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Pediatric Ear Infections (Otitis Media)



An ear infection, or otitis media, is the No. 1 reason parents bring their child to a doctor.  While ear infections are rare in adults, 75 percent of children will develop an ear infection by the time they are 3 years old.


An ear infection usually affects the middle ear and is most often caused by bacteria. The result is a buildup of fluid and mucus behind the eardrum, which causes pressure and, eventually, pain.

Most ear infections occur following a respiratory infection such as a cold or a sore throat. In bacterial infections, the bacterium spreads to the middle ear causing an ear infection. In viral infections, bacteria may be "driven" to the middle ear, resulting in a secondary infection.


There are three main types of otitis media, each with its own set of symptoms:

  • Acute otitis media (AOM) - the most common type of ear infection and is also known as an "earache." AOM affects the middle ear, causing pain. It is sometimes accompanied by a fever.
  • Otitis media with effusion (OME) - this occurs when fluid remains trapped after the infection has passed. Your child may not exhibit symptoms, although your child’s doctor will be able to diagnose OME.
  • Chronic otitis media with effusion (COME) - this occurs when fluid remains trapped in the middle ear over time. If this happens, your child may not be able to ward off new infections. It can also affect hearing. COME is commonly known as “swimmer’s ear.”


An ear infection, or otitis media, is the number 1 reason parents bring their child to a doctor.  Although most ear infections eventually go away on their own, it is sometimes necessary to see a health care provider.

Common symptoms of an ear infection include:

  • Pulling or tugging at one or both ears
  • Crying
  • Difficulty sleeping
  • Difficulty hearing soft sounds
  • Fluid discharge from the ear
  • Trouble with balance
  • Fever (more common in infants and toddlers)

Take your child to the doctor if he has the following symptoms:

  • A temperature above 100.4° F
  • Discharge from the ears that includes blood or pus
  • Was already diagnosed with an ear infection and his symptoms have either not improved or worsened
  • A fever, if he is younger than 3 months of age

Test and Diagnosis

Because ear infections most often follow an illness, your child’s doctor will ask you whether your child has recently had a cold or a sore throat. If the answer is yes, the doctor will follow up with questions about the above symptoms. For instance, has your child been tugging at his ears or has he had trouble sleeping?

If the doctor suspects an ear infection, she will use a lighted device known as an otoscope to look at your child's eardrum for signs of redness or bulging. The doctor may also use a pneumatic otoscope, which releases a puff of air into your child's ear canal to see if there is fluid behind the eardrum. An eardrum with fluid behind it will remain more static than a normal eardrum.

If the results of the above tests are inconclusive, your doctor may perform a test known as tympanometry. The doctor will insert an instrument called a tympanometer -- a soft plug containing a tiny microphone and speaker -- into your child's ear. The device uses sounds and air pressure to measure the eardrum's flexibility at different pressures.

If your child's earache is not accompanied by severe fever or pain, your child’s doctor may suggest waiting a day or two to see if symptoms go away. Most ear infections (otitis media) do not need treatment. If symptoms persist longer than 48 or 72 hours, treatment is most often needed.


If your child's doctor diagnoses an ear infection, she may prescribe an antibiotic. Antibiotics such as amoxicillin are usually taken over the course of a week to 10 days. It is important that your child takes the exact dosage over the full amount of time, even if symptoms improve.

Your doctor may also recommend over-the-counter pain medications such as ibuprofen or acetaminophen. Ear drops are sometimes used as well. (Aspirin is not recommended because of its association with Reye's syndrome in certain children.)

If a virus caused the infection, antibiotics won't help and may even cause side effects such as diarrhea, rashes or nausea. Viral infections will resolve by themselves. Make sure your child gets plenty of rest. Over-the-counter medications can help with symptoms as well. No matter the treatment, it is important to take your child to his follow-up appointment so the doctor can make sure the infection has gone away.


The Centers for Disease Control and Prevention (CDC) recommends the following in order to help prevent ear infections in children:

  • Avoid exposing your child to secondhand smoke or air pollution
  • Make sure children are up to date on their immunizations
  • Breastfeed babies for 12 months or more (if possible)
  • Bottle feed babies in an upright position


What are the symptoms of an ear infection?

If your child is too young to tell you her ears hurt, she may show symptoms such as tugging at one or both ears, crying, sleeplessness, fever or fluid discharge from the ear. She may also experience trouble with balance or an inability to hear quiet sounds.

What causes an ear infection?

Bacteria or a virus, usually following a respiratory infection such as a cold or a sore throat, causes most ear infections. In a bacterial infection, the bacterium spreads to the middle ear, while viral infections may force bacteria to the middle ear, resulting in a secondary infection.

Why do children get more ear infections than adults?

The Eustachian tube, which connects the upper throat to the middle ear, is smaller in children, making it more difficult for fluid to drain out of the ear. Also, because children’s immune systems are not as developed as an adult's, it makes it harder for them to fight infections.

When should I take my child to the doctor?

Most ear infections clear up by themselves in a day or two. Take your child to a doctor if symptoms persist for longer than 48 or 72 hours.

How does a doctor diagnose an ear infection?

A doctor will ask you whether your child has recently had a cold or sore throat and discuss any symptoms he may have. The doctor will then use a device called an otoscope to examine your child’s ears for signs of an infection.

What is the treatment for an ear infection?

Antibiotics such as amoxicillin are most often used to treat ear infections. Over-the-counter medications such as ibuprofen, acetaminophen or eardrops are usually recommended to help with pain.

Are there ways to prevent ear infections in children?

The Centers for Disease Control and Prevention (CDC) recommends avoiding exposing your children to secondhand smoke or other air pollutants and keeping them up to date on their vaccines. You should also breastfeed for at least 12 months (if possible) and bottle-feed your baby in an upright position.


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