Ear infections, medically known as acute otitis media, are among the most common middle ear infections in both children and adults. While they occur far more frequently in infants and young children, adults can also develop acute otitis media, often in the setting of respiratory illness or sinus disease.
Understanding how ear infections develop, how symptoms differ by age, and when treatment or medical evaluation is needed can help reduce discomfort and prevent complications.
This guide, with insights from Alyssa M. Hackett, MD, a pediatric ear, nose, and throat specialist, explains acute otitis media in clear, practical terms, with specific sections for children and adults to reflect how ear infections present and are managed at different stages of life.
What Is Acute Otitis Media?
Acute otitis media is a middle ear infection that affects the air-filled space behind the eardrum, an area essential for hearing and pressure regulation. When fluid builds up in this space and becomes inflamed or infected by bacteria or viruses, symptoms such as ear pain, pressure, and hearing changes can occur.
Dr. Hackett explains, “There are two major types of ear infections, acute otitis media… and acute otitis externa (swimmer’s ear).” Unlike swimmer’s ear, which involves inflammation of the ear canal and is often linked to water exposure in warm or humid environments, acute otitis media most commonly develops after a cold or upper respiratory illness. Water exposure does not cause acute otitis media unless there is a hole in the eardrum.
Acute otitis media also differs from chronic ear infections, which involve repeated or long-lasting inflammation or persistent fluid buildup over time.
How Acute Otitis Media Develops
Ear infections often begin after a cold, sore throat, or sinus infection. These illnesses can cause swelling in the nasal passages and Eustachian tubes, which connect the middle ear to the back of the throat.
The Eustachian tubes play an important role in equalizing air pressure and draining fluid from the middle ear. When these tubes become blocked or do not function properly, fluid can accumulate behind the eardrum, creating an environment where bacteria or viruses can grow.
This buildup increases pressure in the middle ear and often leads to pain, inflammation, and other symptoms of infection.¹
Who Gets Acute Otitis Media?
Acute otitis media can affect people of all ages, but it occurs much more often in children than in adults.
Children
Acute otitis media occurs most frequently in infants and young children due to differences in ear anatomy. As Dr. Hackett explains, “Acute otitis media is more common in children because their normal drainage pathways… are shorter, more horizontal, and the muscles opening and closing them don't work as well.”
This makes it harder for fluid to drain and easier for infection to develop. As children grow, their ear anatomy matures, and ear infections tend to occur less often.
Adults
Adult ear infections are less common, but they can still occur, often developing alongside upper respiratory infections, sinus problems, allergies, or eustachian tube dysfunction, with symptoms more likely to involve pressure or hearing changes rather than classic childhood ear pain.
Symptoms of Acute Otitis Media
Symptoms in Children
Children may not always be able to describe what they are feeling, so symptoms can include both physical and behavioral signs.
Common ear infection symptoms in children include:¹
- Ear pain
- Fever
- Fussiness or irritability
- Trouble sleeping
- Decreased appetite
- Pulling or tugging at the ears
- Trouble hearing or responding to sounds
- Fluid draining from the ear
- Balance difficulties
As Dr. Hackett notes, “The most common signs of an ear infection in babies and children include ear pain, fever, fussiness, trouble sleeping, decreased appetite, and pulling or tugging at the ears.” Older children may describe a feeling of fullness, pressure, or decreased hearing, with or without fever.
Symptoms in Adults
Symptoms in adults are uncommon but may include:¹
- Ear pain or pressure
- Hearing changes or muffled hearing
- A feeling of fullness in the ear
- Ear drainage
- Fever
- Dizziness or balance concerns
Common Causes and Risk Factors
Pediatric Risk Factors
Children may be more likely to develop ear infections due to:¹,²
- Immature Eustachian tube development
- Frequent colds or respiratory infections
- Group childcare exposure
- Drinking while lying down
- Pacifier use
- Exposure to secondhand smoke
- Not being up to date on vaccinations
Adult Risk Factors
Risk factors for adult ear infections may include:¹
- Sinus infections or allergies
- Upper respiratory infections
- Smoking or smoke exposure
How Acute Otitis Media Is Diagnosed
Healthcare providers diagnose acute otitis media through a medical history and physical exam, using an otoscope to look for signs of fluid, inflammation, or infection behind the eardrum.
Additional testing may include:²
- Tympanometry to measure middle ear pressure and movement of the eardrum
- Acoustic reflectometry to help detect fluid behind the eardrum by measuring how sound reflects off the middle ear
- Hearing evaluations when fluid buildup or hearing changes are suspected
Diagnosis may differ slightly between children and adults based on symptoms and risk factors.
