U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ∙ National Institutes of Health

NIDCD Fact Sheet | Hearing and Balance

Ear Infections in Children
What is an ear infection?
An ear infection is an inflammation of the middle ear,usually caused by bacteria, that occurs when fluid builds
up behind the eardrum. Anyone can get an ear infection,
but children get them more often than adults. Five out ofsix children will have at least one ear infection by their thirdbirthday. In fact, ear infections are the most common reason
parents bring their child to a doctor. The scientific name foran ear infection is otitis media (OM).

What are the symptoms of anear infection?
There are three main types of ear infections. Each has adifferent combination of symptoms.
} Acute otitis media (AOM) is the most common earinfection. Parts of the middle ear are infected andswollen and fluid is trapped behind the eardrum. This
causes pain in the ear—commonly called an earache.
Your child might also have a fever.
} Otitis media with effusion (OME) sometimes happens
after an ear infection has run its course and fluid stays
trapped behind the eardrum. A child with OME may
have no symptoms, but a doctor will be able to see thefluid behind the eardrum with a special instrument.
} Chronic otitis media with effusion (COME) happens
when fluid remains in the middle ear for a long time or
returns over and over again, even though there is noinfection. COME makes it harder for children to fightnew infections and also can affect their hearing.

How can I tell if my child has an ear
infection?
Most ear infections happen to children before they’velearned how to talk. If your child isn’t old enough to say“My ear hurts,” here are a few things to look for:} Tugging or pulling at the ear(s)} Fussiness and crying} Trouble sleeping} Fever (especially in infants and younger children)} Fluid draining from the ear} Clumsiness or problems with balance} Trouble hearing or responding to quiet sounds.

What causes an ear infection?
An ear infection usually is caused by bacteria and often
begins after a child has a sore throat, cold, or other upper
respiratory infection. If the upper respiratory infection isbacterial, these same bacteria may spread to the middle ear;
if the upper respiratory infection is caused by a virus, suchas a cold, bacteria may be drawn to the microbe-friendly
environment and move into the middle ear as a secondary
infection. Because of the infection, fluid builds up behindthe eardrum.
The ear has three major parts: the outer ear, the middle
ear, and the inner ear (see figure, page 2). The outer ear,also called the pinna, includes everything we see on theoutside—the curved flap of the ear leading down to theNIDCD...Improving the lives of people with communication disorders

Parts of the ear

supply fresh air to the middle ear, drain fluid, and keep airpressure at a steady level between the nose and the ear.
Adenoids are small pads of tissue located behind the backof the nose, above the throat, and near the eustachiantubes. Adenoids are mostly made up of immune systemcells. They fight off infection by trapping bacteria that enter
through the mouth.

Why are children more likely thanadults to get ear infections?
There are several reasons why children are more likely thanadults to get ear infections.

Credit: NIH Medical Arts

earlobe—but it also includes the ear canal, which begins
at the opening to the ear and extends to the eardrum. Theeardrum is a membrane that separates the outer ear fromthe middle ear.
The middle ear—which is where ear infections occur—islocated between the eardrum and the inner ear. Within
the middle ear are three tiny bones called the malleus,
incus, and stapes that transmit sound vibrations from theeardrum to the inner ear. The bones of the middle ear are
surrounded by air.
The inner ear contains the labyrinth, which help us keep
our balance. The cochlea, a part of the labyrinth, is a snailshaped organ that converts sound vibrations from themiddle ear into electrical signals. The auditory nerve carries
these signals from the cochlea to the brain.

Eustachian tubes are smaller and more level in children
than they are in adults. This makes it difficult for fluid
to drain out of the ear, even under normal conditions. If
the eustachian tubes are swollen or blocked with mucus
due to a cold or other respiratory illness, fluid may not beable to drain.
A child’s immune system isn’t as effective as an adult’s
because it’s still developing. This makes it harder for children
to fight infections.
As part of the immune system, the adenoids respond tobacteria passing through the nose and mouth. Sometimes
bacteria get trapped in the adenoids, causing a chronic
infection that can then pass on to the eustachian tubes andthe middle ear.

