/ Ear Infection
Signs and Symptoms of Ear Infections

Signs and Symptoms of Ear Infections: When to Contact a Doctor

An ear infection is the common term for the condition known as acute otitis media (AOM). AOM occurs when a bacteria or virus causes an infection in the space behind the eardrum. Generally this space, known as the middle ear, is air-filled and contains the tiny bones that vibrate to transmit sound. If an infection causes this space to fill with fluid, it can lead to increased pressure and cause significant discomfort. Because ear infection signs often clear up on their own, treatment may begin with managing pain and monitoring the problem. Ear infection in infants and severe cases often require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — could cause hearing problems and other serious complications. Learn more about how to tell if you have an ear infection.

Causes of Ear Infections

The space behind the eardrum, also called the middle ear, is normally well ventilated by the air that passes up from behind the nose through the Eustachian tubes. This helps keep the middle ear clean and dry and is necessary for the normal functioning of the ear. If due to any reason this airflow is reduced or obstructed, the middle ear becomes damp, warm and a perfect place for germs to breed and cause an ear infection. Eustachian tubes in infants are very soft and often have a hard time staying open and keeping the airflow to the middle ear. This obstruction of the tubes can result in an ear infection. Causes of ear infections include:

  • Viral Infections - In children, the most common trigger of an ear infection is the common cold or flu. Other forms of upper respiratory infections can also cause swelling of the Eustachian tube, which affects the tube's ability to deliver regular airflow to the middle ear.
  • Allergies - Allergies to pollen, food, or animal dander tend to produce the same effect as the common cold or flu. In some cases, exposure to smoke, fumes and various types of airborne toxins can cause swelling in the Eustachian tube that can lead to an ear infection.
  • Bacteria - In rare circumstances where the immune system is lowered by other diseases, bacteria can cause ear infections directly. In such cases, bacteria tend to attack the middle ear often after a viral infection or an allergy. Bacteria can cause damage to the middle tube often triggering high fevers.

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What Role do Adenoids Play?

Adenoids are two small pads of tissues high in the back of the nose believed to play a role in immune system activity. This function may make them particularly vulnerable to infection, inflammation and swelling. Because adenoids are near the opening of the Eustachian tubes, inflammation or enlargement of the adenoids may block the tubes, thereby contributing to a middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children, because children have relatively larger adenoids for their size.

Who is More Likely to Get Ear Infections?

Scientists have identified that certain groups are more likely to contract ear infections. They include:

  • Bottle fed babies are more likely to contract an ear infection than the ones that are breast fed
  • Children between 6 months and 2 years are more likely to develop ear infections because their Eustachian tubes are more horizontal, soft, and less developed
  • Children who are constantly exposed to higher than normal levels of air pollution
  • Children who come in contact with others at public places like daycare centers and public parks
  • Individuals with a family history of ear infections
  • People who smoke or come in contact with smokers
  • People or children with abnormalities of the palate or other orthodontic malformations
  • People with chronic respiratory diseases like asthma or poor immune systems

Ear Infection Symptoms

If you have an ear infection, the doctor would look at the eardrum and see that it is red and often bulging. Other signs of an ear infection vary between children and adults. All are considered when making the diagnosis of an ear infection.

The symptoms of ear infection in adults are:

  • Sharp and sudden pains in the ear
  • Dull and continuous pains in the ear
  • A sharp stabbing pain with immediate warm discharge from the ear canal
  • Feeling like your ear is clogged
  • Nausea
  • Reduced hearing

In children, the symptoms are:

  • Constant pulling, tugging, or scratching the ears
  • Consistently poor sleep
  • Regular fever of 100F or over
  • Difficulty responding to sounds
  • Constant restlessness
  • Ear drainage
  • Constant poor appetite
  • Increased irritability
  • Headaches
  • Crying at night when lying down

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Diagnosing Ear Infections

A doctor can usually diagnose an ear infection based on the symptoms you describe in an exam. The doctor will likely use an instrument with a light (an otoscope) to look at the ears, throat and nasal passage. They also will likely listen to breathing using a stethoscope. If the doctor finds evidence of infection, you are likely to get one of the following diagnoses:

  • Acute otitis media. The diagnosis of "ear infection" is generally shorthand for acute otitis media. Your doctor makes this diagnosis if they observe signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if the onset of symptoms was relatively sudden.
  • Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection.
  • Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, if they found that a persistent ear infection resulted in tearing or perforation of the eardrum.

Related Conditions

Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include:

  • Otitis media with effusion is inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur because the fluid buildup persists after an ear infection has resolved. It may also occur because of some dysfunction or noninfectious blockage of the Eustachian tubes.
  • Chronic otitis media with effusion occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection. This makes children susceptible to new ear infections, and may affect hearing.
  • Chronic suppurative otitis media is a long lasting ear infection that often results in tearing or perforation of the eardrum.

Complications of Persistent Ear Infections

Most ear infections don't cause long-term complications. Frequent or persistent infections and persistent fluid buildup can result in some serious complications:

  • Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was before the infection after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss can occur.
  • Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social, and developmental skills.
  • Spread of infection. Untreated infections or infections that don't respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).
  • Tearing of the eardrum. Most eardrum tears heal within 72 hours. In cases that last longer than 72 hours, surgical repair is needed.

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Preventing Ear Infections

The following tips may reduce the risk of developing ear infections:

  • Prevent common colds and other illnesses. Teach your children to wash their hands frequently and thoroughly and to not share eating and drinking utensils. Teach your children to cough or sneeze into their arm. If possible, limit the time your child spends in-group childcare. A childcare setting with fewer children may help. Try to keep your child home from childcare or school when ill.
  • Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.
  • Breastfeed your baby. If possible, breastfeed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.
  • If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby's mouth while he or she is lying down. Don’t put bottles in the crib with your baby.
  • Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child. Seasonal flu shots, pneumococcal and other bacterial vaccines may help prevent ear infections.

Should any of these symptoms continue or worsen make an appointment with your
primary care physician or see an urgent care immediately.

When to See a Doctor

Signs and symptoms of an ear infection can indicate a number of conditions. It's important to get an accurate diagnosis and prompt treatment. Call your child's doctor if:

  • Symptoms last for more than a day
  • Symptoms are present in a child less than 6 months of age
  • Ear pain is severe
  • Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection
  • You observe a discharge of fluid, pus or bloody discharge from the ear
  • Your child develops stiff neck, a condition where children cannot move their neck due to sharp neck and back pain

Read more from our Ear Infection Series:

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Shannon Chapman

Shannon Chapman

Shannon enjoys breaking down technical subjects and giving others the tools to make informed decisions. Her interests include behavioral economics, sustainable living, meditation, and healthy cooking.

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