An ear infection is one of the most common reasons people, especially young children, end up in a doctor’s office, and most people will have at least one in their lifetime. The term usually means acute otitis media, an infection of the middle ear behind the eardrum, though fluid can also build up without infection, and a separate condition called swimmer’s ear affects the outer ear canal instead. An ear infection can cause sudden pain that is especially distressing in a baby who cannot say what is wrong, but most cases are mild and respond well to simple pain relief or, when needed, antibiotics. This guide explains what an ear infection is, its symptoms, causes, how it is diagnosed, the treatments available, and the latest research.
什么是耳部感染？
耳部感染通常是指急性中耳炎，即中耳的感染——中耳是鼓膜后方一个充满空气的小腔，正常情况下不含液体和细菌。这是幼儿就医最常见的原因之一，大多数孩子在入学前至少会经历一次，但各年龄段的人都可能受到影响。中耳通过咽鼓管与鼻腔和咽喉后部相连，咽鼓管的正常功能是排出液体，并维持鼓膜两侧的气压平衡。
The phrase “ear infection” actually covers three related but distinct problems. Acute otitis media is a true infection of the middle ear, usually following a cold. Otitis media with effusion is fluid trapped behind the eardrum without an active infection, often lingering after an infection clears. Otitis externa, better known as swimmer’s ear, is a separate infection of the outer ear canal, unrelated to the middle ear and needing its own treatment. The table below outlines the key differences.
| 病情 | 发生部位 | 主要特征 |
|---|---|---|
| 急性中耳炎（中耳感染） | 中耳，鼓膜后方 | 突发耳痛、发热，以及鼓膜膨出、充血 |
| 渗出性中耳炎 | 中耳，鼓膜后方 | 感染消退后液体残留，或液体自行积聚；通常无痛 |
| Otitis externa (swimmer’s ear) | 外耳道，从鼓膜到外耳开口 | 耳道疼痛、瘙痒或肿胀，常见于游泳后 |
耳部感染的症状
在儿童中，中耳炎的典型表现包括：突发耳痛、用手拉扯耳朵、发热、烦躁不安、睡眠困难、耳道流液，以及对轻微声音反应迟钝。婴儿可能只是比平时哭闹更多、喂养困难或表现出不稳定感。当感染消退后液体仍然残留，或液体自行积聚时，就会形成渗出性中耳炎——患儿通常看起来并无不适，唯一的迹象可能是轻微的耳闷感或听力下降，往往在体检或学校听力筛查时才被发现。
Adults tend to notice a middle ear infection through ear pain or pressure, drainage, and temporary hearing trouble, without the tugging or crankiness seen in babies and toddlers, which can make it easy to mistake for a bad cold. Swimmer’s ear feels different: centered on the outer ear canal, its pain worsens when the outer ear or jaw is touched or tugged, and the canal may itch, redden, swell, or drain fluid, often within a day or two of swimming. Because the pain patterns differ, describing exactly where and how the ear hurts helps a clinician tell these conditions apart quickly.
耳部感染的原因及危险因素
大多数中耳炎由感冒或流感引发。呼吸道病毒引起鼻腔和咽喉发炎，肿胀可蔓延至咽鼓管——这条连接中耳与鼻腔后部的通道，正常情况下负责排出液体并平衡气压。当咽鼓管堵塞时，液体在鼓膜后方积聚，原本无害地寄居于鼻腔和咽喉的细菌（最常见的是肺炎链球菌、流感嗜血杆菌和卡他莫拉菌）便可大量繁殖并引发感染。识别 普通感冒引起的鼻塞症状 或发现 流感引起的发热和全身酸痛 这也解释了为什么耳部感染多发于秋冬季节。
Children get far more middle ear infections than adults mainly because of anatomy: a young child’s eustachian tube is shorter, narrower, and more horizontal, so it drains less efficiently and lets germs travel up from the nose and throat more easily. Immature immune defenses and larger adenoid tissue, which can itself block the tube, add to the risk, and children outgrow much of this vulnerability as the tube lengthens with growth. Other risk factors include age 6 months to 2 years, daycare attendance, bottle-feeding while lying down, pacifier use, allergies, secondhand smoke, and a family history of ear infections. Swimmer’s ear has a different cause: water trapped in the ear canal after swimming softens the skin, and scratches from cotton swabs or earbuds can break it, letting bacteria overgrow in the warm, moist canal.
