John Carew, MD, is board-certified in otolaryngology and is an adjunct assistant professor at New York University Medical Center.
Ear infections (otitis media) occur when fluid and pus build up in the middle ear, behind the tympanic membrane (eardrum), causing ear pain. This is often due to a cold or allergies that can block drainage, introducing bacteria or viruses, and causing inflammation.
More common in children than adults, ear infections may or may not be accompanied by fever in children. In babies and young children, nonverbal clues that suggest an ear infection include pulling on the ear, crying more than usual, balance or hearing problems, and drainage from the ear.
Most ear infections resolve without antibiotics and are treated with pain relievers and decongestants. A persistent ear infection may require antibiotics, and ear tube placement may be recommended for chronic otitis media.
Ear infections are not contagious, however, the cold virus that sets the stage for ear infections can be spread from person to person. Ear infections occur when the eustachian tube that links the back of the throat to the middle ear is unable to drain, commonly due to congestion and inflammation from a cold or allergies. Bacteria or viruses can then multiply in the middle ear, causing infection.
Ear infections typically clear on their own without antibiotics. You can relieve the pain with over-the-counter pain medications such as Advil (ibuprofen) or Tylenol (acetaminophen) or pain relieving ear drops (available over the counter or by prescription). Applying a warm cloth or hot water bottle to the affected ear can also ease pain and help improve drainage.
Ear infections are caused by a blockage of the eustachian tube, which links the back of the throat to the middle ear. The tube, blocked by inflammation, mucus, or congestion from allergies or a cold, can’t drain the middle ear. Bacteria or viruses can then multiply in the middle ear, leading to an infection.
An ear infection cannot be seen from the outside. Your doctor will use an otoscope—a medical tool with a light and magnifying glass—to see the external ear canal and eardrum (tympanic membrane). If the ear is infected, there will be marked redness in the ear canal, the tympanic membrane will appear bulging, and air bubbles or fluid may be visible behind the eardrum, which may also have a hole or perforation. There may also be green or yellow discharge coming from the eardrum.
An ear infection can last anywhere from a few days to several weeks. Most ear infections clear up on their own in two or three days without any treatment. In some cases, however, an infection can last longer and may require antibiotics. If there is fluid trapped in the ear drum, it may take six weeks or more for an ear infection to fully heal.
The main symptom of an ear infection is pain in the ear. You may also experience a feeling of fullness in the ear, nasal congestion, hearing loss in the affected ear, drainage of fluid from the ear, and a feeling of general illness. A fever may sometimes accompany an ear infection in children, but it is not common in adults.
Adenoids are a mass of soft tissue behind the nasal cavity near the tonsils. Part of the lymphatic system, the adenoids work alongside the tonsils to trap germs coming through the mouth and nose. From there, the lymphatic system flushes them away. In young children, large adenoids can cause difficulty breathing through the nose. Around age 5, the adenoids start to shrink and they are almost completely gone by adulthood.
Audiologists are health care professionals who specialize in disorders related to the inner ear. Audiologists evaluate, diagnose, and treat auditory disorders, such as hearing loss and tinnitus, and vestibular (spatial balance) problems, including vertigo and dizziness.
Ear tubes are tiny cylinders placed through the eardrum (tympanic membrane) to allow air into the middle ear due to chronic ear infections. Also called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes, they are commonly recommended for children who experience repeated middle ear infections.
The eustachian tube is a narrow tube that extends from the middle ear to the upper part of the throat behind the nose. Also known as the auditory tube, it helps keep the middle ear healthy by clearing secretions and equalizing pressure.
A pneumatic otoscope is a diagnostic tool used to inspect the ear canal in the diagnosis of ear infections and other ear problems. It consists of an otoscope (a lighted magnifying glass used to look in the ear) and a pneumatic bulb, which is squeezed to release a puff of air against the eardrum. The test helps to determine if there is fluid trapped in the middle ear.
Tympanometry is a medical test used to detect problems in the middle ear. A tympanometer—a tool that looks like an otoscope or ear thermometer—is inserted into the ear canal, where it delivers sound waves and changes the air pressure in your ear. The returned energy creates a waveform called a tympanogram, which is used to evaluate eardrum functionality.
Explore an interactive model below that shows an up-close cross-section of a human ear, and demonstrates how fluid that builds up during an ear infection puts pressure on the tympanic membrane (eardrum), leading to pain.
U.S. National Library of Medicine. Adenoids. MedlinePlus. Updated March 6, 2020.
American Academy of Audiology. What is an audiologist?
American Academy of Otolaryngology-Head and Neck Surgery. Ear tubes.
Szymanski A, Agarwal A. Anatomy, head and neck, ear eustachian tube. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
U.S. National Library of Medicine. Tympanometry. MedlinePlus. Updated October 8, 2020.
Centers for Disease Control and Prevention. Ear infection. Updated August 27, 2019.
National Institute on Deafness and Other Communication Disorders. Ear infections in children. Updated May 12, 2017.
Nemours KidsHealth. Middle ear infections (otitis media). Updated April 2017.
Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media - prevention and treatment. Infect Drug Resist. 2014;7:15-24. doi:10.2147/IDR.S39637
U.S. National Library of Medicine. Ear infections. MedlinePlus. Updated August 12, 2020.
U.S. National Library of Medicine. Ear infection – acute. MedlinePlus. Updated October 8, 2020.