Ear Infection

Español: Infección de oído

Healthy Ear / Infection of Middle Ear
Anatomy of the ear showing where fluid builds up in the middle ear and puts pressure, or pushes, on the ear.

A healthy ear and an infected ear, including outer, middle, and inner ear, showing inflammation and fluid in the ear.

Is your child’s ear hurting? It could be an ear infection. Children are more likely than adults to get ear infections. Talk to your child’s doctor about the best treatment.

Some ear infections, such as middle ear infections, need antibiotic treatment, but many can get better without antibiotics.

What is an ear infection?

There are different types of ear infections. Middle ear infection (acute otitis media) is an infection in the middle ear.

Another condition that affects the middle ear is called otitis media with effusion. It occurs when fluid builds up in the middle ear without being infected and without causing fever, ear pain, or pus build-up in the middle ear.

When the outer ear canal is infected, the condition is called swimmer’s ear, which is different from a middle ear infection. For more information, visit “Swimmer’s Ear” (Otitis Externa).

Causes

A middle ear infection may be caused by:

  • Bacteria, like Streptococcus pneumoniae and Haemophilus influenzae (nontypeable)—the two most common bacterial causes
  • Viruses, like those that cause colds or flu

baby icon See a doctor right away if your child is younger than 3 months old and has a fever of 100.4 °F (38 °C) or higher.

Symptoms

Common symptoms of middle ear infection in children can include:

  • Ear pain
  • Fever
  • Fussiness or irritability
  • Rubbing or tugging at an ear
  • Difficulty sleeping

When to Seek Medical Care

See a doctor if your child has:

  • A fever of 102.2°F (39°C) or higher
  • Pus, discharge, or fluid coming from the ear
  • Worsening symptoms
  • Symptoms of a middle ear infection that last for more than 2–3 days
  • Hearing loss

This list is not all-inclusive. Please see a doctor for any symptom that is severe or concerning.

Treatment

A doctor will determine what type of illness your child has by asking about symptoms and doing a physical examination. Your doctor can make the diagnosis of a middle ear infection by looking inside your child’s ear to examine the eardrum and see if there is pus in the middle ear.

Antibiotics are often not needed for middle ear infections because the body’s immune system can fight off the infection on its own. However, sometimes antibiotics, such as amoxicillin, are needed to treat severe cases right away or cases that last longer than 2–3 days.

For mild cases of middle ear infection, your doctor might recommend watchful waiting or delayed antibiotic prescribing.

  • Watchful waiting: Your child’s doctor may suggest watching and waiting to see if your child needs antibiotics. This gives the immune system time to fight off the infection. If your child doesn’t feel better after 2–3 days of rest, extra fluids, and pain relievers, the doctor may write a prescription for an antibiotic.
  • Delayed prescribing: Your child’s doctor may give an antibiotic prescription but suggest that you wait 2–3 days to see if your child is still sick before filling it.

How to Feel Better

Some ways to feel better—whether or not antibiotics are needed for an ear infection:

  • Rest.
  • Drink extra water or other fluids.
  • Take acetaminophen or ibuprofen to relieve pain or fever. Ask your doctor or pharmacist about over-the-counter medicines that can help you feel better. Always use over-the-counter medicines as directed.

Over-the-Counter Medicine and Children

Be careful about giving over-the-counter medicines to children. Not all over-the-counter medicines are recommended for children of certain ages.

  • Pain relievers:
    • Children younger than 6 months: only give acetaminophen.
    • Children 6 months or older: it is OK to give acetaminophen or ibuprofen.
    • Never give aspirin to children because it can cause Reye’s syndrome, a rare but very serious illness that harms the liver and brain.
  • Cough and cold medicines:
    • Children younger than 4 years old: do not use unless a doctor specifically tells you to. Use of over-the-counter cough and cold medicines in young children can result in serious and potentially life-threatening side effects.
    • Children 4 years or older: discuss with your child’s doctor if over-the-counter cough and cold medicines are safe to give to your child for temporary symptom relief.

Be sure to ask your doctor or pharmacist about the right dosage of over-the-counter medicines for your child’s age and size. Also, tell your child’s doctor and pharmacist about all prescription and over-the-counter medicines they are taking.

Prevention

You can help prevent ear infections by doing your best to stay healthy and keep others healthy, including:

  • Breastfeed exclusively until your baby is 6 months old and continue to breastfeed for at least 12 months.
  • Don’t smoke and avoid exposure to secondhand smoke.