耳部感染如何诊断
中耳感染的诊断首先需要使用耳镜仔细观察耳道内部，医生可借此检查鼓膜是否出现发红、膨出或混浊。气动耳镜检查会向耳道内轻轻吹入一股气流，以测试鼓膜的活动度；若鼓膜膨出且几乎不动，提示有感染性积液在压力下积聚；若鼓膜内陷、活动受限但无发红，则可能仅为积液，即渗出性中耳炎。当诊断不明确时，可通过鼓室测压法测量鼓膜的柔韧性和中耳压力；对于反复发作的感染或在进行鼓膜置管手术前，还可加做听力检查。
| 测试 | 检测意义 |
|---|---|
| 耳镜检查 | 直接观察鼓膜，判断是否有发红、膨出或混浊 |
| 气动耳镜检查 | 向耳道内吹入气流以测试鼓膜活动度；活动差伴膨出提示存在活动性感染 |
| 鼓室测压 | 测量鼓膜柔韧性和中耳压力，以确认是否有积液 |
| 听力测试（纯音测听） | 用于反复感染、持续积液或鼓膜置管手术前，评估是否存在听力下降 |
耳部感染无法通过血液检查来诊断，诊断依靠耳部检查来确定，因为化验结果很少会改变常规病例的治疗方案。医生仅在特定情况下才会安排血液检查，例如患儿病情较重、疑似感染扩散（如乳突炎），或发热但无明显感染来源的小婴儿。在这些情况下，检查 感染时升高的白细胞计数 以及检测 反映炎症的CRP水平 有助于评估感染的严重程度，并为后续治疗决策提供参考。
耳部感染的治疗方案
中耳感染的治疗首先以缓解疼痛为主，因为耳痛往往是孩子最难受的症状，无论是否同时使用抗生素，对乙酰氨基酚或布洛芬均能有效缓解。对于2岁及以上、症状较轻的健康儿童，"观察等待"是一种被认可的处理方式，即在控制疼痛的同时观察2至3天，再复诊评估，因为许多感染可自行痊愈。当确需使用抗生素时，对于无青霉素过敏史或近期未使用过该类药物的儿童，阿莫西林通常是首选药物。
| 治疗方式 | 作用 |
|---|---|
| 止痛药（对乙酰氨基酚或布洛芬） | 无论是否同时使用抗生素，均可有效缓解耳痛和发热 |
| 观察等待 | 对于符合条件的2岁以上儿童，在控制疼痛的同时，将抗生素使用推迟2至3天 |
| 阿莫西林（或其他抗生素） | 在有抗生素使用指征或症状未能自行缓解时，用于清除感染 |
| 耳管（鼓膜切开置管术） | 为频繁感染或持续积液的儿童引流液体并通气中耳 |
| 抗生素耳滴剂 | First-line treatment for swimmer’s ear, placed directly into the outer ear canal |
Recurrent infections, or fluid lingering about three months or longer with hearing loss, are the usual reasons for ear tubes: tiny tubes placed through the eardrum in a brief procedure that drain fluid, ventilate the middle ear, and reduce how often infections happen. Swimmer’s ear calls for a different approach, treated with topical antibiotic ear drops, sometimes combined with a steroid; oral antibiotics are usually unnecessary because they do not reach effective levels in the canal itself.
与耳部感染共存及长期预后
大多数耳部感染，无论是中耳炎还是外耳道炎，通常在数天至约两周内完全痊愈，大多数儿童和成人的预后良好。出现并发症时，通常也可以得到妥善处理：感染期间的听力下降一般是暂时性的，积液消退后即可恢复；鼓膜因压力破裂后，几乎总能在约72小时内自行愈合。极少数情况下，未经治疗或严重的感染可能蔓延至耳后的乳突骨，引发乳突炎，需要及时就医。因此，若出现疼痛加剧、高烧或耳后肿胀，切勿忽视。
对于频繁感染或积液长期不消退的儿童，更值得关注的是反复听力下降对语言和言语发育的影响，这也是持续性病例需要随访的原因。按时接种肺炎球菌结合疫苗和每年的流感疫苗、尽可能母乳喂养，以及避免二手烟，都有助于降低耳部感染的风险。随着孩子成长、咽鼓管逐渐发育成熟，大多数儿童的耳部感染会越来越少、症状也越来越轻，即使是幼儿期曾多次感染，通常在青春期前也会逐渐好转。
耳部感染研究的最新科学进展
Recent research has focused on making sure ear infection treatment matches the evidence, especially around antibiotic use. According to PubMed-indexed research, a 2025 meta-analysis estimated that US clinicians prescribe roughly 107 million antibiotic-days of therapy every year for acute otitis media in children, and found that fuller adherence to guideline-recommended watchful waiting and shorter courses could cut that total by more than half (Morin et al., 2025). What this means for you: if your child’s doctor suggests watching a mild ear infection for a couple of days before prescribing antibiotics, that approach is backed by strong evidence, not a delay in care.
Other studies have looked at outcomes further down the road. A 2026 study following 7,800 children who had ear tubes placed at a US children’s hospital found that those who got tubes for recurrent infections started with the lowest quality of life but showed the greatest, most lasting improvement, catching up to other groups by 24 months (Kim et al., 2026). What this means for you: ear tubes for a child with frequent infections offer benefits that last well beyond the first few months. A 2026 study of young children in western Pennsylvania found that Haemophilus influenzae, not Streptococcus pneumoniae, is now the leading bacterium in infected middle-ear fluid, with most pneumococcal strains recovered being non-vaccine strains (Martin et al., 2026). What this means for you: pneumococcal vaccination has changed, but not eliminated, the germs behind ear infections, part of why amoxicillin remains the standard first choice.
