An ear infection occurs when a bacterial or viral infection affects the middle ear — the sections of your ear just behind the eardrum. Ear infections can be painful because of inflammation and fluid build-up in the middle ear.
Ear infections can be chronic or acute. Acute ear infections are painful but short in duration. Chronic ear infections either do not clear up, or they recur many times. Chronic ear infections can cause permanent damage to the middle and inner ear.
An ear infection occurs when one of your eustachian tubes becomes swollen or blocked, causing fluid to build up in your middle ear. Eustachian tubes are small tubes that run from each ear directly to the back of the throat. The causes of eustachian tube blockage include:
- sinus infections
- excess mucus
- infected or swollen adenoids (tissue near your tonsils that trap harmful bacteria and viruses)
- changes in air pressure
Ear infections occur most commonly in young children because they have short and narrow eustachian tubes. Infants who are bottle-fed also have a higher incidence of ear infections than their breastfed counterparts. Other factors that increase the risk of developing an ear infection are:
- altitude changes
- climate changes
- exposure to cigarette smoke
- pacifier use
- recent illness or ear infection
A few of the common symptoms of ear infections include:
- mild pain or discomfort inside the ear
- a feeling of pressure inside the ear that persists
- fussiness in young infants
- pus-like ear drainage
- hearing loss
These symptoms might persist or come and go. Symptoms may occur in one or both ears. Pain is usually more severe with double ear infection (infection in both ears). Chronic ear infection symptoms may be less noticeable than those of acute ear infections.
Children younger than 6 months who have a fever or ear infection symptoms should see a doctor. Always seek medical attention if your child has a fever higher than 102°F or severe ear pain.
Your healthcare provider will examine your ears with an instrument called an otoscope that has a light and magnifying lens. Examination may reveal:
- redness, air bubbles, or pus-like fluid inside the middle ear
- fluid draining from the middle ear
- a perforation in the eardrum
- a bulging or collapsed eardrum
If your infection is advanced, your doctor may take a sample of the fluid inside your ear and test it to determine whether certain types of antibiotic-resistant bacteria are present. They may also order a computed tomography (CT) scan of your head to determine if the infection has spread beyond the middle ear. Finally, you may need a hearing test, especially if you're suffering from chronic ear infections.
Most mild ear infections clear up without intervention. Some of the following methods are effective in relieving the symptoms of a mild ear infection:
- applying a warm cloth to the affected ear
- taking over-the-counter pain medication such as ibuprofen or acetaminophen
- using over-the-counter or prescription ear drops to relieve pain
- taking over-the-counter decongestants such as pseudoephedrine
If your symptoms get worse or don't improve, you should schedule an appointment with your doctor. They may prescribe antibiotics if your ear infection is chronic or doesn't appear to be improving. If a child under the age of 2 presents with ear infection symptoms, a doctor will likely give them antibiotics as well. It’s important to finish your entire course of antibiotics if they're prescribed.
Surgery may be an option if your ear infection isn't eliminated with the usual medical treatments or if you have many ear infections over a short period of time. Most often, tubes are placed in the ears to allow fluid to drain out. In cases that involve enlarged adenoids, surgical removal of the adenoids may be necessary.
Ear infections usually clear up without intervention, but they may recur. The following rare but serious complications may follow an ear infection:
- hearing loss
- speech or language delay in children
- mastoiditis (an infection of the mastoid bone in the skull)
- meningitis (a bacterial infection of the membranes covering the brain and spinal cord)
- a ruptured eardrum
The following practices may reduce the risk of ear infection:
- washing your hands often
- avoiding overly crowded areas
- forgoing pacifiers with infants and small children
- breastfeeding infants
- avoiding secondhand smoke
- keeping immunizations up-to-date