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Ear infections may be on the rise in kids and adults as respiratory viruses continue to surge

With a surge in cases of flu, RSV and COVID-19, it's possible many kids could also develop bacterial complications, like ear infections.
/ Source: TODAY

The recent surge in children's respiratory viral illnesses may also be causing a rise in related complications, such as ear infections.

For Nicole Herrador, a school-based occupational therapist in Lindenhurst, New York, that came as a surprise.

When her 11-year-old son developed body aches and a high fever the week before Christmas, she took him to the doctor suspecting he had the flu. At the doctor's office, they swabbed him for flu, respiratory syncytial virus (RSV) and COVID-19 — and checked his ears.

"They said that his ears were severely inflamed and red and full of fluid," she tells "He didn't really complain about any symptoms relating directly to the ear infection." If she hadn't taken him to the doctor, "I would have never known." 

At that point, he was diagnosed with an ear infection and given antibiotics. But a few days later, when the test results confirmed he also had the flu, the doctor's office told Herrador that the flu was likely causing his ear infection.

Amid the surge in pediatric cases of flu, RSV and COVID-19, experts tell that they're also seeing more patients dealing with complications arising from those viral illnesses — including some surprises, like the ear infection Herrador's son experienced.

The so-called "tripledemic" is still ongoing

“Both RSV and influenza virus levels are coming down a little bit, which is welcomed,” Dr. Aaron Milstone, a pediatric infectious disease specialist at the Johns Hopkins Children’s Center, tells “Unfortunately, COVID levels seem to be going up.”

And, so far, the strain on hospital systems has largely continued, Dr. Ishminder Kaur, assistant professor of pediatrics in the division of infectious diseases at UCLA’s David Geffen School of Medicine, tells

Although the levels of each virus have changed over the past few weeks, “it’s just been one after another,” she says.

After a decline, doctors are now seeing more ear infections again

Research published last spring shows that pediatric ear infections generally became less common during the first year of the COVID-19 pandemic, Kaur says. Data from the Centers for Disease Control and Prevention also show a significant decrease in hospital admissions in hospital visits related to ear infections in kids.

But as the pandemic continued into 2021 with fewer public health precautions in place, ear infections became more frequent again.

The authors of last spring's research, which looked at 48 U.S. children's hospitals, noted two increases in ear infection cases — one in April 2021 and another in June 2021 — which were more pronounced in some areas of the country. The April increase was most significant in the South, Midwest and Northeast while the June increase was driven mainly by cases in the South and Midwest.

Data from Italy shows a similar pattern in the primary care setting: a drop in both cases of ear infections and the number of prescriptions for antibiotics to treat pediatric ear infection cases at the height of the pandemic, followed by an increase in prescriptions during the "post-lockdown" periods in 2021 and 2022.

"As we get through this winter and look at data, we might see the number (of ear infections) even went higher proportionately because of the higher number of viral upper respiratory infections," Kaur says.

A spike in ear infections would "make sense when you have just so many kids with respiratory viral illnesses right now," Milstone agrees.

Chanda Costa, a stay-at-home mom in New Jersey, has been experiencing a surge of her own. She tells that all four of her children are currently recovering from ear infections related to viral respiratory illnesses — for the third time in a year.

Two rounds of COVID-19, a case of pneumonia and a case of RSV and now this bout of illness have made this Costa's "worst year in all my years of parenting as far as sickness goes," she says. "It's been terrible."

Doctors are even seeing rarer bacterial complications of viral illnesses more frequently than normal, likely due to the sheer number of kids who are sick.

"Because there are so many more kids getting infected, we're going to just see more of these rare complications," Milstone says. For instance, that includes complications like mastoiditis, which is an infection of the bone behind the ear that can develop due to a middle ear infection, MedlinePlus explains.

"We've definitely seen a couple more cases of mastoiditis in the last few months than we've seen in prior winters," Milstone says, adding that he thinks it's likely "just because we're seeing more kids with respiratory illness who get complicated ear infections."