耳部感染常用术语词汇表
| 术语 | 定义 |
|---|---|
| 急性中耳炎 | 鼓膜后方充气中耳的感染，通常继发于感冒。 |
| 渗出性中耳炎 | 中耳积液，无活动性感染。 |
| 外耳道炎 | An infection of the outer ear canal, commonly called swimmer’s ear. |
| 咽鼓管 | 连接中耳与鼻咽部的狭窄通道。 |
| 鼓室测压 | 一种通过测量鼓膜弹性和中耳压力来检查是否存在积液的检查。 |
| 鼓膜通气管 | 穿过鼓膜置入的微型小管，用于引流积液并为中耳通气。 |
| 乳突炎 | 感染从中耳扩散至耳后乳突骨引起的疾病。 |
关于耳部感染的常见问题
如何判断您或您的孩子是否患有耳部感染？
对于婴幼儿，由于年幼的孩子无法直接表达疼痛，家长需留意以下迹象：揪耳朵、烦躁不安、睡眠困难、发烧以及耳部有分泌物。年龄较大的儿童和成人则更可能主动描述耳痛、耳部压迫感或听力模糊。由于这些症状与其他疾病有所重叠，医生通常需借助耳镜观察鼓膜来确诊。
耳部感染不用抗生素能自愈吗？
是的，许多轻度中耳炎无需抗生素即可好转。对于2岁及以上、症状较轻的健康儿童，在做好疼痛管理的前提下，观察等待两到三天是一种被广泛认可的处理方式。如果疼痛加重或在此期间未见改善，通常会开始使用阿莫西林等抗生素治疗。
What’s the fastest way to relieve ear infection pain at home?
按年龄剂量服用非处方对乙酰氨基酚（扑热息痛）或布洛芬，是感染消退或抗生素起效期间缓解疼痛最可靠的方法。在外耳处敷温热毛巾也有助于舒缓不适，但偏方土方无法替代正规医疗评估，尤其是对年幼的孩子而言。
What’s the difference between a middle ear infection and swimmer’s ear?
A middle ear infection happens behind the eardrum, usually triggered by a cold that blocks the eustachian tube. Swimmer’s ear is an infection of the outer ear canal caused by trapped water or skin injury, and it hurts more when the outer ear is tugged. The two need different treatments: an oral antibiotic versus ear drops.
Can adults get ear infections, and do symptoms differ from children’s?
Yes, adults can get middle ear infections and swimmer’s ear, though less often than children because their eustachian tubes are longer and more vertical. Adults usually notice ear pain, pressure, drainage, and temporary hearing changes, without the tugging or irritability that signals an infection in a baby.
孩子什么情况下需要置入耳管？
耳管通常适用于以下情况：反复发作的耳部感染（通常为六个月内发作三次及以上，或一年内发作四次及以上），或鼓膜后方积液持续约三个月并伴有听力下降。耳管可帮助引流积液、改善中耳通气，从而支持听力发育和语言发展。
参考来源
- 美国疾病控制与预防中心 — 关于耳部感染 — CDC，2024 — cdc.gov
- 美国国家耳聋及其他沟通障碍研究所 — 儿童耳部感染 — NIDCD，美国国立卫生研究院，2022 — nidcd.nih.gov
- 梅奥诊所 — 耳部感染（急性中耳炎）— Mayo Clinic，2024 — mayoclinic.org
- Morin TL, Stein AB, El Feghaly RE 等 — 减少急性中耳炎不必要抗生素使用的干预措施：一项荟萃分析 — Children，2025 — doi.org/10.3390/children12101408
- Kim MS, Sharma P, Irace A, Dedhia K — 鼓膜置管术后按手术适应症分类的长期生活质量结局 — International Journal of Pediatric Otorhinolaryngology，2026 — doi.org/10.1016/j.ijporl.2026.112901
- Martin JM, Hoberman A, Lee MC 等 — 急性中耳炎幼儿细菌病原体评估：2019—2023年宾夕法尼亚州西部前瞻性队列研究 — Journal of the Pediatric Infectious Diseases Society，2026 — doi.org/10.1093/jpids/piag059
延伸阅读
- 在以下指南中了解同样由引流受阻引起的相关疾病： 鼻窦炎的症状与治疗.
- 通过本指南，增强您解读未来检验结果的信心，了解 化验报告中的参考范围、异常标记及后续步骤.
用BloodSense轻松看懂您的化验结果
耳部感染通常通过检查鼓膜来诊断，而非血液检测，但当孩子病情较重或感染有扩散迹象时，血液检查仍会派上用场——白细胞计数和CRP水平是这种情况下最常见的两项检测指标。BloodSense能将充满数字和参考范围的化验报告转化为通俗易懂的解释，无论您是在理解急诊就诊后的检验结果，还是只想更自信地读懂常规检查报告，都能清楚了解异常指标的含义，并随时追踪其变化趋势。
