Ear infection

Symptoms Of Ear Infection 

Ear infections can affect anyone, but are especially common in children. While adults usually describe pain or pressure, young children may show more behavioral signs. 

Common symptoms include:

• Ear pain or a feeling of pressure
• Muffled hearing or hearing loss
• Drainage from the ear
• Sore throat or nasal congestion
• Headache
• Fever over 38°C (100.4°F)
• Dizziness or balance issues

Symptoms in children

• Tugging or pulling at the ear
• Unusual fussiness or irritability
• Crying more than usual
• Trouble sleeping or frequent waking
• Fever
• Trouble hearing or not responding to sounds
• Balance problems or clumsiness
• Fluid (pus or blood) draining from the ear
• Loss of appetite (especially during feeding, due to pressure while swallowing).

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Causes Of Ear Infection

• An ear infection often starts with a common cold or viral infection.

• This virus causes redness and swelling at the back of the nose and the Eustachian tube, a small passage that connects your middle ear to the back of your throat.

• In young children, this tube is shorter and more horizontal, making it easier for germs to travel into the ear.

• When the Eustachian tube doesn't function properly, fluid accumulates in the middle ear. 

• If bacteria are present (and they often are), they can multiply in this trapped fluid, leading to an infection. 

• In some cases, these bacteria form a sticky layer, which makes them harder to remove and can lead to ongoing or repeated infections.

• Your body’s immune system tries to fight back by causing inflammation, which leads to pain, fever, and hearing problems. 

• Over time, as children grow and their immune system matures, the risk of infection generally reduces.

Ear pain, especially in kids, is often triggered by colds or ear infections, as viruses and fluid buildup can irritate the eardrum. Curious to know more?
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Risk Factors For Ear Infection

Ear infections often begin after a cold and are common in children. Certain factors increase the risk of developing acute or chronic ear infections. These include:

Age and anatomy

• Young age (6 months to 2 years)
• Adenoid enlargement (Adenoids are small glands behind the nose that help fight infections) 

Germ exposure

• Frequent colds
• Upper respiratory infections
• Bacteria in the nose/throat 
• Weak immunity or repeated infections

Environmental factors

• Secondhand smoke
• Daycare or crowded places
• Allergies
• Snoring
• Pacifier use and bottle-feeding while lying down

Feeding and family factors

• Not being breastfed long enough
• Family history
• Poor hygiene or limited healthcare.

Diagnosis Of Ear Infection

Early and accurate diagnosis of an ear infection is important to prevent complications. Diagnosis consists of:

History and physical examination

• Your doctor will ask about recent colds, fever, ear pain, fussiness, trouble hearing, or fluid discharge.

• A tool called an otoscope is used to look inside the ear for redness or swelling, fluid buildup behind the eardrum, or bulging or immobility of the eardrum. 

Pneumatic otoscopy

• This special test uses air pressure to check if the eardrum moves normally

• Restricted movement suggests fluid buildup, common in middle ear infections.

Hearing tests

These are done in recurrent or long-term cases, especially in children, to assess any impact on hearing.

• Pure tone audiometry (PTA): The most commonly used hearing test that measures the softest sounds a person can hear at different pitches.

• Tympanometry: This test measures how the eardrum responds to pressure changes, helping confirm fluid behind the eardrum.

• Otoacoustic emissions (OAE): A quick test used in newborns and children that measures sound waves produced by the inner ear (cochlea) in response to clicks or tones.

• BERA (Brainstem Evoked Response Audiometry): Assesses how sound signals travel from the ear to the brainstem. Especially useful for infants, toddlers, or people who can’t give verbal feedback.

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Specialist To Visit

If you're dealing with an ear infection, it’s best to consult a specialist who can diagnose and treat the cause effectively. Doctors who can help include:

• General physician
• Pediatrician
• ENT specialist (Otolaryngologist)
• Audiologist
• Infectious disease specialist

A general physician is the first point of care for mild or typical ear infections; can prescribe basic treatment.

A pediatrician specializes in treating ear infections in infants and children.

An ENT specialist (Otolaryngologist) is best for severe, recurring, or complex ear infections needing specialized care.

An audiologist evaluates hearing or balance problems caused by ear infections.

An infectious disease specialist is consulted for chronic or treatment-resistant ear infections.

When to see a doctor?

See a doctor if there is: 

• Ear pain or pressure
• Fluid or pus from the ear
• Hearing loss
• Fever
• Dizziness or balance issues
• Symptoms lasting for more than 2 days.

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Prevention Of Ear Infection

Ear infections are quite common, especially in children, but the good news is, many can be prevented. Simple daily habits and a few precautions can make a big difference. These include:

For children

• Breastfeed your child: Breastfeeding for at least 6 months strengthens the immune system and lowers infection risk.

• Feed in the right position: Bottle-feeding while lying down can cause fluid to enter the middle ear and cause infections. Always hold your baby in an upright or semi-upright position while feeding. 

• Keep up with the vaccinations: Flu and pneumococcal vaccines help reduce the risk of respiratory infections that often spread to the middle ear.

• Limit pacifier use: Overuse of pacifiers has been linked to more frequent ear infections.

• Choose smaller daycare settings: Smaller daycare groups mean your child is exposed to fewer people and, therefore, fewer germs. This lowers the risk of catching colds and other respiratory infections.

• Avoid tobacco smoke: Secondhand smoke increases a child's risk of ear infections. Maintain a smoke-free home.

• Consider xylitol for older kids: Xylitol, a natural sweetener found in some chewing gums, syrups, or lozenges. Some studies have shown it to reduce the risk of recurrent ear infections.

