Ear Infections

Anatomy of the Ear

Types of Ear Infections

Middle Ear Infections

  • The medical term for this type of ear infection is acute otitis media. 
    • Otitis = ear
    • Media = middle
  • In this type of ear infection, there is infected fluid build-up in the middle ear behind the eardrum.
    • This type of ear infection almost always follows a viral cold with congestion, runny, and cough.
  • This type of ear infection is most common in children 2 years of age and younger but can occur in older children as well.

External Ear Infections

  • The medical term for this type of ear infection is acute otitis externa. 
    • Otitis = ear
    • External = outer
  • In this type of ear infection, there is an infection in the outer ear canal.
    • The ear canal is the part of the ear that goes from the outer ear to the eardrum.
  • An outer ear infection happens when the skin in the ear canal gets irritated or scratched, and then gets infected. 
  • This type of infection is commonly called “swimmer’s ear.”
  • However, your child can develop an outer ear infection even if they have not been swimming.
  • This can happen when a child:
    • Puts cotton swabs, fingers, or other things inside the ear
    • Cleans the ear canal to remove wax
    • Swims regularly
      • Water can soften the skin of the ear canal, which allows germs to infect the skin more easily.
    • Wears hearing aids, headphones, or earplugs that can irritate or damage the skin inside the ear canal.
  • This type of ear infection is most common in children 5 years and older. 

Signs and Symptoms of Ear Infections 

Middle Ear Infections

  • Typically these infections develop during or following a viral cold that includes congestion, runny nose, and/or cough.
    • The onset of pain and/or fever is typically quite sudden. 
  • Fussiness and irritability may develop suddenly as well. 
    • These symptoms may be amplified during naps and overnight sleep, as lying down causes the infected fluid to put more pressure on the eardrum, therefore increasing pain.
  • Ear tugging and pulling is NOT a reliable indicator of anything medical in children under 2 years of age!

External Ear Infections

  • Sudden onset of pain inside the ear
    • Your child will often complain that the pain is worse when the ear is pulled or moved as happens when taking clothing off or brushing hair.
    • Your child will feel pain inside the ear, especially when the ear is pulled or moved.
  • Itching inside the ear
  • White, chunky fluid (pus) leaking from the ear
  • Trouble hearing


  • Ear infections require diagnosis by a trained medical professional.
    • An otoscope is placed in your child’s ear canal to enable the provider to examine the eardrum and ear canal.
  • Remember- ear infections cannot and should not be treated based on signs and symptoms alone!
    • This is very important for many reasons:
      • To confirm that an infection is present
      • To document the frequency of ear infections
      • To determine the most appropriate oral or topical antibiotic to prescribe if indicated
      • To avoid antibiotic use when not necessary


Middle Ear Infections

  • Treatment varies based on your child's age, history of previous infections, and severity of symptoms.
  • Ear infections are often treated with oral antibiotics. 
    • However, depending on the age of your child, their symptoms, duration of symptoms, and their history (or lack thereof) of ear infections, antibiotics may not be prescribed right away.
  • Children age 2 years and younger are typically started on oral antibiotics immediately.
  • Children over 2 years of age can often be monitored to see if the symptoms resolve on their own as long as the pain is easily controlled by pain-reducing medications.
    • This is called the “watch and wait approach.”
  • Treat pain and fever with acetaminophen or ibuprofen as needed. 

External Ear Infections

  • Outer ear infections are treated with prescription ear drops that contain an antibiotic and often an anti-inflammatory medication. 
  • These drops are instilled in your child’s ear canal.
  • Tips for instilling ear drops:
    • Have your child lie down on their side with the infected ear facing up. 
    • Pull down on the bottom of the ear and instill the drops as directed.
    • Encourage your child to remain in this position for 5 to 10 minutes or place cotton in the ear for 10 minutes.
  • Pain typically improves 2-4 days after starting drops.
  • Try to keep the inside of your child’s ear canal dry while the infection heals. 
    • Do not swim until treatment is completed and the pain is completely resolved. 
    • It is okay for your child to shower or bathe but keep the ear as dry as possible.
      • Put vaseline on a cotton ball and place it in the outer ear to cover the opening to the ear canal.
      • Do not push the cotton ball far into the ear canal.
  • Do not allow your child to use in-ear earphones until treatment is completed and the pain has resolved. 

Are Ear Infections Contagious?

  • Middle infections are NOT contagious.
    • Remember that ear infections are usually secondary to a viral cold. 
    • The cold itself can be contagious but the ear infection is not. 
  • External ear infections are not contagious. 

Reach Out to Modern Pediatrics If…

Middle Ear Infection

  • Fever is still present after 5 doses (not days) of antibiotics.
  • Fussiness and/or pain are still present after 5 doses of antibiotics, or if they go away and then return.
  • Antibiotics may not have a noticeable effect until the 5th dose is given.
    • You should expect fever and/or pain prior to receiving the 5th dose of antibiotics.
    • Have acetaminophen and ibuprofen ready during this time.

External Ear Infection

  • Pain is still present after 5 doses (not days) of prescription ear drops.

Follow-up for Ear Infections

  • If your child is no longer exhibiting the signs and symptoms that accompanied the initial ear infection we will re-examine the ears based on the most up-to-date guidelines as follows: 
    • For children <2 years of age and children ≥2 years of age with language or learning problems, we will re-examine their ears 8-12 weeks after diagnosis.
    • For children ≤2 years, this timeframe may coincide with a previously scheduled well visit.  
  • Previously, many health care providers would recommend a follow-up 2 weeks after an ear infection was diagnosed but current evidence proves this is unnecessary.

Can Ear Infections Be Prevented?

Middle Ear Infections

  • Unfortunately, there is no one thing you or your child can do to prevent ear infections.
  • There can be a genetic predisposition to ear infections and honestly many kids just have bad luck! 
  • However, several interventions can help reduce the risk of recurrent ear infections:
    • Continue vaccinating your child per the CDC guidelines
    • Encourage good hand hygiene and cover coughs and sneezes
    • Avoid exposing your child to tobacco smoke
    • Breastfeed your child if possible 

External Ear Infections

  • Avoid cleaning your child’s ears with Q-tips.
    • Ear wax is normal and it helps protect the ear canal.
  • Encourage your child not to stick anything in their ears.
  • After swimming:
    • Encourage your child to shake their ears dry after they swim
    • You may also use over-the-counter ear drying drops such as these
      • These usually contain alcohol or vinegar and can help prevent infection.