Have You Heard the Latest on Ear Infections and Pregnancy?

Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Ear Infection, go here. These expert reports are free of charge and can be saved and shared.


Maybe your ear feels blocked, or everything is beginning to sound a little muffled to you. Maybe your significant other tires of your saying, “What?” all the time. Or perhaps you have a real, honest-to-goodness earache—just like the one you had when you were four years old. Or you might have had an earache when you went to bed, but felt better when you woke up, only to find crusty yellow stuff on your pillow.

Any or all of these signs could mean that you have an ear infection. And with so much else to deal with in pregnancy, it’s probably even more uncomfortable than it otherwise would be. But there are some silver linings. First of all, it’s possible that it isn’t an ear infection (while yellow drainage is suspicious, the other signs mentioned above are less specific). If it is an ear infection, it’s likely treatable, even in pregnancy. Finally, although more serious problems can cause an earache—and an ear infection, conversely, can cause more serious complications—it’s rare to have a dire cause of ear pain.

Ear Infections: the Lingo, the Causes

There’s lots of confusing terminology to be found when you read a journal or textbook article on ear infections. Without getting too technical, let’s discuss a couple of the more common terms used to describe ear infection types. Before we talk about the infections, though, it’s worth spending a moment on anatomy.

Air, sound, and sometimes water (and in a child, sometimes, a bead!) enters the outer ear through the ear canal. At the inner end of the ear canal is the eardrum, otherwise known as the tympanic membrane. An intact eardrum separates the outer ear from the middle ear, so the only thing that gets in is sound (through vibration of the ear drum).

Otitis media (literally, “inflammation of the middle ear”) is the commonly used medical term to describe a middle ear infection. If you’re told you have an “ear infection,” it’s usually known as acute otitis media. There’s also something known as otitis externa (literally, “inflammation of the outer ear”). This is better known as “swimmer’s ear”—an infection of the canal.

We’ve tried to demystify the “what”; now on to the “why.” Both of the above conditions are due to infection, but there are some differences.

Otitis media affects the middle ear thanks to the Eustachian tube, the organ that internally connects the middle ear with the nose. The Eustachian tube is filled with fluid that ideally flows and drains just fine. As part of the normal course of living, it’s filled with viruses and bacteria that most of the time don’t cause any trouble. However, the tube can become blocked—for example, from an inflamed lining such as you might see during an ordinary cold, or from smoke irritation. When that happens, you have a situation equivalent to standing water: germs grow and thrive, and you have your garden-variety middle ear infection.

We normally think of an ear infection as kid disease, but it turns out that pregnant women tend to normally have a little more swelling of the lining of the Eustachian tube. For this reason, they may be at a little higher risk for blockage of that tube, and thus for developing a middle ear infection.

Water in your ear canal generally won’t cause otitis media. It can, however, cause otitis externa, that outer ear infection. It’s really a similar process: germs start to take hold because of the “standing water” in the ear canal, often from swimming or washing hair.

Diagnosis and Treatment

Not all earaches are ear infections—for example, some are just due to fluid buildup from a cold. But if you have an earache for more than a day or two, it’s generally a good idea to see your health care provider. She can use an instrument known as an otoscope to look in the ear. She can then diagnose an ear infection (or the absence of one) based on the appearance of the eardrum (for otitis media) or ear canal (for otitis externa). She’ll also look for pus-like drainage in the canal (that’s the stuff that might have been on your pillow), which can mean a middle ear infection where the ear drum burst. When that happens, usually there is much less pain.

As far as treatment goes, both conditions can be treated by antibiotics that are considered by most to be safe in pregnancy. This is one of those situations where it’s a good idea to have a conversation about treatment with your provider, who will weigh the risks of any particular medication against any possible benefits.

Rarely, ear infections of both types can cause complications as the germs spread. Most of the time, however, they go away with appropriate treatment. Take comfort in the fact that for most people, they are just an occasional annoyance, and in adults, they usually don’t come back often!

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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