How to Prevent Ear Infections and Fluid in the Ears

Ear infections can be painful and disruptive. They are especially frustrating for people who get reoccurring ear infections, or for parents whose children are prone to them.

Approximately 80% of children will experience at least one episode of the middle ear infection acute otitis media (AOM) by their third birthday. About 40% will have six or more recurrences of AOM by the time they reach 7 years old.

Although AOM occurs most often in children, a 2005 global study showed adults ages 25 to 85 accounted for 1.5% to 2.3% of incidences of AOM.

Thankfully, the rate of AOM has declined in the years since 2000 in the United States and some other countries, likely due to the introduction of the pneumococcal vaccine and an understanding of other preventative measures, which are covered in the article below.

Types of Ear Infections

Otitis media (OM), meaning inflammation of the middle ear, is often called an ear infection and used as a blanket term, but there are several conditions of the ear that often fall under that umbrella, including ones that don’t involve infection at all.

Acute Otitis Media (AOM)

AOM is what most people are referring to when they discuss ear infections. They come on suddenly—typically during or after a respiratory infection such as a cold—and usually resolve on their own within a few days or sometimes weeks.

AOM involves fluid in the middle ear, along with bacterial or viral infection.

Symptoms of AOM include:

• Ear pain
• Fever
• Fluid draining from the ear (yellow, brown, or white, not earwax)
• Irritability/crying
• Trouble sleeping
• Loss of appetite
• Trouble hearing

Otitis Media With Effusion (OME)

OME involves fluid trapped in the middle ear without an active infection. It typically doesn’t have the obvious symptoms that come with AOM such as pain or fever, but can cause muffled hearing or a feeling of fullness in the ear.

Chronic Otitis Media

Chronic otitis media refers to some ongoing or long-term problems with the middle ear, including a hole in the eardrum that doesn’t heal, or ear infections that don’t resolve or that keep coming back.

Types of chronic otitis media include:

• Chronic Serous Otitis Media: Fluid remaining in the middle ear
• Non-Infected Chronic Otitis Media: Perforation (hole) in the eardrum without infection or fluid in the middle ear
• Chronic Suppurative (filled with pus) Otitis Media (CSOM): Persistent infection in the middle ear that can cause a perforation in the eardrum
• Chronic Otitis Media With Cholesteatoma: A growth (tumor) in the middle ear made of skin cells and debris

Otitis Externa (Swimmer’s Ear)

Unlike OM, swimmer’s ear is a condition of the outer ear. It is an infection of the ear canal, marked by pain in the ear (especially when pulling on the external ear) and sometimes discharge.

How Ear Infections Happen

Otitis Media

The eustachian tube connects the ear to the throat and helps even out the pressure between the outer ear and the inner ear. There is one in each ear.

Bacteria or viruses can travel up these tubes into the middle ear, often during or shortly after a respiratory illness like a cold.

The eustachian tube can become swollen from bacteria, viruses, allergies, or other irritants such as cigarette smoke, leading to a blockage. Drinking while lying on your back, or sudden changes in air pressure (such as in an airplane or driving on a hilly road), can also cause the tube to close or become blocked.

When the tubes are blocked, fluid can become trapped in the middle ear, causing OME. If bacteria or viruses are present, an infection can develop, causing AOM.

Because children’s eustachian tubes are shorter, narrower, and more horizontal than an adult’s, they are more likely to experience ear infections.

Otitis Externa (Swimmer’s Ear)

Swimmer’s ear is caused by water lingering in the ear (from swimming or any water source), creating an ideal environment for the bacteria that inhabits the ear canal to multiply, causing irritation, infection, or inflammation. Occasionally, swimmer’s ear is caused by fungus instead of bacteria.

