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. 

Three out of four children will have at least one ear 

infection by their third birthday. In fact, ear infections 

are the most common reason parents bring their child 

to a doctor. The scientific name for an ear infection is 

otitis media (OM). 

What are the symptoms of an 

ear infection?

There are three main types of ear infections. Each has a 

different combination of symptoms. 

• Acute otitis media (AOM) is the most common ear 

infection. Parts of the middle ear are infected and 

swollen 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 the fluid 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 no infection. COME makes it harder 

for children to fight new 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’ve 

learned 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

NIDCD Fact Sheet

Ear Infections in Children

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES ∙ NATIONAL INSTITUTES OF HEALTH ∙ NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS hearing balance Credit: NIH Medical Arts

Parts of the ear

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Adenoids are small pads of tissue located behind 

the back of the nose, above the throat, and near 

the eustachian tubes. Adenoids are mostly made up 

of immune system cells. They fight off infection by 

trapping bacteria that enter through the mouth.

Why are children more likely than 

adults to get ear infections? 

There are several reasons why children are more likely 

than adults to get ear infections.

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 be able 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 

to bacteria 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 and the middle ear. 

How does a doctor diagnose a middle 

ear infection?

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 an otoscope, to look at 

the eardrum. A red, bulging eardrum indicates an 

infection. 

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 is bacterial, these same bacteria may spread 

to the middle ear; if the upper respiratory infection 

is caused by a virus, such as 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 behind the eardrum.

The ear has three major parts: the outer ear, the 

middle ear, and the inner ear (see figure, page 1). The 

outer ear, also called the pinna, includes everything 

we see on the outside—the curved flap of the ear 

leading down to the earlobe—but it also includes the 

ear canal, which begins at the opening to the ear and 

extends to the eardrum. The eardrum is a membrane 

that separates the outer ear from the middle ear. 

The middle ear—which is where ear infections occur—

is located 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 the eardrum 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 snail-shaped organ that converts sound vibrations 

from the middle ear into electrical signals. The auditory 

nerve carries these signals from the cochlea to 

the brain. 

Other nearby parts of the ear also can be involved in 

ear infections.

The eustachian tube is a small passageway that 

connects the upper part of the throat to the middle 

ear. Its job is to supply fresh air to the middle ear, drain 

fluid, and keep air pressure at a steady level between 

the nose and the ear. 

NIDCD Fact Sheet

Ear Infections in Children

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A doctor also may use a pneumatic otoscope, which 

blows a puff of air into the ear canal, to check for 

fluid behind the eardrum. A normal eardrum will move 

back and forth more easily than an eardrum with fluid 

behind it. 

Tympanometry, which uses sound tones and air 

pressure, is a diagnostic test a doctor might use if the 

diagnosis still isn’t clear. A tympanometer is a small, 

soft plug that contains a tiny 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 as acetaminophen or ibuprofen, or 

eardrops, to help with fever and pain. (Because aspirin 

is considered a major preventable risk factor for Reye’s 

syndrome, a child who has a fever or other 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, your doctor might ask you to wait a day to 

see if the earache goes away. Sometimes ear pain isn’t 

caused by infection, and some ear infections may get 

better without antibiotics. Using antibiotics cautiously 

and with good reason helps prevent the development 

of bacteria that become resistant to antibiotics. 

If your doctor prescribes an antibiotic, it’s important 

to make sure your child takes it exactly as prescribed 

and for the full amount of time. Even though your 

child may seem better in a few days, the infection 

still hasn’t completely cleared from the ear. Stopping 

the medicine too soon could allow the infection to 

come back. It’s also important to return for your child’s 

follow-up visit, so that the doctor can check if the 

infection is gone.

How long will it take my child to get 

better? 

Your child should start feeling better within a few days 

after visiting the doctor. If it’s been several days and 

your child still seems sick, call your doctor. Your child 

might need a different antibiotic. Once the infection 

clears, fluid may still remain in the middle ear but 

usually disappears within three to 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 not going 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 better on their own but, if 

the infections keep coming back and antibiotics aren’t 

helping, many doctors will recommend a surgical 

procedure that places a small ventilation tube in the 

eardrum to improve air flow and prevent fluid backup 

in the middle ear. The most commonly used tubes stay 

in place for six to nine months and require follow-up 

visits until they fall 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. 

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What research is being done on middle 

ear infections?

Researchers sponsored by the National Institute on 

Deafness and Other Communication Disorders (NIDCD) 

are exploring many areas to improve the prevention, 

diagnosis, and treatment of middle ear infections. For 

example, finding better ways to predict which children 

are at higher risk of 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. 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 the middle 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 and avoid surgery.

Understanding the impact that ear infections have on 

a child’s speech and language development is another 

important area of study. Creating more accurate 

methods to diagnose middle ear infections would 

help doctors prescribe more targeted treatments. 

Researchers also are evaluating drugs currently being 

used to treat ear infections, and developing new, more 

effective and easier ways to administer 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.

NIDCD Fact Sheet

Ear Infections in Children

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Can ear infections be prevented?

Currently, the best way to prevent ear infections is 

to reduce the risk factors associated with them. Here 

are some things you might want to do to lower your 

child’s risk for ear infections.

• Vaccinate your child against the flu. Make sure your 

child gets the influenza, or flu, vaccine every year. 

• It is recommended that you vaccinate your child 

with the 13-valent pneumococcal conjugate vaccine 

(PCV13). The PCV13 protects against more types 

of infection-causing bacteria than the previous 

vaccine, the PCV7. If your child already has begun 

PCV7 vaccination, consult your physician about how 

to transition to PCV13. The Centers for Disease 

Control and Prevention (CDC) recommends that 

children under age 2 be vaccinated, starting at 2 

months of age. Studies have shown that vaccinated 

children get far fewer ear infections than children 

who aren’t vaccinated. The vaccine is strongly 

recommended for children in daycare. 

• Wash hands frequently. Washing hands prevents the 

spread of germs and can help keep your child from 

catching a cold or the flu. 

• Avoid exposing your baby to cigarette smoke. 

Studies have shown that babies who are around 

smokers have more 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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Where can I get more information?

The NIDCD maintains a directory of organizations 

that provide information on the normal and 

disordered processes of hearing, balance, smell, taste, 

voice, speech, and language. Please see the list of 

organizations at http://www.nidcd.nih.gov/directory. 

Use the following keywords to help you search for 

organizations that can answer questions and provide 

printed or electronic information on ear infections:

• Otitis media (ear infection)

• Speech-language development

• Early identification of hearing loss in children

For more information, additional addresses and phone 

numbers, or a printed list of organizations, contact:

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

E-mail: nidcdinfo@nidcd.nih.gov

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NIDCD supports and conducts research and research training on the 

normal and disordered processes of hearing, balance, smell, taste, 

voice, speech, and language and provides health information, based 

upon scientific discovery, to the public.

hearing, balancesmell, tastevoice, speech, language

NIDCD Fact Sheet: Ear Infections in Children

NIH Publication No. 10-4799

Updated October 2010

For more information, contact:

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

E-mail: nidcdinfo@nidcd.nih.gov

Internet: http://www.nidcd.nih.gov

The NIDCD Information Clearinghouse is a service of the 

National Institute on Deafness and Other Communication 

Disorders, National Institutes of Health, U.S. Department 

of Health and Human Services.

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