Ear infection (middle ear)

Also known as middle ear infection or acute otitis media

An ear infection occurs when bacteria or viruses infect the middle ear, causing pain and discomfort. They are common in young children, who should be taken to a doctor.

This page refers to middle ear infections. For pain and itchiness in your outer ear, see ear infection (outer ear), also known as otitis externa or swimmer's ear.

Key points

  1. Ear infections are common in young children up to 7 years old and can affect adults. They can cause pain and often fever.
  2. The pain from an ear infection comes on rapidly and usually wears off within 24 hours.
  3. Treatment includes pain relief and sometimes antibiotics.
  4. Always see your doctor, nurse or mobile hearing clinic if your baby or child has sore ears. You can also call Healthline on 0800 611 116. 
  5. After an ear infection, fluid may remain behind the eardrum for several weeks to months, so your child will need a follow up ear check.
  6. Most children outgrow ear infections and have no problems with learning or hearing long term.

What is an ear infection?

Ear infections often happen either during or just after a cold, when bacteria or viruses travel up the Eustachian tube, which connects the space behind the ear drum (middle ear) to the back of the nose.

As the infection spreads, the Eustachian tubes get blocked because of swelling and infected fluid (pus), which spreads into the middle ear and puts pressure on the eardrum. The eardrum bulges out and causes a painful earache.

The pressure of the pus can cause the eardrum to burst and pus to leak out, called otorrhoea (runny ear). Fluid can also remain in the middle ear after an ear infection and cause glue ear.  

Who is at risk of ear infections? 

Ear infections are very common in babies and young children, who are more likely to develop them than older children and adults. This is because children’s Eustachian tubes are smaller, shorter and flatter (more horizontal) than adults. This makes it easier for bacteria and viruses to enter them and for the tubes to become blocked. Adenoid tissue may also contribute to bacteria being able to enter the Eustachian tube.

Children are more likely to get ear infections if they:

  • live in houses that are crowded
  • live with someone who smokes
  • go to early childhood education centres where they are exposed to more colds and flu viruses
  • are bottle-fed
  • have a lot of colds, infected tonsils, swollen adenoids or other infections
  • have brothers and sisters with ear infections (or other viral illness).

How do I know if my child has an ear infection?

Older children will complain of significant ear pain and may have a fever. They may also feel unwell and complain of reduced hearing in the affected ear. In babies and younger children, sometimes the only sign of an ear infection is a fever.

If the ear infection causes an earache, your baby or child may:

  • cry and become distressed, upset and harder to settle
  • become clingy or grizzly
  • keep touching an ear again and again.

Older children may have problems with balance.

Should I take my child to the doctor?

If you think your child has an ear infection, take them to your doctor. They will ask how your child has been feeling and behaving, and will look inside their ears with a special instrument (called an otoscope), for signs of infection. 

Sometimes, the pressure of the pus can cause the eardrum to burst, and the pus leaks out of the ear – this is a runny ear. Because there is no more pressure on the eardrum, the pain goes away and your child seems to be much better. But the ear infection is still there. Your child will need to see a doctor to check if the infection needs to be treated and to make sure the eardrum heals properly. 

What is the treatment for ear infection?

Pain relief

  • Regular pain relief, such as paracetamol can help ease pain and discomfort.
  • Discuss with your pharmacist or doctor what pain relief is best for your child (do not give aspirin to children under 16 years).
  • Measure children's doses accurately and follow product directions.

Antibiotics 

Ear infections usually do not need treatment with antibiotics. After one week, at least 3 out of 4 children will be better whether they take antibiotics or not. However, antibiotics are likely to be given if your child:

  • is under 3 years old
  • is 3 years or older and has high fever, severe pain, or has fluid coming out of their sore ear 
  • still has pain or discomfort after 48 hours of pain relief.

If you or a child has a runny ear, you may also be given antibiotic ear drops. 

Grommets

If the ear is always getting infected, and it is not getting better with antibiotics, your doctor may suggest small tubes (grommets) be put in the ear so air can get into the middle ear. You will need to visit an ear, nose and throat (ENT) specialist for this type of treatment. See glue ear for more information.

Surgery

If an infection is very bad, the eardrum can burst. It may heal without any damage but, if it happens too often, it may form a scar and hearing will be affected. An operation to fix the damaged part of the ear may be needed.

What can I do to ease discomfort caused by ear infection?

  • Provide the pain relief recommended by your doctor.
  • Let your child rest and give them comfort and cuddles.
  • Keep them at home when they are unwell or have a fever.
  • Hold a warm cloth, wheat bag or hot water bottle over the affected ear, taking care not to burn the delicate skin.
  • Prop older children up on pillows to sleep. It may feel better if they lie with the sore ear on the pillow.
  • Keep your child's ears dry and clean.
  • Keep your home quiet as loud noises can upset children with sore ears and make it harder for them to hear people talking.
  • There does not appear to be any benefit from giving decongestants or antihistamines.

How long does an ear infection last?

The pain from an ear infection comes on rapidly and doesn't last long. It usually wears off within 24 hours. 

After an ear infection, your child may have fluid behind their eardrum (effusion) which can last several weeks to months. This may cause your child to have an ongoing feeling of discomfort in their ears. It is more a dull, abnormal feeling than a nasty, sharp pain.

The fluid can also cause a short-term decrease in hearing in that ear. See glue ear and hearing loss in babies and children.

When should I go back to my doctor?

Always see your doctor, nurse or mobile hearing clinic if your baby or child has sore ears. You can also call Healthline on 0800 611 116. 

Go back to your doctor if:

  • an earache is not settling after 2 days
  • a runny ear is not settling after 2 weeks
  • your child has frequent ear infections.

 Also, see your doctor again if there are any of the following symptoms:

  • swelling, redness or tenderness in or around the ear
  • other facial symptoms or vertigo (spinning sensation)
  • vomiting or generally feeling more unwell
  • stiff neck, sensitivity to light or ongoing poor eating.

For children, see your doctor or nurse for an ear check after 4 to 6 weeks to make sure the fluid has cleared.

How can I prevent ear infections? 

It's not easy to prevent ear infections, but the following may help reduce the risk:

  • Breastfeed your baby for 3 to 6 months – this may be because breastfeeding boosts the immune system (the body's defence against potentially harmful germs). 
  • Hold baby upright if bottle feeding.
  • Be smoke-free.
  • Keep rooms warm and dry.
  • Make sure your child gets the B4 School Check and has their hearing tested.
  • Get your child vaccinated and keep them up-to-date with all vaccinations.

Learn more

Ear infections KidsHealth, NZ, 2015
Your child's speech and hearing milestones National Foundation for the Deaf, NZ

References

  1. Earache Choosing Wisely, Australia
  2. Ear infections, earache and glue ear HealthEd, NZ, 2016

Reviewed by

Dr Andrew Cho works in private practice at Robot Head and Neck Surgery and as an otolaryngologist, and head and neck surgeon at Counties Manukau DHB, Auckland. He has previously worked at Starship Hospital in Auckland and undertook a prestigious American Head and Neck Society Fellowship at the University of California in head and neck oncological surgery and microvascular reconstruction. His area of expertise includes general ENT, paediatric ENT, sinusitis, and head and neck surgery.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Andrew Cho Last reviewed: 29 Feb 2016