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

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

• Ear infections are very common, especially in children under 6 years old.¹
• 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.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.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.

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.

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.

Ear infections can be caused by two types of germs: bacteria and viruses.

Here's what happens.

• The lining of your child's middle ear and eustachian tube gets 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.⁴
• 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.

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.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?

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.

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 2008. All rights reserved.