ear infection child specialist tests overview

Overview

An ear infection is inflammation and fluid buildup behind the eardrum, often caused by bacteria or viruses. In children, it usually affects the middle ear and can cause pain and hearing problems.

Yes, ear infections are very common in young children. About 4 out of 5 children will have at least one ear infection before age 3.

Ear infections affect children more often than adults because their eustachian tubes (the small passages that connect the middle ear to the back of the throat) are shorter and more horizontal, making it easier for fluid to get trapped.

Symptoms

Common symptoms

• Ear pain, especially when lying down
• Tugging or pulling at the ear
• Trouble sleeping
• Fussiness or crying more than usual
• Loss of appetite
• Mild fever (100°F / 37.8°C or higher)

Symptoms in children

• Babies may be irritable, have trouble feeding, or tug at their ear.
• Older children may complain of earache or say they feel pressure in the ear.
• Hearing may seem muffled for a few days.

Symptoms in older adults

• Ear infections are less common in older adults, but symptoms may include ear pain, hearing loss, and dizziness.

Causes

Main causes

• Bacteria (like Streptococcus pneumoniae) or viruses (like respiratory syncytial virus) that infect the middle ear.
• Blockage of the eustachian tube due to colds, allergies, or enlarged adenoids.

Risk factors

• Age: children under 5 are at highest risk.
• Attending daycare or group childcare.
• Bottle feeding while lying down (instead of breastfeeding).
• Exposure to secondhand smoke.
• Season: more common in fall and winter.

When to see a doctor

See a doctor urgently if:

• Ear pain lasting more than 48 hours
• Fever over 102°F (39°C)
• Fluid or pus draining from the ear
• Signs of hearing loss (not responding to sounds)

Book a routine appointment if:

• Mild ear pain without fever that goes away in a day or two
• You suspect an ear infection but symptoms are mild

Diagnosis

A doctor or nurse will look inside your child's ear with a lighted instrument called an otoscope. They may also use a pneumatic otoscope to puff a small amount of air against the eardrum to see if it moves normally.

Tests that may be done

• Otoscopy: looking at the eardrum for redness, bulging, or fluid behind it.
• Tympanometry: a small probe placed in the ear canal measures how the eardrum moves in response to sound and air pressure. This helps detect fluid in the middle ear.
• Hearing test (audiometry): if hearing loss is suspected, a specialist may recommend a hearing evaluation.

What to expect at your appointment

The tests are quick and usually not painful. Your child may feel a little pressure or a tickle in the ear. The doctor will explain the results right away and discuss next steps.

Treatment

Treatment depends on the child's age, the severity of the infection, and whether it is likely to be bacterial or viral. Many mild infections resolve without medication. When bacteria is likely, antibiotics may be prescribed. The goal is to relieve pain and prevent complications.

Self-care at home

• Apply a warm, not hot, cloth to the outside of the ear for comfort.
• Give over-the-counter pain relievers (like paracetamol or ibuprofen) as directed by the doctor or pharmacist for children over 3 months.
• Keep your child upright while feeding to help fluid drain.
• Encourage rest and extra fluids.

Medical treatments

If the doctor decides antibiotics are needed, they will prescribe a course, usually for 7–10 days. Always finish the entire course as directed. Some children may also benefit from ear drops if the eardrum has ruptured. In certain cases, the doctor may recommend a 'watchful waiting' approach for 48–72 hours before starting antibiotics.

When is surgery considered?

If a child has frequent ear infections (three or more in 6 months) or persistent fluid behind the eardrum causing hearing loss, a minor surgery called tympanostomy tube placement (inserting small tubes in the eardrums) may be considered. This helps drain fluid and prevent infections. Discuss the risks and benefits with your child's doctor.

Living with this condition

Once the infection clears, most children return to normal activities within a few days. Keep follow-up appointments to check if the fluid has fully drained and hearing has returned to normal.

Lifestyle tips

• Avoid exposing your child to secondhand smoke.
• Breastfeed for at least the first 6 months if possible — it may reduce the risk of ear infections.
• Wash toys and hands often to reduce the spread of colds.
• Make sure your child is up to date on vaccines (see Prevention section).

Diet and exercise

A balanced diet supports the immune system. Encourage plenty of fluids like water. Avoid giving a bottle while your child is lying down, as this can let milk flow into the ear tubes. Return to normal play once the fever and pain are gone.

Mental health and emotional wellbeing

Ear infections can be painful and stressful for both child and parent. Your child may be clingy or irritable — that is normal. Offer extra comfort and cuddles. If your child's mood or behavior does not improve after the infection clears, talk to your doctor.

Prevention

Not all ear infections can be prevented, but you can lower your child's risk with a few habits. Breastfeeding, avoiding smoke, and keeping up with vaccinations help a lot.

Vaccines

The pneumococcal vaccine (PCV13) and the yearly flu vaccine can help prevent some ear infections caused by bacteria and viruses. Check with your doctor to make sure your child's vaccinations are current.

Screening programmes

There is no routine screening for ear infections in healthy children. However, if your child has had repeated infections or signs of hearing problems, the doctor may recommend regular hearing checks.

Complications

If left untreated

• Hearing loss, usually temporary but can become permanent with repeated infections.
• Spread of infection to nearby areas, such as the mastoid bone behind the ear (mastoiditis).
• Rupture of the eardrum (usually heals on its own but can cause scarring).

Long-term outlook

With proper care, most ear infections resolve without lasting problems. Even if your child has a few infections, most do well. Following the doctor's advice and keeping up with vaccines can help keep your child healthy.

Find support

International organisations

• World Health Organization – Ear Infections

Local organisations

• NHS – Ear Infections in Children ↗ · United Kingdom

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