Otitis Media

What is an ear infection?

An ear infection, also called otitis media, is inflammation in the middle ear. It often occurs after a cold, sore throat or respiratory infection. The infection causes pus and fluid to build up inside the ear, putting pressure on the eardrum.

Ear infections are common in children. More than 80 percent of children have at least one ear infection by the time they are 3 years old. Ear infections account for about 30 million visits to the pediatrician each year — the most common reason children visit their doctor.

What are the symptoms of an ear infection?

Common symptoms of an ear infection may include:

  • irritability
  • trouble sleeping or staying asleep
  • tugging or pulling at one or both ears
  • fever
  • fluid draining from ear
  • loss of balance
  • trouble hearing
  • ear pain
  • nausea and vomiting
  • decreased appetite

Although any child can get an ear infection, children may be at higher risk if they are:

  • around people who smoke
  • in daycare with other kids
  • bottle-fed, especially if given bottles while lying in bed

What causes ear infections in children?

Children most often get ear infections after being sick with a cold, sore throat or upper respiratory infection. This infection can spread to the ear, causing fluid buildup behind the eardrum.

One reason children are more likely to get ear infections than adults because they have smaller eustachian tubes, the canals that link the middle ear with the upper throat area. These tubes normally help drain fluid and equalize the pressure inside the ear, but when they become swollen, the excess fluid can’t drain.

How are ear infections diagnosed?

Your child’s doctor will take a medical history and examine the outer ear and eardrum using an otoscope. This is a lighted instrument that allows the physician to see inside the ear. An eardrum that looks bulging and red is likely infected.

The doctor may also use a pneumatic otoscope, which blows a puff of air into the ear to test eardrum movement. If the eardrum doesn’t move easily back and forth, it could be a sign of fluid behind it.

If the diagnosis is still not clear, your doctor may use a test called tympanometry. This test uses air pressure and sound tones to measure the flexibility of eardrum at various pressures.

How are ear infections treated?

Your child’s doctor will likely prescribe antibiotics to treat the infection and may also give your child pain medicine.

If your child gets ear infections several times a year, your child's doctor may suggest a procedure to place small tubes in the ear to help drain the fluid and relieve the pressure from the middle ear.

Your child's doctor may also recommend removing the adenoids (lymph tissue located in the space above the soft roof of the mouth) if they are infected. This helps some children with chronic ear infections. 

How we care for ear infections

Our physicians in the Boston Children’s Hospital General Pediatric Otolaryngology Program have extensive expertise treating ear infections, particularly as a chronic condition. The program is the oldest, largest and one of the most recognized centers for Pediatric Otolaryngology in the United States.