How does a doctor diagnose a middle
ear infection?

Other nearby parts of the ear also can be involved in ear
infections.

The first thing a doctor will do is ask you about your child’s
health. Has your child had a head cold or sore throat
recently? Is he having trouble sleeping? Is she pulling at
her ears? If an ear infection seems likely, the simplest way
for a doctor to tell is to use a lighted instrument, called anotoscope, to look at the eardrum. A red, bulging eardrum
indicates an infection.

The eustachian tube is a small passageway that connects
the upper part of the throat to the middle ear. Its job is toA doctor also may use a pneumatic otoscope, which blows
a puff of air into the ear canal, to check for fluid behind the2eardrum. A normal eardrum will move back and forth moreeasily than an eardrum with fluid behind it.
Tympanometry, which uses sound tones and air pressure, isa diagnostic test a doctor might use if the diagnosis still isn’t
clear. A tympanometer is a small, soft plug that contains atiny microphone and speaker as well as a device that varies
air pressure in the ear. It measures how flexible the eardrum
is at different pressures.

How is an acute middle ear infection
treated?
Many doctors will prescribe an antibiotic, such as amoxicillin,
to be taken over seven to 10 days. Your doctor also may
recommend over-the-counter pain relievers such asacetaminophen or ibuprofen, or eardrops, to help with feverand pain. (Because aspirin is considered a major preventablerisk factor for Reye’s syndrome, a child who has a fever orother flu-like symptoms should not be given aspirin unless
instructed to by your doctor.)
If your doctor isn’t able to make a definite diagnosis of OM
and your child doesn’t have severe ear pain or a fever, yourdoctor might ask you to wait a day or two to see if theearache goes away. The American Academy of Pediatrics
issued guidelines in 2013 that encourage doctors toobserve and closely follow these children with ear infections
that can’t be definitively diagnosed, especially thosebetween the ages of 6 months to 2 years. If there’s noimprovement within 48 to 72 hours from when symptoms
began, the guidelines recommend doctors start antibiotic
therapy. Sometimes ear pain isn’t caused by infection, andsome ear infections may get better without antibiotics.
Using antibiotics cautiously and with good reason helps
prevent the development of bacteria that become resistantto antibiotics.
If your doctor prescribes an antibiotic, it’s important to makesure your child takes it exactly as prescribed and for the fullamount of time. Even though your child may seem better ina few days, the infection still hasn’t completely cleared fromthe ear. Stopping the medicine too soon could allow theinfection to come back. It’s also important to return for yourchild’s follow-up visit, so that the doctor can check if theinfection is gone.

How long will it take my child toget better?
Your child should start feeling better within a few days after
visiting the doctor. If it’s been several days and your childstill seems sick, call your doctor. Your child might need adifferent antibiotic. Once the infection clears, fluid may still
remain in the middle ear but usually disappears within threeto six weeks.

What happens if my child keeps
getting ear infections?
To keep a middle ear infection from coming back, it helps
to limit some of the factors that might put your child at
risk, such as not being around people who smoke and notgoing to bed with a bottle. In spite of these precautions,some children may continue to have middle ear infections,sometimes as many as five or six a year. Your doctor may
want to wait for several months to see if things get betteron their own but, if the infections keep coming back andantibiotics aren’t helping, many doctors will recommend asurgical procedure that places a small ventilation tube in theeardrum to improve air flow and prevent fluid backup in themiddle ear. The most commonly used tubes stay in place
for six to nine months and require follow-up visits until theyfall out.
If placement of the tubes still doesn’t prevent infections,a doctor may consider removing the adenoids to prevent
infection from spreading to the eustachian tubes.

Can ear infections be prevented?
Currently, the best way to prevent ear infections is toreduce the risk factors associated with them. Here are somethings you might want to do to lower your child’s risk forear infections.

