Ear infection symptoms can come on rapidly, especially in children. Signs and symptoms of ear infections include:

In children:

• Ear pain – especially when lying down
• Trouble sleeping
• Pulling or tugging at an ear
• Crying more than normal
• Fussiness
• Loss of balance
• Headache
• Loss of appetite
• Fever (100° F or higher)
• Fluid draining from the ear
• Trouble hearing

In adults:

• Ear pain
• Trouble hearing
• Fluid draining from the ear

If symptoms of an ear infection last for more than a day or you notice signs of an ear infection in your child (less than 6 months) call your child’s doctor right away. Other reasons to contact your healthcare provider are if the pain is severe, your infant or child is not sleeping well, or you notice fluid draining from the ear.

The main types of ear infections include:

Acute otitis externa (AOE). This type of infection occurs in the ear canal and is commonly known as swimmer’s ear.

Acute otitis media (AOM). The most common type of ear infection. Infection occurs in the middle ear and causes fluid to be trapped behind the eardrum. The inflammation causes pain and may be accompanied by a fever.

Otitis media with effusion (OME). May occur after an ear infection has occurred and fluid remains trapped behind the eardrum. A child with OME usually has no symptoms and requires a medical diagnosis with a special instrument to see the trapped fluid.

Chronic otitis media with effusion (COME). May affect hearing. COME occurs when fluid stays trapped in the middle ear for a long time or it continues to return without an infection present. Children with chronic otitis media have a harder time fighting off infections.

Bacteria usually cause ear infections, especially streptococcus pnemoniae. Colds and flu also may lead to viral ear infections that are followed by bacterial infections. Lastly, an injury to the ear can cause inflammation in the middle ear. Bobby pins or cotton swabs can injure the ear and lead to a bacterial infection. When you clean your ears, never insert cotton swabs into the ear canal.

• Age (younger)
• Allergies
• Exposure to cigarette smoke
• Family history of ear infections
• Injury to the ear
• Immune deficiency
• Group childcare
• No breastfeeding
• Using a pacifier
• Upper respiratory tract infection
• Gastroesophageal reflux
• Environmental irritant exposure
• Craniofacial abnormalities (i.e., cleft palate)

Your doctor will ask you about your health and your medical history. If you are bringing your child in, your doctor will ask you if your child has had a recent sickness, like a cold or sore throat. Your doctor will use a special instrument known as an otoscope to look inside the ear and examine the eardrum. A red eardrum that bulges into the ear canal indicates an ear infection. Your doctor may also use a pneumatic otoscope which uses bursts of air to check for the presence of fluid behind the eardrum. Usually, the eardrum will move easily back and forth under the pressure of air. But, if there is fluid there will be more resistance. Lastly, if your doctor is still unable to conclusively diagnose an ear infection, then he or she may use a tympanometer. This instrument measures sound tones and air pressure to closely examine how the eardrum reacts to sound waves and pressure.

Many doctors will use the watch-and-wait strategy with patients who have non-infected fluid buildup and allow the fluid to go away on its own. For some people, this may take a few weeks to months. If the fluid is infected, the first line of treatment is to prescribe antibiotic eardrops. New pediatric guidelines encourage physicians to observe and follow children with ear infections for 48-72 hours from when the symptoms begin before beginning antibiotic therapy. Many children can recover from ear infections without antibiotics. Over-the-counter pain relievers, like acetaminophen or ibuprofen, are often prescribed to help with fever and pain. There are pain-relieving eardrops that may be prescribed as well. Lastly, if your child suffers from chronic ear infections, your doctor may recommend surgical intervention. In this simple surgery, your child’s surgeon will place a small ventilation tube in the eardrum to help improve airflow and prevent fluid build-up in the middle ear.

Consult your primary healthcare provider before you try alternative treatments and/or herbal or nutritive supplements to make sure they are safe and do not interact with any medications you are taking. Helpful alternative treatments for ear infections include:

Vitamin D. Vitamin D may improve immunity and help fight off infections, including ear infections.

Herbal remedies. Garlic, mullein flowers, calendula flowers, yarrow, and St. John’s wort are all herbs that have anti-inflammatory, antimicrobial, and immune-stimulating properties. There are herbal remedy compounds specific for ear infections available at natural food stores.

Osteopathic manipulative treatments (OMTs). Osteopathy is a noninvasive medical approach to improving body health by strengthening the musculoskeletal framework. OMTs have been used to treat acute and chronic cases of otitis media. This involves manipulating the jawbone to indirectly affect the Eustachian tube of the inner ear and other techniques used to open the Eustachian tube. Must be performed by licensed osteopaths.

Probiotics. Supplementing with probiotics may prevent bacterial infections like Streptococcus salivarius found in the pharynx, or mouth and throat region. Children who supplemented with probiotics had a significant reduction in pharyngeal and middle ear infections as found in a recent study by Di Pierro et al.

Xylitol. This sugar alcohol is found in fruits, vegetables, and the bark of the common birch tree. Studies have shown that xylitol may reduce the incidence of ear infections in healthy children and may prevent otitis media.

• Hygiene to prevent the spread of viruses (wash hands often)
• Avoid pacifiers and do not prop your baby’s bottle
• Eliminate exposure to second-hand smoke
• Identify unknown allergies
• Use xylitol gum after meals
• Breast-feed your baby
• Immunize against pneumococcal and influenza viruses

• Speed delays
• Spread of infection to nearby tissues
• Impaired hearing
• Tearing of the eardrum

American Speech-Language-Hearing Association. (2020). Ear infections (otitis media). Retrieved from American Speech-Language-Hearing Association: https://www.asha.org/siteassets/uploadedfiles/ais-ear-infections-otitis-media.pdf

Centers for Disease Control.

Harmes, K. M., et. al. (2013, October 1). Otitis media: Diagnosis and treatment. American Family Physician, 88(7), 435-440. Retrieved from American Academy of Family Physicians:

Lieberthal, A. S., et. al. (2013, March). The diagnosis and management of acute otitis media. Pediatrics, 131(3). Retrieved from American Academy of Pediatrics: https://pediatrics.aappublications.org/content/pediatrics/early/2013/02/20/peds.2012-3488.full.pdf

Marom, T., et. al. (2016, February). Complementary and alternative medicine treatment options for otitis media: A systematic review. Medicine, 95(6). Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753897/

Mayo Clinic Staff. (2019, May 14). Ear infection (middle ear). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616

National Institute of Deafness and Communication Disorders. (2013, March). NICFD fact sheet: Ear infections in children. Retrieved from National Institute of Health: https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/NIDCD-Ear-Infections-In-Children.pdf