Note: Xylitol for ear infection prevention is generally recommended for children aged 2 years and above.

For adults

• Quit smoking: Smoking can impair ear function and increase infection risk. Even secondhand smoke harms ear health.

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• Stay vaccinated: Flu and pneumococcal shots aren’t just for kids; they protect adults too, especially those with chronic illnesses.

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• Manage allergies and colds: Treat allergic rhinitis and avoid catching colds, which can lead to fluid buildup and ear issues.

• Avoid air pressure extremes: Sudden pressure changes during takeoff or landing can hurt your ears. Try yawning, swallowing, chewing gum, or wearing special earplugs to ease the pressure.
  
  

Treatment Of Ear Infection

Most cases clear up on their own in 2–14 days. Management consists of:

Over-the-counter pain relievers

Pain is the most common symptom of an ear infection. It can be managed with over-the-counter pain medications like:

• Paracetamol
• Ibuprofen

Note: Consider topical analgesic eardrops for temporary relief 

Antibiotics

These are usually prescribed if symptoms are severe, last more than 2–3 days, or affect children under 6 months. They're also used for recurring infections or if there's fluid buildup behind the eardrum. Common antibiotics for ear infections:

• Amoxicillin
• Amoxicillin-clavulanate
• Cefdinir
• Cefuroxime
• Ceftriaxone
  

Ofloxacin or ciprofloxacin ear drops may be considered for outer ear or perforated eardrum infections.

Ear drainage (tympanocentesis or myringotomy)

• Considered for severe, recurrent, or complicated cases. 
• Tympanostomy tubes may help with chronic fluid buildup or multiple infections.
  

Chronic ear infections or a burst eardrum

• Treated mainly with special antibiotic ear drops (quinolones), sometimes combined with mild steroids to reduce swelling

• Oral antibiotics are used only if there's a fever or the infection has spread beyond the ear

• Regular cleaning by a doctor may be needed to help the medicine work better and prevent further damage.

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Home-care For Ear Infection

Don’t ignore ear pain. If symptoms are severe, persistent, or getting worse, it’s important to see a doctor. But for mild cases or while you wait for treatment, here are some home remedies that may offer relief and comfort:

Warm or cold compresses

Applying a warm or cold pack over the ear can reduce pain and inflammation by improving blood flow to the area.

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Olive oil 

Warm olive oil may soften hardened wax and ease an earache, but it doesn’t treat the infection directly. Always consult a professional first, as it should be avoided if there's a ruptured eardrum.

Ginger or garlic oil

Applying ginger-infused oil or garlic oil around (not into) the ear may offer mild anti-inflammatory relief, but evidence remains limited.

What’s not recommended

• Ear candling: This is an alternative practice where a hollow, cone-shaped candle is lit and placed in the ear canal. It has no proven benefit and can cause serious harm, like burns or eardrum perforation.

• Essential oils inside the ear: Oils like tea tree may have in‑lab antimicrobial properties, but they're untested in humans and could irritate the ear canal.
  
  

Complications Of Ear Infection

Ear infections are usually mild, but if left untreated or recurring, they can lead to serious complications like: 

• Ear pain and fever: Most common during infection, and is usually managed with pain relief and resolves with treatment.

• Temporary hearing loss: Caused by fluid in the middle ear, it usually improves after the infection clears.

• Chronic ear discharge (otorrhea): Fluid or pus may continue to drain if the eardrum is damaged or if there's a chronic infection.

• Infectious eczematoid dermatitis: A skin reaction around the ear due to chronic discharge or irritation, leading to itching, redness, or crusting.

• Eardrum rupture: Pressure from fluid buildup may cause the eardrum to burst. It often heals on its own, but sometimes needs care.

• Balance problems or vertigo: Inner ear involvement may cause dizziness or unsteadiness.

• Persistent hearing loss: Ongoing infections may damage hearing, affecting speech and development in children.

• Cholesterol granuloma: A cyst-like lesion caused by blocked drainage and bleeding. It can damage middle ear structures.

• Cholesteatoma: Recurrent ear infections can lead to abnormal skin growth in the middle ear, which can damage nearby structures.

• Petrositis: A rare complication where the infection spreads deeper into the skull bone near the ear.

• Labyrinthitis: Inflammation of the inner ear that can cause severe vertigo, nausea, and hearing loss.

• Facial paralysis: Inflammation or pressure near facial nerves can cause temporary or permanent weakness. 

• Mastoiditis: A serious infection of the bone behind the ear, which may cause swelling and requires urgent treatment.

• Meningitis: In rare cases, bacteria can spread to the brain's lining, leading to a life-threatening infection.
  
  

Alternative Therapies For Ear Infection

Alternative therapies may offer extra support for ear infection relief, but they’re not a substitute for medical treatment. Always talk to your doctor before starting anything new, especially for children. Therapies that may help include:

Echinacea and osteopathic manipulation

Echinacea, a herbal supplement, may help boost immunity. Osteopathic manipulation (also called Osteopathic Manipulative Treatment (OMT) is a hands-on technique used by trained doctors (DOs) to gently move and stretch the muscles, joints, and bones.

For ear infections, it focuses on improving drainage from the middle ear, especially in children, by releasing tension in the neck and upper back, which may help reduce fluid buildup and pressure behind the eardrum. Some studies show reduced infections when both are used together.

Chiropractic adjustments

Certain gentle techniques targeting the neck and skull may help improve middle ear drainage, but evidence is limited and should only be done by licensed practitioners.

Ear acupuncture

This involves placing tiny needles in specific points on the outer ear. Some people find it helps with pain relief, though its role in treating the actual infection isn’t well-proven.