ear infection child on one side

Overview

An ear infection happens when the middle ear (the space behind the eardrum) becomes swollen and filled with fluid, usually because of bacteria or a virus. When only one ear is affected, it is called a one-sided ear infection. It can cause ear pain, fever, and sometimes trouble hearing. In children, it is one of the most common reasons for doctor visits.

Yes, ear infections are very common in children. Around 4 out of 5 children will have at least one ear infection by the time they turn 3 years old.

Ear infections affect children of all ages, but they are most common in babies and toddlers, especially those between 6 and 18 months old. Children who go to daycare, are around secondhand smoke, or have a family history of ear infections may be at higher risk.

Symptoms

Common symptoms

• Ear pain, especially when lying down
• Tugging or rubbing the ear
• Fever, often around 100.4°F (38°C) or higher
• Irritability or fussiness without a clear reason
• Trouble sleeping because lying down makes the pain worse

Symptoms in children

• Crying more than usual, especially in babies
• Not responding to soft sounds in one ear
• Loss of appetite or trouble feeding
• Balance problems or clumsiness
• Fluid draining from the ear (yellow or bloody)

Symptoms in older adults

• Ear infections are less common in older adults, but if they occur, symptoms may include ear pain, hearing loss, dizziness, or a feeling of fullness in the ear.
• Older adults with ear infections should see a healthcare provider promptly, as the condition can be more serious.

Causes

Main causes

• A cold, flu, or respiratory infection that causes fluid to build up in the middle ear
• Bacteria or viruses that travel from the nose or throat to the middle ear
• Swelling of the Eustachian tube (the small passage between the ear and throat), which traps fluid

Risk factors

• Age: children under 5 are at higher risk because their Eustachian tubes are shorter and more horizontal
• Drinking from a bottle while lying down
• Pacifier use after 6 months of age
• Exposure to secondhand smoke
• Attending daycare or group childcare
• Season: more common in fall and winter

When to see a doctor

See a doctor urgently if:

• Your child is under 6 months old with any sign of ear infection
• There is discharge, pus, or blood from the ear
• Your child has a high fever or seems very ill
• Your child shows any of the emergency symptoms listed above

Book a routine appointment if:

• Ear pain lasting more than 2 days
• Fever lasting more than 2 to 3 days
• Your child has trouble hearing for more than a few days
• Recurrent ear infections (aim to see a doctor if this happens often)

Diagnosis

A healthcare provider will examine your child's ear using a special light tool called an otoscope, which lets them see the eardrum. They may also gently puff air near the eardrum to see if it moves normally. This helps tell if there is fluid behind the eardrum.

Tests that may be done

• Pneumatic otoscopy: a painless test where air is blown toward the eardrum to check if it moves
• Tympanometry: a test that measures how well the eardrum moves in response to air pressure
• A hearing test if the infection has been frequent or fluid has stayed in the ear for a long time

What to expect at your appointment

The examination is quick and usually painless, though your child may be upset. The provider may look into one or both ears, and possibly the throat and nose. They will ask about your child's symptoms, fever, and any recent colds. Afterwards, they will discuss whether treatment is needed or if you should simply watch and wait.

Treatment

Treatment focuses on easing pain and helping your child rest. Many ear infections are caused by viruses, so antibiotics may not be needed. When antibiotics are used, it is for bacterial infections or when symptoms are severe. Always follow the healthcare provider's advice about whether to use antibiotics.

Self-care at home

• Give your child a warm, not hot, compress wrapped in a cloth to hold against the outside of the painful ear for 10–15 minutes
• Encourage rest and extra fluids to keep them hydrated
• Elevate your child's head slightly while sleeping by placing a pillow under the mattress (never use pillows for babies under 1 year)
• Offer soft, easy-to-chew foods and avoid giving a bottle while lying down

Medical treatments

For pain and fever, your healthcare provider may recommend an over-the-counter pain reliever that is safe for your child's age and weight. Always follow the dosing instructions on the package or from your provider. If a bacterial infection is diagnosed, the provider may prescribe an antibiotic. It is important to give the full course exactly as directed, even if your child feels better sooner.

When is surgery considered?

If your child gets many ear infections or has fluid that stays in the middle ear for months and affects hearing, a specialist might recommend tiny tubes (called grommets) placed in the eardrum. This allows fluid to drain and helps prevent future infections. Surgery is rarely the first step and is only considered after other options have been tried.

Living with this condition

While your child has an ear infection, keep them comfortable, give plenty of fluids, and watch for any warning signs. Sleep and rest are important. Keep follow-up appointments if your doctor asks to check the eardrum again after a few weeks.

Lifestyle tips

• Keep your child away from secondhand smoke, which can make ear infections worse
• When breastfeeding, feed your baby sitting up rather than lying down
• Limit pacifier use after 6 months of age to reduce infection risk
• Encourage regular handwashing to prevent colds that can trigger ear infections

Diet and exercise

There is no special diet for ear infections, but plenty of fluids and soft foods can help if swallowing is painful. Gentle play and normal activity are fine as long as your child feels well enough. Avoid swimming or getting water into the ear until the infection is fully healed.

Mental health and emotional wellbeing

Ear infections can be distressing for both children and parents. Your child may be fussy and sleep poorly, which can feel overwhelming. It is important to take care of your own mental health too—ask for help from a partner, family, or friends, and reach out to a healthcare professional if you feel anxious or unable to cope.

Prevention

You cannot always prevent ear infections, but you can lower the risk by avoiding secondhand smoke, practicing good hand hygiene, breastfeeding when possible, and making sure your child gets recommended vaccinations.

Vaccines

Some childhood vaccines, such as those against pneumococcal infections and influenza (flu), can help reduce the risk of ear infections. Your healthcare provider can tell you which vaccines are recommended for your child.

Screening programmes

If your child has frequent or persistent ear infections, the doctor may recommend regular hearing tests to check that fluid is not causing hearing problems.

Complications

If left untreated

• Fluid that stays in the middle ear for weeks or months, causing temporary hearing loss
• Persistent tearing or a hole in the eardrum (perforation)
• Spread of infection to nearby structures, such as the mastoid bone (behind the ear), causing swelling and redness
• Rarely, spread of infection to the brain or the lining of the brain (meningitis)

Long-term outlook

With proper care, most ear infections in children go away completely within 1 to 2 weeks, and any hearing loss linked to fluid usually improves on its own. Even when an ear infection comes back, treatments are very effective. Following your healthcare provider's advice and watching for warning signs gives your child the best chance of a full recovery.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.