Ear Infection

An ear infection develops between your eardrum and inner ear. It occurs when your eustachian tube (connecting your middle ear to the back of your throat) doesn’t work correctly. Usually, the eustachian tubes control the air pressure in your ear and prevent any fluid collection in your middle ear. When fluid doesn’t drain, you don’t hear well.

Viruses and bacteria usually cause infections that lead to fluid collection. Infected fluid in your middle ear can cause muffled hearing, ear pain and discomfort.

While ear infections are most common in children between 6 months and 2 years, they frequently affect children up to age 8. Ear infections can — but rarely — affect older children or adults. Children are more likely to get ear infections because:

• Their narrow, more horizontal eustachian tubes don’t promote fluid drainage as well.
• Their developing immune system is less able to fight infection.

Ear infections often develop because of other upper respiratory illnesses like a cold or influenza. A virus or bacteria can trigger congestion and swelling in your eustachian tubes and nasal passages. As a result, fluid can build up and become infected behind your eardrum. Children are at greater risk because their eustachian tubes are narrow and more horizontal, making it harder for trapped fluid to drain.

Ear infections can also develop in other ways:

• Adenoids. Your adenoids are part of your immune system. They are two small lumps of tissue located in the back of your nose near the opening of your eustachian tubes. If your adenoids swell, they can block your eustachian tubes and cause an ear infection. Children are at a higher risk of developing ear infections this way because they have larger adenoids than adults. Adenoids shrink (and may disappear) by age 13.
• Middle ear conditions. Several other middle ear problems can lead to ear infections, including:
• Otitis media with effusion: Swelling or fluid collection can develop without a bacterial or viral infection. It can happen due to lingering fluid after an ear infection clears or because of eustachian tube dysfunction.
• Chronic otitis media with effusion: Fluid buildup persists in the middle ear, increasing the risk for new ear infections. Over time, this condition can reduce hearing.
• Chronic suppurative otitis media: These ear infections do not clear up with standard treatment and can eventually cause a hole in the eardrum.

Ear infection symptoms differ between adults and children. Signs in an adult include:

• Difficulty hearing (sounds are muffled)
• Drainage from your ear (brown, white or yellow fluid can indicate a broken eardrum)
• Ear pain
• Feeling a fullness or pressure in your ear
• Loss of appetite
• Trouble sleeping

Don’t put anything in your ear if you’re experiencing drainage. Touching your injured eardrum may cause more damage.

Children can have the same symptoms as adults. But they also experience other signs. A fever between 100.5°F to 104°F and headaches are common symptoms in children. Your child may also develop some new behaviors, including:

• Acting fussy
• Crying more than usual
• Difficulty sleeping
• Loss of balance
• Mouth breathing or snoring (these may be signs of inflamed adenoids)
• Refusing to eat (swallowing changes middle ear air pressure, causing pain)
• Rubbing or tugging on their ears

There are several risk factors for ear infections, including:

• Age. Children between 6 months and 2 years are at greatest risk.
• Allergies. Seasonal allergies can increase ear infection risk when pollen counts are high.
• Bottle feeding. Infants who drink from a bottle, especially if they’re lying down, develop more ear infections than breastfed babies.
• Chronic illness. Chronic respiratory conditions, like asthma and cystic fibrosis, and immune deficiency conditions increase the risk of ear infections.
• Cleft palate. Bone structure and muscle differences associated with this condition make it harder for the eustachian tubes to drain.
• Colds. Catching a cold boosts your ear infection risk. Consequently, children in group daycare settings may develop more ear infections if they are around other children with upper respiratory illnesses.
• Ethnicity. Alaska Native, Hispanic and Native American children are more likely to develop ear infections than children from other ethnic groups due to a variety of health disparities.
• Family history. Getting frequent ear infections can run in families.
• Poor air quality. Air pollution and secondhand smoke exposure raise the risk of ear infections.

Our expert providers can often diagnose an ear infection simply by looking in your or your child’s eardrum. A quick visual exam with a lighted tool called an otoscope can show if the eardrum is inflamed, swollen or red. Our providers may also use a pneumatic otoscope that blows a gentle puff of air against the eardrum to check for trapped fluid. If your eardrum doesn’t move, trapped fluid is present.

In some instances, our providers may recommend additional tests. These can include:

• Acoustic reflectometry. Sound waves can detect fluid trapped in your middle ear.
• Hearing tests. If you’ve had long-term or frequent ear infections, an audiologist (hearing specialist) will conduct hearing tests to detect hearing loss.
• Tympanocentesis. This procedure removes a fluid sample from your middle ear to detect viruses and bacteria.
• Tympanometry. This test checks for fluid in your middle ear by measuring and recording how your eardrum moves in response to air pressure and sound.

Ear infections frequently clear up on their own within two weeks. But if the infection is severe or happens often, you may need treatment. Our providers will talk with you about the infection to identify the most appropriate therapy. Treatment options include:

• Antibiotics. Our providers prescribe antibiotics for ear infections caused by bacteria. If the infection is mild, they may wait a few days to see if it clears up on its own. Or you may need antibiotics immediately for a severe infection.
• Medication. Our providers may prescribe pain-relieving ear drops or recommend over-the-counter medications.
• Ear tubes (tympanostomy tubes). Candidates for this surgery are children who get multiple ear infections that don’t respond to antibiotics. This procedure can also help children who have ear infection-related hearing loss. During this quick 10-minute outpatient procedure, an ear, nose and throat (ENT) specialist places a small metal or plastic tube into a small incision in your child’s eardrum. The tubes, which stay in place for 12 to 18 months, allow any trapped fluid to drain. When they fall out, the hole in the eardrum heals on its own.

You can’t always prevent ear infections. But you can take steps to reduce the likelihood that you or your child will develop one, including:

• Avoid smoking, secondhand smoke and vaping
• Prevent colds with frequent handwashing and coughing or sneezing in your elbow

You can specifically protect your child by:

• Bottle-feeding in an upright position, keeping their head above their stomach
• Breastfeeding for the first six to 12 months
• Staying current on vaccinations, including COVID-19, influenza, pneumococcal and meningitis vaccines