Acute Otitis Media Treatment
Treatment depends on age, symptom severity, medical history, and overall health.
Treatment in Children
Some ear infections can be treated with over-the-counter medications to help manage pain and discomfort. As Dr. Hackett explains, “Not all ear infections in children require antibiotics, as many mild cases—especially those caused by viruses—can resolve on their own.” In older children with mild symptoms, a period of careful observation may be appropriate.
Symptom relief may include:¹
- Age-appropriate acetaminophen or ibuprofen
- Adequate hydration and rest
- Warm compresses applied gently to the ear
Treatment in Adults
Adults with acute otitis media may also be managed without immediate antibiotics when symptoms are mild. Treatment focuses on relieving pain, addressing contributing sinus or respiratory conditions, and monitoring symptoms over time. Antibiotics may be recommended when a bacterial infection is suspected or symptoms do not improve.
Adults with acute otitis media are typically treated with:¹
- Pain management medications
- Treatment of underlying sinus or respiratory conditions
- Antibiotics when bacterial infection is suspected
- Monitoring for symptom improvement
Possible Complications if Left Untreated
Although many ear infections resolve without complications, untreated or recurrent infections can lead to:¹,³
- Temporary or permanent hearing loss
- Speech or language development delays in children
- Persistent middle ear fluid
- Recurrent infections
- Rarely, infection spread to nearby structures
When to See a Healthcare Provider
Knowing when to seek medical care for ear infection symptoms can help prevent complications and support proper healing.
Children
Dr. Hackett advises, “Parents should seek medical care if symptoms are severe, last more than 48 hours, are accompanied by high fever, or if there is drainage from the ear.” Infants under six months should always be evaluated promptly if an ear infection is suspected.
Medical follow-up is also important for children who experience recurrent ear infections or have persistent fluid in the middle ear, particularly when hearing or speech development may be affected, as further evaluation by a pediatric ENT may be needed.
Adults
Adults should seek medical evaluation if ear pain persists, hearing changes develop, or symptoms worsen instead of improving. Drainage from the ear, dizziness or balance problems, and recurrent ear infections are also reasons to seek care, as these symptoms may indicate complications or an underlying condition that requires treatment.¹
Preventing Ear Infections
While ear infections cannot always be completely prevented, both children and adults can take steps to reduce the risk of acute otitis media and fluid buildup in the middle ear. Prevention strategies focus on limiting inflammation, supporting healthy ear drainage, and reducing exposure to common triggers.
Children
Strategies to avoid ear infections in babies and children include:¹
- Reducing or eliminating pacifier use when possible
- Avoiding exposure to tobacco smoke
- Encouraging breastfeeding when appropriate
- Keeping up to date with routine vaccinations, including flu and pneumococcal vaccines
Adults
Adults can prevent ear infections by:²
- Managing allergies and sinus conditions
- Avoiding smoking and secondhand smoke
- Treating respiratory infections promptly
- Supporting overall immune health
Frequently Asked Questions
Are ear infections contagious?
Ear infections themselves are not contagious, but respiratory infections that can lead to ear infections may spread between individuals.
Do all ear infections require antibiotics?
Many mild infections resolve without antibiotics, particularly those caused by viruses. Providers determine treatment based on symptoms and risk factors.
Can untreated ear infections cause hearing loss?
Persistent or recurrent infections can lead to temporary or, in rare cases, permanent hearing loss if not properly treated.³
Expert Ear Infection Care for Every Stage of Life
Acute otitis media is a common but treatable middle ear infection that can affect both children and adults, and early, expert care can make a meaningful difference in comfort, recovery, and long-term hearing health. Recognizing symptoms early and understanding when evaluation is needed helps prevent complications and ensures timely treatment.
ENT & Allergy Associates provides comprehensive ear infection care for adults and children, with experienced specialists who tailor treatment to each patient’s age, symptoms, and medical history. With convenient locations across New Jersey, New York, Texas, and Pennsylvania, expert adult and pediatric ENT care is close to home when you need it most.
If you or your child is experiencing symptoms of an ear infection, scheduling an evaluation can help you get clear answers and the right care sooner. Schedule an appointment online today.
Sources:
MedlinePlus. Ear infection - acute.
Healthline. Acute Otitis Media: Causes, Symptoms, and Diagnosis.
- MedlinePlus. Ear infection - chronic.