Baby Ear Infection: Causes, Symptoms, Diagnosis & Treatment

Written by Rohit Garoo Experience: 9 years

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Did you know? Ear infections are far more common in infants than adults and are difficult to detect as the ears are still concealed. Ear infections quite often cause your baby to cry inconsolably and clingy. So how do you deal with the situation?

MomJunction helps you deal with it. We’ll explain the various reasons, symptoms, and treatments for ear infections in babies. We also familiarize you with the numerous precautions you must take to prevent an infection.

What Is An Ear Infection?

The human ear is segmented into three sections viz. outer, middle and inner. The middle ear is connected to the nasal cavity through a tube called the eustachian tube. The tube is narrow at the beginning but widens as it reaches the middle ear. It is for the most part closed but opens once in a while to equalize the air pressure in the middle ear and drain the fluids secreted by the middle ear. This exposes the middle ear to virus and bacteria from the sinonasal cavity, making the region the primary center of ear infections (1).

What Is An Ear Infection
Image: Shutterstock

Ear infections are of three types:

  1. Acute otitis media (AOM)
  2. Otitis media with effusion (OME)
  3. Chronic otitis media with effusion (COME):

AOM is the case when the middle ear suffers a bacterial or viral infection, causing severe pain and discomfort. OME is also referred to as glue ear and is caused when there is an accumulation of fluid in the middle ear that eventually gets infected by bacteria. When this condition repeatedly occurs with or without an infection, then it is called chronic otitis media with effusion (COME).

When the baby develops an infection in both his ears, then it is a case of bilateral ear infection. In any case, the baby will show discomfort due to an inflammatory reaction of the tympanic membrane, also known as the eardrum.

Why Are Babies More Prone To Ear Infections?

According to Dr. Margaretha Casselbrant of Children’s Hospital of Pittsburgh, ear infections are the next common ailment among babies after a common cold. Babies are prone to ear infections primarily due to the following reasons:

1. Underdeveloped immune system

Babies have an underdeveloped immune system. This invariably means they have less resistance to fight pathogens and take a longer time to fight an infection.

2. Developing eustachian tubes

Like many other parts of their body, eustachian tubes are also still developing. These tubes are shorter, narrower and horizontal in babies (2). This makes it easier for mucus and fluids to move from the nasal cavity to the middle ear but difficult for it to drain back. As your baby grows, the eustachian tube will slowly become longer and more vertical. For this reason it is not advisable to let your baby feed while lying flat.

In short, a baby’s developing body makes him vulnerable to ear infections. But you might want to know the causes of ear infection in babies so that you can be careful.

What Causes Ear Infection?

Ear infection can be the result of several factors, right from a cold to allergies. Here are some common reasons for ear infection:

1. Common cold

Cold is the leading cause of ear infection in babies. The cold viruses can conveniently travel to the middle ear through the short eustachian tube and cause a swelling of the tubes and the middle ear. The swelling entraps the natural fluid-like secretions of the middle ear, which may soon become a harboring site for organism growth, leading to infection. Organisms causing this are several viruses of which Rhinovirus is the most common. However several bacteria can also cause otitis media. The most common bacteria causing this is Streptococcus, Haemophilus, Moraxella, Staphylococcus, ect.

2. Allergy

General allergy towards a certain food or airborne irritants can lead to an inflammation of the sinonasal cavity. This can create pressure on the eustachian tube narrowing it down to the point that it can no longer allow the passage of the fluids from the middle ear to the nasal cavity. This can lead to infection in the fluid collected in the middle ear.

Sometimes, an allergy may show a direct effect on eustachian tube causing it to swell.

3. Sinonasal infection

Sinusitis, the infection of nasal sinuses, cause the eustachian tube to swell, thus creating pressure on the middle ear (3). The bacteria may infect the inner lining of the eustachian tube causing it to bloat. Either way, it leads to an ear infection due to the invasion of bacteria in the fluid secreted by the middle ear.

