Why Do Children Get Ear Infections More Than Adults?

A Keck Medicine of USC ear, nose and throat expert explains why middle ear infections tend to develop more in children.

There are three areas of the ear where infections can occur: the outer ear (the ear canal), the middle ear (behind the eardrum) and the inner ear. Middle ear infections, which are often described as an earache, are more common in children. By age three, 50%-85% of children have experienced at least one middle ear infection.

There’s a clear anatomical reason for this, says Seiji Shibata, MD, PhD, an otolaryngologist with the USC Caruso Department of Otolaryngology – Head and Neck Surgery, part of Keck Medicine of USC. Children are more prone to middle ear infections because their eustachian tubes, the narrow passageways connecting the middle ear to the back of the throat, are more horizontally positioned and narrower than adults’. This creates poor drainage and allows for easier bacterial movement from throat to ear.

The primary trigger for a middle ear infection is often an upper respiratory infection. When children get colds, congestion blocks their already vulnerable eustachian tubes. Children are vulnerable to colds due to their less mature immune systems. “Greater exposure to other children who also have immature immune systems allows upper respiratory infections to spread rapidly in this population, triggering more middle ear infections,” Dr. Shibata says.

By contrast, adults have usually outgrown any issues related to their eustachian tubes. Instead, adults mainly get outer ear infections, called “swimmer’s ear,” from water exposure, improper cleaning or disturbance of the ear’s natural acidic environment and protective earwax. The exception is adults with eustachian tube dysfunction; they can still get middle ear infections, Dr. Shibata says.

How to diagnose and treat an ear infection

Ear infections present different symptoms depending on their location (e.g., the outer ear versus the middle ear). Outer ear infections cause pain especially when you pull on or touch the ear. Middle ear infections often cause muffled hearing. Meanwhile, infections of the inner ear are rare but more serious, potentially causing deafness and vertigo, and require immediate attention.

Dr. Shibata recommends seeking medical help if symptoms from an ear infection worsen or don’t improve within a few days. However, if you also experience hearing loss, not just muffled hearing, talk to your doctor as soon as possible.

Dr. Shibata also offers several prevention strategies:

For middle ear infections:

• Prevent respiratory infections: Wash hands, wear masks when needed and clear nasal passages regularly.
• Stay hydrated and manage allergies to keep eustachian tubes functioning properly.
• Consider vaccinations: Pneumococcal vaccination can help prevent certain infections.

For outer ear infections:

• Leave ears alone: Resist the urge to clean inside your ears. “There is a misconception that you need to regularly clean your ears,” Dr. Shibata says. “You don’t really need to; the ear is self-cleaning.” If you feel you must, wiping away visible wax from outside the ear canal is sufficient.
• Keep ears dry: Try using a hair dryer at arm’s length to dry out the fluid in your ear.
• Use alcohol and vinegar drops after swimming to help dry and maintain the ear’s protective acidic environment.
• Choose over-ear protection instead of earplugs when possible.

How to treat recurrent ear infections

If ear infections recur, you should see an ear, nose and throat specialist, Dr. Shibata says. Children who have several ear infections per year might want to also consider ear tubes — hollow tubes placed in the eardrum to prevent fluid buildup in the middle ear.

People with diabetes or compromised immune systems should be particularly vigilant in treating an ear infection. “These small ear infections can have serious consequences if your immune system is compromised,” Dr. Shibata says. So, if you notice the symptoms, touch base with your doctor to learn what they might recommend.

Finally, do what you can to avoid upper respiratory infections. Most ear infections get better on their own within a few days. Understanding what causes them — whether it’s respiratory infections in children or water exposure in adults — helps you take simple preventive steps and know when medical attention is truly needed.

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