Middle ear infection (acute otitis media)

A middle ear infection (also called acute otitis media) is an infection in the part of the ear behind the eardrum. Infections are more common in young children, especially those who are exposed to cigarette smoke, go to day care, or use a dummy. Infections usually get better in one to two days.

What causes it?

Infections can be caused by viruses or bacteria.

Signs and symptoms

  • ear pain
  • tugging or rubbing the ear
  • crying at night
  • fever (temperature over 38°C)
  • runny nose, sore throat or cough
  • fluid or blood leaking from the ear (this is a sign of a ruptured (burst) ear drum).

How is it diagnosed?

A doctor can diagnose a middle ear infection by examining the ear using a special instrument with a magnifying lens and a torch. You will be asked to assist with the examination by holding your child sideways with their head held onto your chest and your other arm around their arms.

What is the treatment?

Pain medication such as Paracetamol (Panadol) and/or Ibuprofen (Nurofen) is usually the only treatment. Occasionally, your child’s doctor may recommend stronger pain medication.

Some bacterial infections are treated with antibiotics. Medications such as antihistamines and decongestants are not recommended.

Care at home

Give your child regular pain relief. Follow the instructions on the bottle for the right dose. Do not give more than the recommend number of doses in a day.

Children with a ruptured ear drum should not get any water in the ear until it has healed. This usually takes about 10 days but a doctor will need to check your child’s ear to be certain.

Children are usually safe to travel on a plane two weeks after the pain has gone.

When should I see a doctor?

See your GP immediately if your child has:

  • symptoms of a middle ear infection and is less than six months old
  • symptoms for over two days
  • a lot of ear pain, or swelling and redness in the bony area behind the ear
  • fluid leaking from the ear

See a doctor if your child has plane travel planned within two weeks of an infection.
All children with a middle ear infection should see their GP in three months to make sure all the fluid behind the eardrum has gone.
In an emergency, call 000 immediately. Otherwise, contact your local doctor or visit the emergency department of your nearest hospital. For non-urgent medical advice, call 13 HEALTH (13 43 25 84) to speak to a registered nurse 24 hours a day, seven days a week for the cost of a local call.

Things to remember

  • Middle ear infections usually get better in two days without needing antibiotics.
  • See a doctor if the ear is leaking fluid, swollen or red or you have other concerns.

Resource No: FS166. Developed by Emergency and Ear, Nose and Throat, Queensland Children’s Hospital. Updated: August 2019.

All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.