4. Adenoid and tonsil infection

Adenoids are a pair of lymphatic tissue, quite similar to tonsils, located right above the posterior end of the nasal cavity. Just like tonsils, they are known to play a role in maintaining the immunity of the body. When adenoids or tonsil inflame, due to bacterial or viral infection, they can put pressure on the eustachian tube that is small and horizontal in babies. Babies have larger adenoids than adults making them more prone to blocked eustachian tubes due to swollen adenoids (4).

5. Accumulation of milk in eustachian tube

Babies that are bottle-fed and drink milk on their back are at a greater risk of having an inflamed eustachian tube as milk rolls down from their mouth into the ears while feeding. The oral and nasal cavities are connected and drinking while on the back can cause the milk to pass into the nasal cavity. From here the milk can move towards the middle ear by passing through the horizontal eustachian tubes of the baby. Here the milk may get accumulated with the natural milk bacteria causing infection and inflammation.

Risk Factors

There are certain conditions that can put your baby at a higher risk of contracting an ear infection. Following are the common risk factors for ear infections:

  1. Premature babies: Premature babies are born with an immensely underdeveloped immune system (5). They also have a poorly developed first line of defense, such as skin and mucus membrane, that help keep bacteria at bay.
  1. Babies that suffered serious illness early in life: Those affected by a disease during early months of their life can have a weakened immune system. Such babies are prone to ear infections.
  1. Babies constantly exposed to pollutants: Pollutants can be something as generic as cigarette smoke. They can harm the baby’s immunity development, eventually making him prone to various infections.
  1. Babies in daycare settings where there a number of babies in a group.

Signs And Symptoms Of Ear Infection

Your baby cannot talk. The only way he can communicate is through his cries. But his cry can mean many things, so how can you understand that he is crying due to ear infection? Recognize the symptoms:

1. Fluid discharge from the ear

It is the paramount sign of an ear infection. If you notice a clear or yellowish-red fluid draining from your baby’s ears, then it definitely means something is wrong. A perforated eardrum could be leaking the accumulated and infected fluid from the baby’s middle ear. The yellowish nature of the fluid is due to the buildup of pus that is an aggregation of white blood cells that attack pathogens. It is thus a definite indicator of an infection. This is a late sign, and hopefully can be prevented by investigating earlier why your baby is so uncomfortable.

2. Unpleasant smell from the baby’s ear

You may notice an unpleasant smell emanating from the baby’s ear even when he is clean. The smell is distinct from that of ear wax and lasts for days together. The smell usually derives from the pool of infected fluid that lies behind the eardrum.

3. Tugging at ears while crying

The baby may tug at his ears especially during his chronic bursts of crying. It is a sign of discomfort in that part of the body. Your baby may tug or pinch severely when he is lying down or sleeping. Since young babies cannot talk, tugging at the ear is their way to communicate a feeling of discomfort.

4. Fever

An ear infection can cause high fever for several days without any visible illness. This means the baby will not have a cold or any other infection, but his temperature will be more than 102 degrees F. According to Dr. Max M. April from the American Academy of Otolaryngology, a constant fever around 102 degrees F is one of the hallmarks of a baby’s ear infection.

Sometimes, your baby may not have a fever but may still have an ear infection. Dr. Jennifer Shu of American Academy of Pediatrics states that parents must also check for other symptoms of ear infection and not just rely on the fever.

5. Delayed or lack of response towards sounds

An ear infection can be one of the several underlying reasons for a baby’s lack of response to sounds. When fluid builds up in the middle ear, it slows the passage of sound towards the inner ear. The infection makes the fluid thicker, thus impeding the movement of sound impulses from the outer ear to the inner ear. It means your baby will have trouble responding to sounds and voices.

6. Reduced appetite

Eustachian tubes widen naturally while swallowing (6). During an ear infection, the walls of the tube swell thus making their widening quite painful. For this reason, the baby may want to avoid the feeds. He may get irritable when he is coaxed to feed and stop halfway. In some cases, the baby may make choking sounds or cough due to the pain caused by the infection.