Hospitals are reporting more cases of rare invasive strep A infections among kids, Kaur notes. Invasive strep A, like bacterial ear infections, can develop on the heels of a viral illness.

Can COVID-19, RSV and flu cause ear infections?

The short answer is that, yes, upper respiratory illnesses caused by viruses can lead to ear infections down the line.

In some cases, as with RSV, the virus can directly cause an infection in the ear, Kaur explains. But in many other instances, the virus causes inflammation in the area that sets the stage for a separate bacterial infection to take hold.

It's often down to simple anatomy. The eustachian tube connects the area behind your nose — the nasopharynx — to the middle ear, Kaur explains. "When you have a viral infection, there is mucus buildup, inflammation and swelling, which alters the function of that tube," she says. That leads to the buildup of fluid in the area and, ultimately, the collection of enough bacteria to cause an infection.

Many different kinds of viral respiratory infections can create the opportunity for a bacterial ear infection, including RSV, influenza, adenovirus, rhinovirus and more.

Earlier in the pandemic, doctors weren't sure if COVID-19 could also lead to ear infections. "But what we've learned from COVID is that can anything can happen," Milstone says.

Now, both he and Kaur believe it's very possible that COVID-19 could lead to a subsequent ear infection in this way. And a series of eight case studies, published in 2021 in the Journal of Laryngology and Otology, suggests that it does happen.

Do adults also get ear infections like these?

Yes, adults can get ear infections after a case of a respiratory viral infection, too. It's just much less common, Kaur says.

Again, that's partly due to anatomy. "As we grow, our eustachian tube stretches out, and it drains downwards," she explains. That makes it less likely for fluid to get caught and, therefore, reduces the chances for infections to develop.

Adults also have some level of protection against many of these illnesses due to past infections, Milstone says, while kids may be encountering them for the first time. Depending on that level of protection, as well as your lifestyle and behavior, you may be more or less likely to get sick, explained previously.

What parents need to know

First off, know that it's very common for a child to develop an ear infection following a viral respiratory illness — and pediatricians are great at spotting the signs, the experts say.

Ear infections like these typically show up about two weeks after the initial viral illness, Kaur says, and certainly within a month. Parents should be on the lookout for a high fever or a child tugging at their ear after the other symptoms — like a runny nose and cough — have resolved, she adds.

If appropriate, the pediatrician can prescribe antibiotic treatment to address the ear infection. However, not all ear inflammation is due to an infection, and not all ear infections are bacterial. So, your child may not need to get antibiotics.

Although her kids received antibiotics for their previous ear infections, Costa says the doctor didn't prescribe those treatments this time because the infections weren't as severe.

"There could be some cases where the virus itself is just causing a fluid buildup and it's not truly infected," Kaur explains. And in those cases, your child's pediatrician may advise watchful waiting for a day or two first.

Most ear infections don't cause complications, according to the Mayo Clinic, but repeated ear infections and those that go untreated can lead to: hearing loss (temporary or permanent), social or developmental delays (particularly if an infant or toddler loses hearing for a prolonged period), tearing of the ear drum, spread of the infection to the brain or surrounding membranes.

Keep in mind, there are ways to help prevent ear infections. That can include preventing the viral infections that contribute to ear infections through the use of vaccines, masks, hand-washing and other protective tools and behaviors. The pneumococcal vaccines in particular have been shown to reduce the risk for ear infections, Kaur says.

For now, though, we can expect to see COVID-19 continue to spread and, potentially, cause complications like ear infections — especially after so much travel and gathering during the winter holiday season.

"The truth is that people are doing all the behaviors that allow respiratory viruses to spread," Milstone says. That doesn't mean we necessarily need to go back into lockdowns, he explains, "but when we do none of those things, it just allows the viruses to spread at will. So that's where we are right now."

For Herrador, her son's ear infection is a reminder to take these illnesses seriously. She encourages other parents to "go check because you might be surprised when you get there that there's something else going on," she says.

"Listen to your gut," Costa agrees. "And know it will pass."