Ear infections: Symptoms, types, and causes

Viral or bacterial infections can occur in the middle of the ear. These often cause pain, inflammation, and fluid buildup.

Around 75 percent of children will have at least one ear infection before they reach 3 years old. Ear infections are the most common reason that children visit doctors.

Ear infections are also known as glue ear, secretory otitis media, middle ear infection, or serous otitis media.

Infections in the ear are well understood, and their common occurrence means that research is frequently carried out. This article explains the symptoms and causes of ear infections, the treatment options available, as well as the different types and testing methods.

Fast facts on ear infections:

Here are some key points about ear infections. More detail and supporting information is available in the main article.

Ear infections are more common in young boys than young girls.

Most ear infections improve without treatment.

Vaccinating a child against the flu can help prevent ear infections.

Biofilms of antibiotic-resistant bacteria may be to blame for prolonged and repeated cases of ear infection

Secondhand smoke increases the risk of ear infections.

What is an ear infection?

Anatomy of ear model.
Ear infections are very common and affect 5 out of 6 children in their first 3 years.

An ear infection is a bacterial or viral infection of the middle ear. This infection causes inflammation and the buildup of fluid within the internal spaces of the ear.

The middle ear is a air-filled space situated behind the eardrum. It contains vibrating bones that convert sound from outside of the ear into meaningful signals for the brain.

Ear infections are painful because the inflammation and buildup of excess fluid increases pressure on the eardrum.

An ear infection can be acute or chronic. Chronic ear infections may permanently damage the middle ear.


In adults, the symptoms are simple. Adults with ear infections experience ear pain and pressure, fluid in the ear, and reduced hearing. Children experience a wider range of signs. These include:

tugging or pulling at the ear

ear pain, especially when lying down

difficulty sleeping

crying more than normal

loss of balance

difficulty hearing


lack of appetite


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Ear infections are generally divided into three categories.

Acute otitis media (AOM)

AOM is the most common and least serious form of ear infection. The middle ear becomes infected and swollen, and fluid is trapped behind the eardrum. Fever can also occur.

Otitis media with effusion (OME)

After an ear infection has run its course, there may be some fluid left behind the eardrum. A person with OME may not experience symptoms, but a doctor will be able to spot the remaining fluid.

Chronic otitis media with effusion (COME)

COME refers to fluid repeatedly returning to the middle ear, with or without an infection present. This leads to a reduced ability to fight other infections and has a negative impact on hearing ability.


An ear infection often begins with a cold, flu, or allergic response. These increase mucus in the sinuses, and lead to the slow clearance of fluid by the eustachian tubes. The initial illness will also inflame the nasal passages, throat, and eustachian tubes.

The role of eustachian tubes

The eustachian tubes connect the middle ear to the back of the throat. The ends of these tubes open and close to regulate air pressure in the middle ear, resupply air to this area, and drain normal secretions.

A respiratory infection or allergy can block the eustachian tubes, causing a buildup of fluids in the middle ear. Infection can occur if this fluid becomes infected bacterially.

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