What is an ear infection?

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

Ear infections are common, especially in children. Children usually get fewer ear infections as they get older.

What are the symptoms of an ear infection?

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

• pain or itch in or around your ear
• fever or headache
• leaking pus or fluid from your ear
• redness, swelling or a warm feeling around your ear
• difficulty hearing, or hearing noises in your ears such as ringing or buzzing
• the feeling of spinning (vertigo) or difficulties with balance
• nausea or vomiting

Babies and small children might:

• pull or rub their ear
• have a fever
• show redness or swelling around the ear
• be irritable, tired or have less energy as usual
• have symptoms of a cold, such as a runny nose or sore throat

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What causes an ear infection?

Bacteria, viruses or fungi are usually responsible for an ear infection.

You are more likely to develop an infection if your ear is exposed to bacteria or viruses. This could be because of a generalised illness or an injury in, on or around your ear. Factors that can increase your chance of developing an ear infection include:

• having a cold or other respiratory infections
• air pressure changes, such as occurs on planes
• swimming in dirty water
• cleaning ears too much with cotton buds, causing scratches
• cuts or scratches on the outer ear
• not drying ears well after swimming or bathing

When you catch a cold, the infection can move up a tube in your middle ear called the Eustachian tube. Middle ear infections are more common in babies and children because they have smaller Eustachian tubes.

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.

How are ear infections diagnosed?

Your doctor will ask about your symptoms and perform a physical examination. This will include examining your or your child's ears with an otoscope — a special magnifying glass with a torch that is gently inserted in the ear canal to view the eardrum.

Blood tests or imaging scans are rarely needed.

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

You should see 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, 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?

Treatment for ear infections depends on the type and where on the ear it's located. You or your child may need:

• professional cleaning of the ear canal
• ear drops with antibiotics or antifungal medicine, sometimes with steroids to reduce swelling
• medicine for pain relief, such as paracetamol or ibuprofen
• antihistamines or anti-nausea medicine

Middle ear infections

Middle ear infections usually go away on their own after a few days. Antibiotics aren't usually needed, unless you or your child have a high fever or are very unwell. If you or your child aren't feeling better after 2 days, consider returning to your doctor for a review.

Children under 6 months old, Aboriginal and/or Torres Strait Islander children and children with certain medical conditions are more likely to have complications from ear infections. For this reason, they are more likely to need antibiotics.

Outer ear infections

Outer ear infections always need treatment with antibiotic ear drops. 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.

How can ear infections be prevented?

• There is no need to remove the wax in your child's ears. The body is able to do this by itself.
• Avoid putting anything into your ear, not even a cotton bud, even if your ear feels blocked or painful.
• Keep your child away from cigarette smoke — this reduces the risk of 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.
• Make sure that you or your child drains water out of your ears after swimming.
• Use earplugs for swimming, if you are prone to ear infections.

Complications of an ear infection

Most ear infections will resolve without any complications. Sometimes, the fluid buildup in the middle ear can cause pressure, and lead to the eardrum to tear. This is known as a burst eardrum. The eardrum usually heals by itself without any special treatment.

Some children develop glue ear, where fluid remains in the middle ear after an infection. This can affect your child's hearing and language development. Usually, the fluid goes away by itself within 3 months. If it doesn't, your child may need grommets. These small plastic tubes are surgically placed in the eardrum to allow fluid to drain out of the middle ear. This surgery is performed by an ear, nose and throat (ENT) specialist.

Rarely, ear infections can lead to:

• Mastoiditis, an infection spread from the ear to the mastoid bone behind the ear.
• Facial nerve paralysis, causing paralysis of the muscles in your face that help you smile, blink, and make other facial expressions.
• Sepsis, a serious condition caused by the body's response to an infection, leading to inflammation and damage to tissues and organs.

Resources and support

Learn more about ear health on the Australian Government Department of Health and Aged Care website.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.