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Ear infection - acute

Mastoiditis - redness and swelling behind ear
Ear tube insertion - Series

Definition

Ear infections are one of the most common reasons parents take their children to the doctor. The most common type of ear infection is called otitis media. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum.

An acute ear infection starts over a short period of time and is painful. Ear infections that last a long time or come and go are called chronic ear infections.

Alternative Names

Otitis media - acute; Infection - inner ear; Middle ear infection - acute

Causes

The eustachian tube runs from the middle of each ear to the back of the throat. Normally, this tube drains fluid that is made in the middle ear. If this tube becomes blocked, fluid can build up. This can lead to infection.

Anything that causes the eustachian tubes to become swollen or blocked causes more fluid to build up in the middle ear behind the eardrum. Some causes are:

Ear infections are also more likely in children who spend a lot of time drinking from a sippy cup or bottle while lying on their back. However, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole in it.

Acute ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.

Risk factors for acute ear infections include:

Symptoms

In infants, often the main sign of an ear infection is acting irritable or crying that cannot be soothed. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.

Symptoms of an acute ear infection in older children or adults include:

The ear infection may start shortly after a cold. Sudden drainage of yellow or green fluid from the ear may mean the eardrum has ruptured.

All acute ear infections involve fluid behind the eardrum. At home, you can use an electronic ear monitor to check for this fluid. You can buy this device at a pharmacy. You still need to see your doctor to confirm an ear infection.

Exams and Tests

The health care provider will look inside the ears using an instrument called an otoscope. This may show:

The health care provider might recommend a hearing test if the person has a history of ear infections.

Treatment

Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do NOT have:

If there is no improvement or if symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.

ANTIBIOTICS

A virus or bacteria can cause ear infections. Antibiotics will not help an infection that is caused by a virus. Many health care providers no longer prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.

Your health care provider is more likely to prescribe antibiotics if your child:

If antibiotics are prescribed, it is important to take them every day and to take all of the medicine. Do NOT stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.

Side effects of antibiotics may include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.

Some children have repeat ear infections that seem to go away between episodes. They may receive a smaller, daily dose of antibiotics to prevent new infections.

SURGERY

If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

If the adenoids are enlarged, removing them with surgery may be considered if ear infections continue to occur. Removing tonsils does not seem to help prevent ear infections.

Outlook (Prognosis)

Most often, an ear infection is a minor problem that gets better. Ear infections can be treated, but may occur again in the future.

Most children will have minor, short-term hearing loss during and right after an ear infection. This is due to fluid in the ear. Fluid can stay behind the eardrums for weeks or even months after the infection has cleared.

Speech or language delay is uncommon, but it may occur in a child who has lasting hearing loss from many, repeated ear infections.

Possible Complications

Rarely, a more serious infection may develop, such as

When to Contact a Medical Professional

Call your child's doctor if:

Let the doctor know right away if a child younger than 6 months has a fever, even if no other symptoms are present.

Prevention

You can reduce your child's risk of ear infections with the following practices:

References

Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304:2161-2169.

Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics. 2013;132:1146-1154.

Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med. 2011;364:105-115.

Moreno M, Furtner F, Rivara FP. Parental smoking and childhood ear infections: A dangerous combination. JAMA Pediatrics. 2012;166:104.

Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guidelines: acute otitis externa. Otolaryngol Head Neck Surg. 2014;150:S1-S24.

Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013;149:S1-S35.

Tähtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med. 2011;364:116-126.


Review Date: 5/14/2014
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.