7. Loss of balance

If your baby is old enough to crawl or walk a few steps on his own, then he may lose his balance. His walk can be unstable. He might also crawl in a zig-zag pattern. This could mean that the fluid buildup in the middle ear is so much that it now puts pressure on labyrinth – the part of the inner ear also responsible for maintaining body balance. In a worst-case scenario, it could mean the infection has trickled down to the inner ear but this is not likely to happen until or unless every symptom of middle ear infection is neglected.

8. General irritability

The baby may show signs of general irritability especially when he is being held or lying down. It means that the baby is feeling uncomfortable, which is an indicator of an ear infection.

Sometimes the symptoms of ear infection are misleading. They might actually be pointing at some other condition, while you are busy finding a cure for the ear infection.

Ear infection or teething?

There can be situations where you baby has no ear infection but may still be irritable and pull his ears. If he is generally healthy, then it can be that the baby is feeling pain in the gums due to teething. Here is how you can differentiate between the symptoms of ear infection and teething:

  • The first teeth to emerge are the lower central incisors that are present on the lower jaw. Since lower jaw hinges to the skull at a point quite close to the ears, the teething pain from the lower jaw may radiate to the ears. If your baby is tugging the ear around the time when he is teething in the lower, consider this point too.
  • The first teeth can appear anytime between four to seven months. Therefore ear pain due to teething is possible only after four months of age.
  • In teething ear pain, the baby will show no general symptoms of ear infection and will quite likely feel irritable only when fed.
  • There will be no fever since there is no infection. Even if the baby develops a fever, it will not be greater than 101 degree F.
  • Teething will not cause cold or a runny nose (like in ear infection) but causes excessive drooling.
  • Whereas ear infection pain aggravates when the baby is placed on his back, teething pain is not dependent on the position of the baby. Therefore, the baby may cry spontaneously any time and in any position.
  • Usually, when babies cry due to teething, they can be soothed. But in an ear infection, the baby can constantly be colic.

Observing your baby’s symptoms and learning more about ear infection will help you differentiate between an actual ear infection and earache during teething. It is always safe to take your baby to the doctor when you are in doubt.

When you are affirmative about symptoms of ear infection, then you need to take the baby to a doctor.


A pediatrician can diagnose your baby’s condition through one or more of these methods:

1. Ask about the symptoms

The pediatrician will ask about the symptoms that you have noticed in your baby. He will also inquire about his past medical history and whether he suffered cold or throat infection in the recent past. This will help your doctor to conclude on the baby’s ear infection.

2. Use of otoscope

Your pediatrician will look at the baby’s ears using a lighted camera-like instrument referred to as an otoscope. Otoscope will help the doctor see the eardrum better. An inflamed or reddened eardrum indicates the presence of an infection. The physician will also use a pneumatic otoscope that sends a puff of air into the ear canal. A normal eardrum will move to and fro due to the air. But an eardrum having infected fluid behind it cannot move freely.

3. Tympanometry

Tympanometry involves the placing of a small plug-like speaker with a sensor inside the ear of your baby. It is connected to a device that emits sounds at different frequencies. The sensor then measures the movement of the eardrum at the various frequencies by detecting the change in the air pressure in the ear canal. An impaired movement of the eardrum will show abnormal changes in the air pressure, which can help the doctor detect the presence of an ear infection.

Treatment Of Ear Infection

Once your pediatrician has made an affirmative diagnosis of an ear infection, he will quite likely take the following course of remedy:

1. Antibiotic prescription

The doctor will prescribe a course of antibiotics to treat the infection and prevent it from recurring.He may also prescribe oral antibiotics depending on the age of the baby. Your pediatrician may also prescribe certain pain relief medication to alleviate the pain and help the baby sleep and feed more comfortably. If the eardrum perforated a topical antibiotic eardrop can be used.

