Ear infections are common, especially in children. Most children have at least one ear infection before they reach school age. Children usually get fewer ear infections as they get older.

What is an ear infection?

There are several different types of ear infection, depending on which part of the ear is infected. Two common types are middle ear infections (otitis media) and outer ear infections (otitis externa). Ear infections can be caused by bacteria or viruses.

The middle ear is the part of the ear just behind the ear drum, connected to the throat by a short tube known as the Eustachian tube. When you have a cold, the infection can spread up this tube to the middle ear. Middle ear infections are especially common in babies and children because their Eustachian tubes are small.

The outer ear, or ear canal, can also become infected. It is often caused by water remaining in the ear canal, such as after swimming. For this reason it is also called swimmer’s ear. Outer ear infections can also result from damage to the ear canal, such as by using cotton buds.

What does an ear infection feel like?

Symptoms depend on which part of your ear is infected and can include:

• ear pain or itch
• fever or headache
• having trouble hearing
• ears feeling plugged or full, sometimes with ringing or buzzing
• becoming dizzy or losing your balance
• nausea or vomiting
• discharge (fluid leaking) from your ear
• redness or swelling of your ear

Babies and small children might:

• pull or rub their ear
• have a high temperature (38°C or above)
• have redness around the ear
• be restless or irritable
• not respond to noises that would normally attract their attention

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When should I (or my child) see a doctor?

You should visit your doctor if:

• you or your child is in pain
• there is discharge from your or your child's ear
• you or your child is unwell or vomiting or has a fever
• you or your child can't hear properly
• your child gets repeated ear infections

Go to your nearest emergency department if there is redness, pain or swelling of the bone behind the ear or if the ear is pushed forward. This could be a sign of a serious infection called mastoiditis.

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How are ear infections treated?

Middle ear infections

Middle ear infections (otitis media) usually go away on their own within a week. You or your child may need medicine for pain relief, such as paracetamol or ibuprofen.

Antibiotics are generally not recommended for middle ear infections unless there are signs that your child is unwell, such as fever or vomiting. It’s best to take your child back to the doctor to check their ears again after 1 to 2 days if they’re not better.

Children under age 2, Aboriginal or Torres Strait Islander children and children with certain medical conditions are more likely to have complications from ear infections and are more commonly prescribed antibiotics.

Outer ear infections

Outer ear infections (otitis externa) are generally treated with antibiotic ear drops. The drops may also contain other medicines such as steroids. You should lie down with your ear facing upwards while the drops are put in and stay lying down for a few minutes so the drops stay in your ear.

It’s important to avoid swimming for a week while the infection is healing.

Why don’t doctors give antibiotics for middle ear infections just in case?

Often, the infection will go away by itself after about 4 days. On average, children who take antibiotics have ear pain for only about 12 hours less than children who don’t take antibiotics.

On the other hand, if antibiotics are prescribed, some children will have side effects. Using antibiotics can also cause bacteria to become resistant to them, meaning that the antibiotics might not work in future.

For these reasons, antibiotics are not generally recommended for middle ear infections unless your child is at risk of developing complications. For more information, speak to your doctor or visit the Australian Commission on Safety and Quality in Health Care website.

Can an ear infection cause any other problems?

Ruptured ear drum

Sometimes people with middle ear infections have pressure from fluid building up in the middle ear, which can cause the ear drum to tear. This is known as a ruptured or burst ear drum. If this happens to you or your child, you may see yellow discharge coming from the ear and you may notice that pain suddenly improves.

The ear drum usually heals by itself. You should see your doctor after 6 weeks to make sure the tear has healed. It’s important not to get your ear wet while the ear drum is healing.

Glue ear

For some children, fluid remains in the middle ear after an infection. This is called glue ear. The fluid may affect your child’s hearing and language development.

The fluid usually goes away by itself within 3 months. If it doesn’t, your child may need grommets. These are small plastic tubes surgically placed in the ear drum to allow fluid to drain out of the middle ear. This surgery will be done by an ear, nose and throat (ENT) specialist.

What can I do to prevent ear infections?

Middle ear infections are often a result of a simple cold. While it’s hard to prevent colds, good hygiene can help lower your chance of catching one.

Keep your child away from cigarette smoke. Exposure to cigarette smoke increases your child’s risk of ear infections.

If your child keeps getting ear infections, they may need grommets put in their ears to prevent recurring infection.

Your risk of an outer ear infection may be reduced by:

• ensuring that you or your child drain water out of your ears after swimming
• using ear plugs for swimming if you are prone to these infections
• not putting anything into your ear, not even a cotton bud, even if your ear feels blocked or painful