any prescribed medication, and return to the doctor if symptoms continue or get worse.

Lifestyle tips

• Do not put cotton buds, fingers, or any object into the ear
• If there is any discharge, wipe the outer ear gently with a soft cloth and keep it dry
• For babies, try to offer feeds while they are sitting upright
• Consider removing a pacifier if your child has frequent infections

Diet and exercise

A balanced diet, regular physical activity, and good hydration support a healthy immune system and may help clear infections more quickly. There is no specific diet or exercise that treats an ear infection directly.

Mental health and emotional wellbeing

Repeated ear infections can be stressful for both a child and their parents. Worries about hearing, speech, sleep, and school attendance are normal. If you feel anxious, talk to your doctor. For ongoing emotional strain, ask your local health service about counselling or parent support.

Prevention

You cannot prevent every ear infection, but you can reduce the risk. Avoid exposing children to secondhand smoke, keep up to date with vaccines, wash hands often, and breastfeed your baby for as long as possible. Also, avoid giving bottles while a baby is lying down.

Vaccines

Making sure you and your child are up to date on recommended vaccinations — such as the flu vaccine and the pneumococcal vaccine — can lower the chance of developing infections that sometimes lead to ear infections.

Screening programmes

There is no routine screening for ear infections. Children with frequent ear infections or hearing problems may be referred for a hearing test to make sure their hearing is developing normally.

Complications

If left untreated

• Temporary hearing loss, which usually returns to normal after the infection resolves
• Build-up of fluid in the middle ear that persists for weeks or months, possibly affecting speech and language development in children
• A burst (perforated) eardrum — typically heals on its own, but sometimes leaves a small hole that needs extra care
• A severe infection spreading beyond the ear, such as to the mastoid bone behind the ear, which requires urgent treatment

Long-term outlook

The outlook for ear infections is very good. Most resolve within a few days, and even burst eardrums usually heal on their own. Children commonly grow out of ear infections as their Eustachian tubes get wider and the immune system matures. With appropriate care, long-term problems are rare.

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