When we think of ear infections, many of us can immediately recall that painful clogged feeling from childhood, along with the taste of the bright pink bubble gum medicine used to treat them. Ear infections are common in children, and a vast majority of kids will experience one by their third birthday.

But not all ear infections are the same – the symptoms and treatments depend on where the infection is located inside the ear. Here are a few things parents and patients should know as they prepare for a conversation with their doctor about a painful ear infection.

1. All parts of the ear can get infected

The ear is made up of three parts – the external (outer ear), middle ear, and internal (inner ear). All three of these areas can get infected. Infection of the outer ear is marked by redness, pain, and swelling. Infections in the canal portion of the outer ear are often referred to as swimmer’s ear. They’re often caused by a combination of cotton swab use and exposure to water and are usually accompanied by pain, swelling, redness, as well as loss of hearing and drainage.

Infections of the middle ear are also common and are typically caused by improper drainage of a young child’s eustachian tube. Symptoms include pain, fever, hearing loss, and redness of the eardrum.

In the inner ear, infections can affect the cochlea and the balance canals. Separate from infections marked by hearing loss, infection of the inner ear can affect balance, giving individuals extreme vertigo that can last days at a time. Vertigo can come with nausea and vomiting. Treatment is typically limited to addressing those symptoms, including lots of fluids and medications that can reduce the effects of vertigo.

2. Not all ear infections require oral antibiotics

It’s important for patients and parents to understand that infections in different parts of the ear require different treatments. For outer ear infections, a thorough cleaning of the ear along with a topical antibiotic applied directly to the outer ear is typically recommended.

Middle ear infections are the ones that typically require oral antibiotics. In these cases, antibiotics can be used to treat the infection, but persistent fluid may lead to recurring infections, in which case doctors may look for other treatments.

3. Some kids are more prone to ear infections than others

Persistent fluid in the middle ear is often a sign that a young child’s Eustachian tube is not draining properly. In young children, the Eustachian tube is not fully developed, which means fluid can get trapped in the ear. This persistent fluid can lead to repeat infections as well as hearing loss, which can affect language and other developmental milestones in young children.

In these instances, doctors may recommend that a child have tubes put in their ears. This is a minor surgical procedure that involves making a tiny incision in the eardrum to remove any lingering fluid and placing a small tube (grommet) in the eardrum that helps prevent the return of fluid.

If fluid has persisted for more than three months, a child should see an ear, nose, and throat (ENT) specialist and have an audiogram to document their hearing. Similarly, four ear infections in six months or six episodes in 12 months typically warrants an ENT referral for consideration of tube placement.

4. The ears are self-cleaning (that means no cotton swabs…or ear candles!)

There’s an old adage that nothing smaller than your elbow should go in your ear. That’s a good rule of thumb. And it’s especially true for cotton swabs – they do not belong in your ears, especially after you’ve gone in the water. For clogged ears after swimming, there are over-the-counter drops that can help evaporate water without the need for invasive tools or dangerous digging. Ear candling is also not recommended. It is ineffective, unnecessary, and dangerous.