What is Ear infection?

Ear infection

What is an ear infection?

Has your young child been crying more than usual and pulling on their ear? If so, your child could have an ear infection.

Ear infections usually start when your child gets a cold, a sore throat or another common

infection
You get an infection when viruses, bacteria, fungi or other tiny organisms get into your body. These bugs are so tiny that you can't see them without a microscope. For example, an infection in your airways causes the common cold. And an infection in your skin can cause rashes such as athlete's foot.

infection. The infection spreads to one or both ears, making them swollen, blocked and painful.

If your child is crying more than usual, they could have an ear infection.

Your doctor might call it an acute ear infection, acute otitis media or purulent otitis media.

Key points for parents about ear infections

Ear infections are very common, especially in children under 6 years old.

Source:
Froom J, Culpepper L, Jacobs M, et al.
Antimicrobials for acute otitis media? A review from the International Primary Care Network.
BMJ. 1997; 315: 98-102.

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Ear infections hurt and can stop your child from hearing properly.
Most children (4 in 5) feel better without any treatment after two or three days.

Source:
Rosenfeld RM.
Natural history of untreated otitis media.
Laryngoscope. 2003; 113: 1645-1657.

²
You can help your child's ear pain by giving them a painkiller such as acetaminophen (brand name Tylenol) or ibuprofen.
Some children may need antibiotics. These can help clear up the infection, but they have side effects.

Source:
Del Mar C, Glasziou P, Hayem M.
Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis.
BMJ. 1997; 314: 1526-1529.

³
If your child has problems hearing after an ear infection clears up, they may have fluid trapped in the ear. To learn more about this condition, see Ear infection with fluid.

How ears work

To understand what happens when your child gets an ear infection, it helps to know a little about the ears and how they work.

Your outer ear is the part you can see. It "catches" the sounds around you.
The hole in the middle is your ear canal. It carries sounds into your ear.
Stretched across the end of your ear canal is your eardrum. This thin tissue moves when sounds reach it.
Behind your eardrum is your middle ear. It's usually filled with air. It also has three tiny bones that move when sounds reach them.
The bones carry sounds to your inner ear. Here, special nerves pick up the sounds and send signals to your brain. (Your inner ear also helps you keep your balance.)
Your brain translates these signals and recognizes them as sounds.
Your eustachian tube connects your middle ear to the back of your nose (just above the roof of your mouth). This tube is closed most of the time. But when you swallow or yawn, it opens briefly. This lets air flow into the tube, so that the air pressure inside your ear and outside your head is the same.
Your eustachian tube also lets any fluid in your middle ear to drain off down your throat.

What happens with ear infections

Ear infections usually start with an illness such as a cold or sore throat. The germ causing the illness travels up your child's eustachian tube to their middle ear. So, this part of the ear gets infected and painful. To learn more, see Illnesses that can lead to ear infections.

Small bones within the middle ear carry sound to the inner ear.

Ear infections can be caused by two types of germs:

bacteria
Bacteria are tiny organisms. There are lots of different types. Some are harmful and can cause disease. But some bacteria live in your body without causing any harm.

bacteria and

viruses
Viruses are microbes (tiny organisms) that need the cells of humans or other animals to exist. They use the machinery of cells to reproduce. Then they spread to other cells in the body.

viruses.

Here's what happens.

An infected eardrum looks red and irritated.

The lining of your child's middle ear and eustachian tube gets

inflammation
If your skin or some other part of your body becomes red, swollen, hot or sore, we say it is inflamed. It means that your body is trying to protect you from germs, from something in your body tissues that can hurt you (like a thorn or sliver), or from things that cause allergies (allergens). Inflammation is part of the way the body heals an infection or injury.

inflamed (red and swollen) because of the illness.
A thick fluid (called mucus) starts to build up in your child's eustachian tube and middle ear.
The fluid may stop your child's eardrum and tiny bones in the middle ear from moving properly to carry sound. So, your child may have trouble hearing.
Bacteria or viruses get trapped in the fluid.

Source:
Chonmaitree T, Heikkinen T.
Role of viruses in middle-ear disease.
Annals of the New York Academy of Sciences. 1997; 830: 143-157.

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Your child's body makes chemicals that fight the bacteria or viruses. These chemicals cause more swelling.
The swelling pushes against your child's eardrum, which gets red and painful.
Your child's eardrum may burst. If it does, you may see fluid coming out of your child's ear. This helps lessen your child's pain. The tear in the eardrum will heal after a few days.

Most ear infections last only a few days. But in some children, fluid stays trapped in the middle ear even after the child seems better. This can lead to a condition called fluid in the ear, which can last for many months. Fluid in the ear can stop your child from hearing properly. This could make learning difficult. For more about this condition and how it's treated, see our articles on Ear infection with fluid.

Most children don't get ear infections after a cold or sore throat. Usually your child's body fights off the germ that's causing the illness in a few days. And if fluid builds up in their middle ear, it usually drains away without causing any problems. But some children seem to get ear infections every time they have a cold or similar illness.

Why my child?

Anyone can get an ear infection. But children are more likely to get them than adults because their eustachian tubes are much shorter. Shorter tubes get blocked with mucus more easily, so the fluid can't drain from the middle ear.

Source:
National Institute on Deafness and Other Communication Disorders.
Ear infections: facts for parents about otitis media.
February 2002. Available at http://www.nidcd.nih.gov/health/hearing/otitismedia.asp (accessed on 2 December 2008).

⁵

Some children are more likely than others to get ear infections. Things that make it more likely that someone will get an illness are called risk factors. One of the biggest risk factors for ear infections is going to day care or preschool. This is because children who go to day care or preschool mix with lots of other children, so the illnesses that lead to ear infections can easily pass from one child to another. For more on the risk factors for ear infections in children, see Who's at risk?

Children who go to day care or preschool are more likely to get ear infections than children who don't.

If your child gets lots of ear infections or gets very painful ear infections, there are some things you can do that might help prevent future infections. See How to help keep your child from getting ear infections.

Sources for the information on this page:

Froom J, Culpepper L, Jacobs M, et al.Antimicrobials for acute otitis media? A review from the International Primary Care Network.BMJ. 1997; 315: 98-102.

Rosenfeld RM.Natural history of untreated otitis media.Laryngoscope. 2003; 113: 1645-1657.

Del Mar C, Glasziou P, Hayem M.Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis.BMJ. 1997; 314: 1526-1529.

Chonmaitree T, Heikkinen T.Role of viruses in middle-ear disease.Annals of the New York Academy of Sciences. 1997; 830: 143-157.

National Institute on Deafness and Other Communication Disorders.Ear infections: facts for parents about otitis media.February 2002. Available at http://www.nidcd.nih.gov/health/hearing/otitismedia.asp (accessed on 2 December 2008).

This information was last updated on May 12, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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