Risk Factors

Risk factors for developing OM include:

• Age: Children are more likely to develop OM than adults, especially children aged 6–24 months.
• Family History: Being prone to ear infections can run in families.
• Allergies: Allergies can lead to enlarged adenoids that can block the eustachian tubes, causing fluid to build up in the middle ear.
• Upper Respiratory Infections: Ear infections commonly develop during or after respiratory infections such as colds.
• Chronic Illness: Some chronic illnesses such as immune deficiency and chronic respiratory disease (like cystic fibrosis and asthma) can put a person at increased risk for ear infections.
• Ethnicity: Native Americans and Hispanic children have more occurrences of OM than other ethnic groups.
• Sex: OM occurs more often in males.
• Birth Order: Children with older siblings are more at risk for OM.
• Smoking: Smoking or exposure to cigarette smoke increases the risk of OM.
• Childcare Setting: Children who are in daycare are at a higher risk for ear infections.
• Infant Feeding: Babies who are not breastfed have a greater chance of developing OM.

Prevention

Ear infections can’t always be avoided, but there are ways to reduce the risk.

Adults

• Avoid cigarette smoke: Quit smoking (or don’t start), and avoid exposure to secondhand smoke.
• Control allergies: Speak to your healthcare provider about identifying and managing your allergies.
• Practice good hygiene: Wash your hands frequently with soap and warm water, and take measures to avoid colds and other respiratory infections.
• Get vaccinated: Make sure all of your vaccinations are up to date, including boosters (adults also need regular booster shots), and get your yearly flu shot.
• Keep ears clean and dry: Regularly clean excess earwax, and dry ears after swimming and showering. Do not put cotton swabs or any foreign objects into the ear, and never use “ear candles.”

Infants and Children

• Breastfeed: Breastfeeding for at least the first year can help reduce ear infections during a child’s first five years.
• Avoid cigarette smoke: Do not smoke (or allow anyone else to smoke) around children.
• Vaccinate: Make sure your child is up to date on vaccinations, including the annual flu shot for children six months and older.
• Bottle feed at an upright angle: If bottle feeding, feed your baby in a position that raises their head higher than their stomach to avoid fluids such as formula flowing into their eustachian tubes. Never prop a bottle to feed or allow a baby or child to take a bottle to bed.
• Switch to a sippy cup: When developmentally appropriate, switch from a bottle to a sippy cup to reduce the surface area available to collect germs.
• Practice good hygiene: Wash your own hands and your child’s hands regularly with soap and warm water. Teach your child good hygiene habits.
• Avoid sick people: Keep your child away from others who are sick. This is not always possible if they are in a daycare setting.
• Watch for mouth breathing/snoring: Frequent snoring or mouth breathing may indicate enlarged adenoids, which could contribute to ear infections.
• Stop using pacifiers with children over 12 months: Pacifier use has been associated with an increased risk of ear infections. Pacifier use has also been associated with a decreased risk of SIDS. Stopping the use of pacifiers after the risk of SIDS goes down at a year old can help prevent ear infections without negating the benefits of pacifiers in SIDS reduction.

When to See a Doctor

Call your healthcare provider immediately if any of the following occurs in you or your child:

• Stiff neck
• Severe ear pain
• A fever over 104 degrees F (40 degrees C). Note: A baby under three months of age who has a temperature over 100.4 degrees F (38 degrees C) is an emergency situation and needs immediate medical attention, even if no other symptoms are present.
• (Child) acts sluggish, looks or acts very sick, or is crying and cannot be soothed
• Walk is not steady
• Physically very weak
• Signs of facial weakness (such as a crooked smile)
• Bloody or pus-filled fluid draining from the ear
• You feel you or your child needs immediate medical attention

Call your healthcare provider during office hours if:

• Symptoms (including fever) are not better or have gotten worse after two to three days
• You feel you or your child needs to be seen by a healthcare provider
• You have any questions or concerns

Frequently Asked Questions

How do you treat an ear infection?

Most ear infections will go away on their own within a few days, but in some cases, antibiotics may be needed.

How can you tell if you have an ear infection?

Some symptoms of an ear infection in adults include ear pain, fever, muffled hearing, a feeling of fullness in the ear, and fluid draining from the ear. An ear infection can be confirmed by a physical exam from a healthcare professional.

What does an ear infection feel like?

An ear infection can cause pain in the ear (sharp or dull) and/or a feeling of fullness in the ear.

How long does an ear infection last?

Ear infections usually get better within a few days, with or without antibiotics, but the fluid in the middle ear may last six weeks or longer.