Understanding Ear Infections: What Parents and Patients Should Know

Ear infections are among the most common reasons children visit the doctor, especially in the fall and winter months when colds and respiratory illnesses are on the rise. But, they can affect people of all ages. Knowing the signs, treatment options, and preventive steps can make a big difference in recovery. 

Here, Riverside Healthcare’s Joanna Lambert—a primary care nurse practitioner (NP)—discusses what families should know about ear infections and how Riverside providers can help.

What Is an Ear Infection?

An ear infection occurs when bacteria or viruses cause inflammation and fluid buildup in the middle ear—the space just behind the eardrum. “The very basic definition of an ear infection would be when a virus or bacteria infect the space behind the eardrum,” Lambert states. “This space is normally just filled with air. But, when you get the infection, it will fill with pus and become inflamed.”

There are also outer ear infections, commonly known as “swimmer’s ear,” which happen in the ear canal. These infections often develop after swimming or even prolonged bath time for young children, when water lingers in the ear. Symptoms include significant pain when the ear is touched, swelling in the canal, and discharge.

Another related condition is otitis media with effusion, which is not an infection but rather fluid buildup behind the eardrum. This can cause pressure, muffled hearing, or a sensation of being underwater but doesn’t usually come with fever or pain.

Common Symptoms to Watch Out For

The most common sign is ear pain, but symptoms look different depending on age. “Older children can verbalize and tell you they have pain in their ear,” notes Lambert. “Infants and toddlers aren’t going to be able to verbalize it so well, but you’ll see behaviors like pulling or rubbing on the ear, fussiness, poor sleep, and sometimes even diarrhea or fever.”

Ear infections often follow upper respiratory illnesses such as a cold, runny nose, or sore throat, which create the perfect conditions for fluid buildup in the ear.

Why Children Are More at Risk

Ear infections are far more common in children than adults, largely due to anatomy. “Kids’ eustachian tubes are more horizontal, while an adult’s will be more slanted,” Lambert explains. “When you have nasal congestion and drainage, it collects behind that eardrum instead of draining properly. That’s a perfect environment for bacteria.”

Developing immune systems and frequent exposure to germs in daycare or preschool also contribute to higher infection rates. Secondhand smoke exposure can increase the risk further.

Treatment: Watchful Waiting vs. Antibiotics

Not every ear infection requires antibiotics. In fact, Lambert notes that two-thirds of children will recover without antibiotics. Providers often recommend watchful waiting in certain situations, particularly for children over 23 months with mild symptoms.

“We watch these kids for twenty-four to forty-eight hours,” says Lambert. “If they improve, you don’t need to give them an antibiotic. If they don’t improve, then we go ahead and treat.” For children under six months or those with severe pain, high fever, or ear discharge, antibiotics are usually prescribed right away.

Prevention Strategies

While ear infections can’t always be avoided, parents can take steps to lower risk. Lambert recommends keeping infants slightly upright during bottle-feeding, avoiding prolonged pacifier use, and reducing exposure to smoke in the home. Breastfeeding can provide protective antibodies for infants, and good hygiene habits—like handwashing and covering coughs—help reduce illness overall.
“Sometimes it feels like your toddler is sick every other week,” Lambert shares, recalling her own experience as a parent. “That’s just because their immune systems are still developing and learning to fight off viruses.”

When to See a Specialist

For children who have frequent infections—often defined as six in a year or three within six months—providers may refer them to an ear, nose, and throat (ENT) specialist. Tubes placed in the ears can help prevent recurrences by allowing fluid to drain. 

“They’re great at what they do,” Lambert notes. “Most tubes fall out within two years, and by then, kids’ anatomy has changed enough that infections often become less frequent.”

Knowing When to Seek Care

Parents should seek medical attention if their child has severe ear pain not relieved by over-the-counter medication, fever over 102°F, symptoms lasting longer than 48 hours, or ear discharge. In some cases, a ruptured eardrum may occur, but it usually heals with appropriate treatment and follow-up care.

Riverside Healthcare’s primary care team is available to diagnose, treat, and guide families through ear infections and other common illnesses. To find a primary care provider for your family visit myrhc.net/acceptingnew.