What are ear infections?

They’re more common in children and can be very painful. Find out what causes ear infections, plus how to recognise and treat them in this guide

Written by Cheryl Freedman on 24 January, 2019 Reviewed by Dr Gio Miletto on January 30, 2019

You know the signs well – that tell-tale twinge in your ear, followed by full-on pain and throbbing. Or maybe it’s the dreaded ear-rubbing from your little one, combined with sleepless nights and crying.¹ If you or one of your children always seems to have an ear infection, you’re not alone. But why do you get them, what’s going in on your body and are some people really more prone?

What is an ear infection?

Usually when we talk about ear infections, we mean acute otitis media (AOM). This can be either a viral or bacterial infection, or most often both combined, that affects the middle ear, or the space behind your eardrum, causing inflammation and pain.² Your Eustachian tubes – tiny tubes that control pressure in the ear and let mucus drain away – can become blocked following an upper respiratory tract infection (URTI). A URTI causes swelling of nose, throat and tubes – such as your sinuses – and increases secretions that don't drain away properly because of the swelling. Virus and bacteria grow in the blocked secretions, causing AOM. Swelling and mucus can remain for weeks, even months, after the URTI has resolved.³ While middle ear infections are more common, you can also get an infection of the outer ear, in which the ear canal becomes inflamed.⁴

What causes an ear infection?

For middle ear infections, common triggers that can block the Eustachian tubes are:⁵

• colds

• allergies
• sinus infections
• infected or swollen adenoids

For the outer ear, the following can lead to infection:⁶

• water or shampoo entering the ear
• swimmer’s ear, when stagnant water is left in your ear
• a build-up of wax causing irritation
• eczema
• psoriasis

What are the symptoms of an ear infection?

• pain or discomfort inside the ear
• a feeling of pressure or ‘fullness’ in the ear
• slight loss of hearing
• fluid draining from the ear
• fever
• nausea^7,8

For children, symptoms can also include:⁹

• irritability and fussiness
• tugging at the ear
• lack of interest in meals
• loss of balance

Who’s most at risk of ear infections?

Anyone can get them, but children are more likely – one in four children has had at least one middle ear infection by the age of 10 years.¹⁰ The peak age for ear infections is between six and 15 months old, according to a 2014 study by the UK’s Northampton General Hospital. Babies of this age have shorter, more horizontal Eustachian tubes, which make it easier for viruses and bacteria to reach the middle ear.¹¹ Children also have developing immune systems, so are less able to fight off an infection. Adults are more prone to ear infections if you have:¹²

• diabetes
• a weakened immune system
• a chronic skin condition, like eczema or psoriasis

How to treat an ear infection

Ibuprofen or paracetamol can help with the soreness. Making a compress from a warm flannel can also help soothe pain.¹³ For particularly severe or long-lasting ear infections, your doctor may prescribe antibiotics. Antibiotics can shorten the duration of the acute illness by a few days, but the time it takes for the mucus and inflammation to go away after the infection is about the same as without antibiotics. The use of antibiotics is often related to age, so the younger the child, the more likely it is their GP will prescribe antibiotics, especially between six months to two years old.¹⁴

Can you prevent ear infections?

There are definitely steps you can take to reduce the risk. For example, avoid putting anything in the ears that could cause irritation or allow bacteria or viruses to enter, like cotton buds. Avoid smoky environments, and when washing your hair, take care to avoid water or shampoo from getting in. For children, the NHS advises making sure your child’s vaccinations are up-to-date, and avoiding dummies once your child is six months old.¹⁵

When should you see a doctor?

Most ear infections will clear up without treatment in three to five days, but they do occasionally lead to serious complications, so it’s important not to ignore any symptoms. If the person with the ear infection has a weak immune system, medical condition or is frequently getting ear infections, it’s important to see your GP. Otherwise you only need to seek medical attention if you notice:¹⁶

• symptoms don’t improve after three days
• the ear infection is severely painful
• a very high temperature
• a change in hearing
• vomiting or dizziness
• fluid or swelling around the ear

Advice is for information only and should not replace medical care. Please check with your GP before trying any remedies. Sources 1. Mayo Clinic. Ear infection (middle ear) 2. As above 3. NHS Inform. Middle ear infection (otitis media) 4. Guy’s and St Thomas’ NHS Foundation Trust. Otitis externa 5. Elaine K. Luo. Healthline. Ear infections 6. As Source 4 7. As Source 1 8. As Source 3 9. As Source 3 10. National Institute for Care and Excellence. Most common ear infections should not be treated with antibiotics, says NICE 11. As Source 4 12. Qureishi A, et al. Update on otitis media – prevention and treatment 13. NHS Inform. Earache 14. As Source 3 15. NHS. Ear infections 16. As above