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Eye and Ear Problems

Ear Infections

Prevention - Home Treatment - When to Call a Health Professional

Ear infections can occur in the middle ear or the ear canal. For information about infections in the ear canal, see Swimmer's Ear on See Swimmer's Ear.

A middle ear infection (otitis media) usually develops during a cold. Colds can cause the eustachian tube (which connects the middle ear to the throat) to swell and close. When the eustachian tube is closed, air cannot reach the middle ear. This creates a vacuum that draws fluid into the middle ear. Bacteria or viruses then grow in the fluid, causing a middle ear infection.

The infected fluid that is trapped in the middle ear puts pressure on the eardrum. If the ear infection is not treated, the pressure may continue to build until the eardrum ruptures. A single eardrum rupture usually is not serious and rarely causes hearing loss. However, repeated eardrum ruptures can lead to permanent hearing loss (see "Recurrent Ear Infections and Persistent Effusion" on See Recurrent Ear Infections and Persistent Effusion).

Symptoms of a middle ear infection include ear pain, dizziness, ringing or a feeling of fullness in the ear, hearing loss, fever, headache, and runny nose. Children who can't yet talk may tug on their painful ears. Drainage from the ear that is bloody or looks like pus may indicate a ruptured eardrum. Ear pain usually improves once an eardrum ruptures.

When a person has fluid build-up in the middle ear, it is called serous otitis or effusion. Effusion generally occurs after a middle ear infection has cleared up. There may be no symptoms, or there may be a muffling of sound, minor hearing loss, and mild discomfort. Effusion is not a cause for concern and may not require treatment unless it lasts

longer than 3 months or causes significant hearing loss in both ears. See Recurrent Ear Infections and Persistent Effusion.

Ear infections can occur in the ear canal or middle ear. Dizziness can be caused by an inflammation of the inner ear.

Prevention

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  • Breast-feed your baby. Breast-fed babies have fewer ear infections. If you bottle-feed your baby, hold the baby in an upright position to prevent milk from getting into the eustachian tubes. Do not allow infants to fall asleep with a bottle (however, it is all right to let a nursing baby fall asleep at the breast).

  • Avoid exposing children to cigarette smoke, which is associated with more frequent ear infections.

  • If possible, limit your child's contact with other children who have colds.

    Recurrent Ear Infections and Persistent Effusion

    If your child has at least 3 ear infections in a 6-month period, or 2 ear infections before the age of 6 months, talk to your paediatrician about preventive antibiotic treatment. This is a low dose of antibiotics given daily throughout the season when your child is prone to ear infections. Daily antibiotic treatment may reduce the frequency of ear infections, but it may not always prevent fluid build-up (effusion) in the middle ear.

    Daily antibiotic treatment is prescribed less often than it used to be. This is because there is growing concern that routine use of antibiotics may cause bacteria to change so that common antibiotics cannot kill them.

    If your child has repeated ear infections (3 in 6 months, or 4 to 6 in a year), your doctor may suggest

    inserting ear tubes (tympanostomy tubes) through your child's eardrums to help prevent ear infections. The tubes remain in the child's eardrums for 6 to 12 months.

    In some children, fluid remains in the middle ear more than 3 months after an ear infection clears up. If this occurs in your child, he or she should be given a hearing test because long-lasting effusion can cause hearing loss. If your child has effusion and significant hearing loss in both ears at the same time for more than 3 months, your doctor may recommend ear tubes.

    There are no firm guidelines for treating recurrent ear infections and long-lasting effusion. Ask your doctor about the long-term risks and benefits of all the available treatment options.

  • Wean your child from his or her pacifier at about 6 months of age. Babies who continue to use their pacifiers after 12 months of age are more likely to develop ear infections.

  • Wash your hands often if you have a cold or other upper respiratory infection to prevent spreading the infection.

  • Make sure your child is up to date with his or her immunizations. (Children over 2 years of age who have repeated ear infections need to get the pneumococcal vaccine. See Pneumococcal Infection.)

Home Treatment

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  • Apply heat to the ear to ease the pain. Use a warm washcloth or a heating pad set on low. Don't use a heating pad on an infant, and never leave a child alone with a heating pad.

  • Acetaminophen, aspirin, or ibuprofen will help relieve earache. Do not give aspirin to anyone younger than 20 years of age.

  • Rest. Let your energy go to fighting the infection.

  • Drink more clear liquids.

  • If dizziness occurs, See Dizziness and Vertigo.

  • If an ear infection has caused the eardrum to rupture, avoid getting water in the ear until the eardrum heals (about 3 to 4 weeks).

When to Call a Health Professional

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  • If your child has a severe earache and cannot be quieted even after you apply Home Treatment for several hours.

  • If ear pain occurs with other signs of serious illness, such as headache with severe stiff neck, fever, irritability, or confusion. (See "Encephalitis and Meningitis" on See Encephalitis and Meningitis.)

  • If your baby pulls or rubs his or her ear and appears to be in pain (crying, screaming).

  • If ear pain increases despite Home Treatment.

  • If your child has a fever over 38.9°C (102°F) with other signs of an ear infection.

  • If you suspect that the eardrum has ruptured or there is drainage from the ear that looks like pus or contains blood.

  • If symptoms do not improve after 48 hours of treatment with an antibiotic.

  • If your child has ear tubes and develops an earache or has drainage from the ear.

  • If mild ear pain continues for longer than 3 to 4 days.

  • If there is redness or swelling behind the ear.

 

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