What research is being done on middle
ear infections?
Researchers sponsored by the National Institute on Deafnessand Other Communication Disorders (NIDCD) are exploring
many areas to improve the prevention, diagnosis, andtreatment of middle ear infections. For example, finding
better ways to predict which children are at higher riskof developing an ear infection could lead to successful
prevention tactics.
Another area that needs exploration is why some children
have more ear infections than others. For example, Native
American and Hispanic children have more infections than
do children in other ethnic groups.

} Vaccinate your child against the flu. Make sure yourchild gets the influenza, or flu, vaccine every year.
} It is recommended that you vaccinate your child withthe 13-valent pneumococcal conjugate vaccine (PCV13).
The PCV13 protects against more types of infectioncausing bacteria than the previous vaccine, the PCV7. If
your child already has begun PCV7 vaccination, consult
your physician about how to transition to PCV13. TheCenters for Disease Control and Prevention (CDC)
recommends that children under age 2 be vaccinated,starting at 2 months of age. Studies have shown thatvaccinated children get far fewer ear infections thanchildren who aren’t vaccinated. The vaccine is strongly
recommended for children in daycare.
} Wash hands frequently. Washing hands prevents thespread of germs and can help keep your child fromcatching a cold or the flu.
} Avoid exposing your baby to cigarette smoke. Studies
have shown that babies who are around smokers havemore ear infections.
} Never put your baby down for a nap, or for the night,
with a bottle.
} Don’t allow sick children to spend time together.
As much as possible, limit your child’s exposure
to other children when your child or your child’s
playmates are sick.

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What kinds of preventive measures
could be taken to lower the risks?
Doctors also are beginning to learn more about what
happens in the ears of children who have recurring ear
infections. They have identified colonies of antibioticresistant bacteria, called biofilms, that are present in themiddle ears of most children with chronic ear infections.
Understanding how to attack and kill these biofilms would
be one way to successfully treat chronic ear infections andavoid surgery.
Understanding the impact that ear infections have ona child’s speech and language development is anotherNotes

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important area of study. Creating more accurate methods
to diagnose middle ear infections would help doctors
prescribe more targeted treatments. Researchers also areevaluating drugs currently being used to treat ear infections,and developing new, more effective and easier ways toadminister medicines.
NIDCD-supported investigators continue to explore vaccines
against some of the most common bacteria and viruses
that cause middle ear infections, such as nontypeable
Haemophilus influenzae (NTHi) and Moraxella catarrhalis.
One team is conducting studies on a method for delivering
a possible vaccine without using a needle.

Where can I find additional
information about ear infections?

For more information, additional addresses and phone
numbers, or a printed list of organizations, contact us at:

The NIDCD maintains a directory of organizations thatprovide information on the normal and disordered
processes of hearing, balance, taste, smell, voice,speech, and language. Visit the NIDCD website at
http://www.nidcd.nih.gov to search the directory.

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free Voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Fax: (301) 770-8977
Email: nidcdinfo@nidcd.nih.gov

Use the following keywords to help you findorganizations that can answer questions and provide
printed or electronic information on ear infections:

http://www.nidcd.nih.gov
Follow the NIDCD on Twitter at @NIDCD} Early identification of hearing loss in children} Otitis media (ear infection)} Speech-language development
More NIDCD fact sheets on Hearing and Balance:} Your Baby’s Hearing and Communicative
Development Checklist

The NIDCD supports and conducts research andresearch training on the normal and disordered
processes of hearing, balance, taste, smell, voice,speech, and language and provides health information,
based upon scientific discovery, to the public.

} What to Do if Your Baby’s Screening Reveals aPossible Hearing Problem
Visit the NIDCD website at http://www.nidcd.nih.gov
to read, print, or download fact sheets.

Ear Infections in Children
NIH Publication No. 10-4799
March 2013
Reprinted February 2015

NIH...Turning Discovery Into Health®