2. Tympanocentesis

If the accumulation of the fluid in the middle ear is too severe, the doctor may recommend its drainage through a process called Tympanocentesis. This is a subsequent step, though, which is taken only if the antibiotic treatment has failed or the baby’s condition worsened. In this process, the doctor will puncture the eardrum with a thin needle to drain the middle ear fluid. Apart from providing immediate relief, the drained fluid can be sent for laboratory analysis to determine the actual cause of infection.

3. Use of tympanostomy tubes

The tubes are used when the baby suffers from a chronic aggregation of fluid in the middle ear, eventually leading to repeated ear infections. Tympanostomy tubes are tiny plastic tubes of 1 to 1.5mm length open at both the ends. The doctor inserts the tube right into the eardrum, and it stays there for six to 12 months. It eventually falls off on its own as the eardrum grows and expands. In some extreme cases, a longer duration tube could be used. This will stay in the ear for over three years or more depending on the severity of the case.

The purpose of tympanostomy tube is to maintain equilibrium in the air pressure outside and inside the middle ear. This helps keep the middle ear ventilated thus facilitating the evaporation of fluid in baby’s ear that builds up in the region. If there is an accumulation of fluid or mucus in the middle ear, then it will simply trickle down the ear canal through the hole in the tympanostomy tube. It is very important, if these tubes are inserted, to prevent water coming into the ears, as thus can cause infection by entering the middke ear through these tubes.

4. Removal of adenoids

If your baby shows a chronic ear infection as a direct consequence of repeated adenoid infection, then your doctor may recommend a surgical removal of the adenoids. It is an invasive procedure and is recommended when adenoids are the cause of the problem, and no other medication shows satisfactory results.]

Tips To Alleviate The Baby’s Earache

Remember you must never attempt treating your baby’s ear infection on your own. At most, you can aim at relieving the intensity of the pain.

Never put any oil, eardrops or cotton buds to inspect or mitigate your baby’s ear pain (7). So, what can you do to relieve his pain?

1. Sleep with the sore ear up

Let your baby sleep with his infected ear side up. This will cause the gravity to move the fluid in the middle ear downwards eventually draining it to the nasal cavity from where it can move out of the nostrils.

2. Keep your baby’s nose clear

Pinch and wipe your baby’s nose from time to time. Like mentioned in the previous point, middle ear fluid can find its way to the nostrils for discharge. A clear nostril can help in easy movement of the fluid. It also prevents the movement of the mucus upwards through the eustachian tube towards the middle ear.

3. Wiggle the ears

According to popular American pediatrician Dr. William Sears, wiggling the baby’s ears can help reduce ear pressure by making middle ear fluid slowly trickle downwards from the eustachian tube. Gently pinch your baby’s ear lobes and move it sidewards. Do not pull the ear rather move them gently at the same place.

4. Use warm compress

Dip a soft cloth in warm water and squeeze the excess water out. Place the warm cloth on the affected ear of the baby. This can help relieve the irritation caused by the ear infection and provide relief to the baby.

Earache is unbearable even for an adult. Imagine how difficult it would be for a baby who cannot express his pain in words. Instead of acting after the ear is infected, take some precautions to avoid the problem.

Prevention Of Ear Infection

Here are some easy ways you can prevent the onset of an ear infection in your little one:

1. Maintain basic hygiene

Basic hygiene is the first step towards ensuring that the baby is not overwhelmingly exposed to a set of infections that his immune system is not yet ready to tackle. Give your baby regular baths and wash his hands periodically since babies tend to put them in their mouth. Also, ensure the baby is handled by individuals whom you can trust with their health and hygiene since cold is commonly spread through contact with infected individuals. Keep the baby’s toys and bottles clean by regularly disinfecting them.

2. Breastfeed your baby

Breast milk is the best food for your baby not just in terms of nutrition but also in helping him build immunity. Breast milk is rich in antibodies that can provide your little one the much-needed resistance against various disease-causing pathogens. In fact, a study by the US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) showed that the babies breastfed for the first six months of their lives are less likely to develop an ear infection.

