Ear infections are one of the most common infections in children. In fact, according to the American Academy of Pediatrics (AAP), approximately 5 out of every 6 children will have one ear infection by the time they turn three. “Most common in children, involving fluid or pus behind the eardrum,” says Marcy Borieux, MD, FAAP, pediatrician at Summer Health. While some children experience them occasionally, others suffer from frequent or recurring infections. In this article, we’ll take a closer look at what causes ear infections, how to prevent them, and safe and effective treatments to manage symptoms.

What are ear infections?

An ear infection happens when bacteria or viruses invade the ear, leading to an infection. There are two main types of ear infections: one affects the middle ear (known as otitis media), and the other affects the outer ear, often referred to as swimmer’s ear or otitis externa.

Types of ear infections:

• Middle ear infection: This is the most common ear infection in children. It involves fluid and pus buildup behind the eardrum.This can cause ear pain, fever, and temporary hearing difficulties.

• Outer ear infection: This infection affects the ear canal and is often triggered by moisture from bathing or swimming. Symptoms may include ear itchiness, pain, and frequent ear rubbing.

• Inner ear infection:Though rare, inner ear infections can be caused by viruses or bacteria. Symptoms often include vertigo (a spinning sensation), hearing loss, and balance problems.

Common causes of ear infections

• Viral upper respiratory infections (like the common cold)

• Bacterial infections (like Streptococcus pneumoniae)

• Eustachian tube dysfunction (often due to colds or allergies)

• Exposure to tobacco smoke

• Moisture retention in the ear canal

• Anatomical factors, such as shorter and more horizontal eustachian tubes in young children

Symptoms of ear infections

The symptoms of an ear infection can vary from child to child and can range in severity. Here are some common signs to watch for:

• Ear pain or earache

• Fever

• Irritability

• Ear discharge

• Pus

• Poor appetite

• Muffled hearing

• Nausea and vomiting

• Lethargy

• Headache 

Why are ear infections common in children?

Ear infections are more common in children due to several anatomical and physiological factors:

• Children have shorter, more horizontal, and less functional eustachian tubes. This makes it easier for fluid to get trapped in the middle ear and harder for it to drain properly, creating an ideal environment for infection. 

• Children’s immune systems are still developing, so they are less efficient at fighting off the viruses and bacteria that can cause ear infections.

• Children have frequent respiratory infections, which can lead to swelling or blockage of the eustachian tubes and increase the risk of ear infections.

Are ear infections preventable? 

While not all ear infections can be prevented, there are several effective strategies that can significantly reduce a child's risk:

• Stay up to date with vaccinations: Keep your child up to date with vaccinations, especially the pneumococcal vaccine and the influenza vaccine, can help prevent upper respiratory illnesses that may lead to ear infections. 

• Breastfeeding: For infants, exclusive breastfeeding for at least the first six months provides important immune support. Breast milk contains antibodies that help infants fight infections. 

• Avoid tobacco smoke: Secondhand smoke is a major risk factor for ear infections.

• Keep ears dry: To help prevent outer ear infections (swimmer’s ear), make sure your child’s ears are dried thoroughly after swimming or bathing. Using a towel or tilting the head to let water drain can help. Avoid inserting objects like cotton swabs or Q-Tips into the ear canal.

• Manage nasal congestion and allergies: Allergies and chronic nasal congestion can lead to fluid buildup in the eustachian tubes. 

How are ear infections diagnosed?

If your child is showing common symptoms of an ear infection, it's important to schedule a visit with your pediatrician. During the appointment, the doctor will perform an otoscopic examination—a simple procedure where a special instrument (an otoscope) is used to look inside the ear for signs of redness, inflammation, fluid buildup, or infection behind the eardrum. 

Your child’s temperature may also be taken to check for fever. If there is ear discharge, the doctor may take a sample for a culture test to identify the specific cause, such as a bacterial or fungal infection. 

Treatment for ear infections 

Treatment for ear infections depends on the age of the child and the severity of the symptoms. Always discuss medical treatment with your pediatrician first. Common treatment options include:

• Over-the-counter pain relievers (children’s acetaminophen or ibuprofen (if 6 months old or older)

• Oral antibiotics

• Antibiotic ear drops (for swimmer’s ear or if your child has ear tubes)

• Tympanostomy tubes (may be considered for recurrent cases)

• Watchful waiting and monitoring the child’s symptoms to see if the infection goes away on its own 

Antibiotics for ear infections 

Most babies and toddlers will need antibiotics if they have an ear infection, but for children over 2, it really depends on how bad their symptoms are. “Antibiotics are recommended for most infants and toddlers with an ear infection, but for children over two years of age, they are recommended depending on the severity of their symptoms, explains Dr. Borieux. “A time of initial observation is sometimes fine for mild infections.” 

This gives the body a chance to fight it off on its own. If antibiotics are needed, the most common side effects to watch for are diarrhea, rash, and vomiting. 

Tympanostomy tubes

If your child keeps getting ear infections, talk to your child’s pediatrician about tympanostomy tubes. “Tympanostomy tubes should be considered for children with recurrent acute otitis media, conventionally defined as three or more episodes within six months, or four or more episodes within 12 months,” says Dr. Borieux. These tiny tubes help prevent future infections by allowing fluid to drain from the middle ear. While they’re most commonly placed in younger kids, there's no strict age limit, and depends on your child’s specific condition.

Home remedies for ear infections

Home remedies can be used for symptom relief but should not replace medical treatment. Safe home remedies for treating ear infections include:

• Warm compresses

• Ensuring adequate hydration

• Over-the-counter pain relievers 

It is important to consult a healthcare provider for proper diagnosis and treatment. Avoid ear candles, hydrogen peroxide, or oil drops. Not only are they ineffective, but they may cause serious harm. 

When to consult a pediatrician

Consult your pediatrician if your child:

• Has severe symptoms such as high fever or severe pain

• Experiences hearing loss

• Has trouble with balance 

• Has persistent symptoms beyond 48 to 72 hours

• Has discharge from the ear

If you have questions about ear infections or if your child has an earache, reach out to your local or Summer Health pediatrician for support. Summer Health is a pediatric telehealth platform offering 24/7 care, providing answers for everything from urgent concerns to everyday questions about your child’s health.