3. Immunize your baby

Pediatricians recommend several immunizations right after the birth of your baby and during the first 12 months of his life. Do not miss those immunization shots since it helps the baby develop immunity towards numerous pathogens that can indirectly lead to an ear infection. These vaccinations include those for flu, influenza, and pneumonia (8), which in a way affect the eustachian tube.

4. Avoid daycare centers

Daycare centers can be breeding grounds for bacteria as there are many other babies in the facility. Your baby may come in contact with infected children or daycare workers, resulting in an ear infection.

5. Do not expose the baby to cigarette smoke

Tobacco smoke paralyzes the tiny hair-like structures present in the eustachian tube that are responsible for keeping the tube clean. This increases the risk of fluid and mucus accumulation. Studies have shown that babies exposed to second-hand cigarette smoke are prone to ear infections.

6. Do not bottle feed the baby on his back

Since milk flows faster from bottle than breast, there is a risk of the milk flowing into the eustachian tubes. Feeding on the bottle while lying on the back can cause the milk to flow into the nasal cavity. From here it can enter the eustachian tube and get stranded. This creates perfect conditions for bacteria to thrive on the stagnated milk, which over the course of time can lead to ear infections.

Therefore, the best position to bottle feed your baby is to hold him on your lap at an inclination and prop the bottle horizontally in his mouth. If your baby can hold the bottle, then make sure his crib or bed is in a horizontal position.

7. Be proactive about allergies

Make sure you bring all of your baby’s allergies under prompt medical attention. Prevention or treatment of the triggers ensures that there are fewer chances of ear infection.

8. Baby ear infection and flying

Many parents have reservations about travelling by air when a baby has an ear infection. It is understandable since traveling by air can cause fluctuations in the ear-nasal air pressure. It occurs due to the difference between the air pressure inside the aircraft (low pressure) and the middle ear (high pressure). This pressure difference causes the eustachian tube to open widely to equalization the pressure. However, it can be a painful process for babies suffering from ear infection.

If the baby has a serious ear infection, then flying could rupture eardrum due to pressure imbalances. However, it seldom happens and you can give your baby something to drink once the plane reaches a stable high altitude and the cabin pressure starts dropping. You can know the drop in the pressure as the ears make clicking sound while swallowing. Swallowing is a process that causes eustachian tubes to open. Feeding your baby in flight can help ease the pressure before the natural onset of high pressure inside the middle ear.


When left untreated for a long time, ear infections can have serious consequences. One of the biggest outcomes is the diminished ability to hear that can further transform into deafness. A ruptured eardrum is another complication. Following are some major problems that can occur due to repeated ear infections:

1. Mastoiditis

This is a condition where the bone beneath the ear called mastoid gets infected. Mastoid has air pockets, which drain into the middle ear. An infection in the middle ear increases the risk of mastoiditis since it exposes the mastoid bone to bacteria and viruses (9).

2. Cholesteatoma

This happens due to repeated ear infections. Cholesteatoma is an abnormal accumulation of cells inside the middle ear right behind the ear drum. These accumulated cells appear as thick sheets of dead skin that eventually can cause damage to the bones of the middle ear (10).

3. Labyrinthitis

Sometimes a severe middle ear infection can trickle to the inner ear infecting the labyrinth bone. This condition occurs when the infection is neglected for a long time.

4. Meningitis

In some cases, the bacteria from the middle ear may move into the nasal cavity from where it could enter the central nervous system. The bacteria may also enter the central nervous system through the labyrinth bone in case the baby suffered labyrinthitis. Either way, it can cause a serious nervous system infection called meningitis.

Ear infection in infants is painful, and doesn’t sub-side easily. You will feel helpless when the baby cries non-stop. This is when you need to stay balanced. Do not panic but think what you need to do to alleviate his pain.

Consult a pediatrician when you feel something is bothering your baby as self-medication will turn the problem from bad to worse.

Do you have an experience to share? Do let us know. Leave a comment below.

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Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University. Also, he holds a certificate in Developmental Psychology from The University of Queensland and loves to expand his knowledge through certifications in full bio

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