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Middle Ear Infection FAQs (Acute Otitis Media)

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 9, 2023.

What is a middle ear infection?

If you’re a parent you know about ear infections, a common condition that affects children at a very young age. The late night tears, the ear tugging, the repeated trips to the pediatrician, and the pink liquid antibiotic. It’s a familiar scene. As consistently predictable as this routine seems, acute otitis media (AOM) - the medical term for the most common type of ear infection - can be more complicated.

Acute otitis media (AOM) is a swollen and often infected middle ear where fluid builds behind the eardrum and leads to pain. Acute otitis media is also the most common diagnosis in a pediatrician’s office.

Roughly 25% of all infants in developed countries will have at least one ear infection by their first birthday. By age three, up to 90% of children have had an ear infection. Children in day care are more prone to ear infections, too.

Acute otitis media is infrequent in older school-age children, adolescents, and adults, but can still occur.

Common ear infection questions you might ask your doctor include:

  1. What are the symptoms of an ear infection?
  2. What are the risk factors?
  3. How do you diagnose an ear infection?
  4. Which medicines treat an ear infection?
  5. What if my child has frequent middle ear infections?
  6. Plane Travel - What to do?
  7. Can I prevent an ear infection?
  8. Are there alternative treatments for otitis media?
  9. What are other related ear conditions?
  10. How can I keep up with the latest medical news on ear infections?

What is acute otitis media?

Acute Otitis Media (AOM) is an infection in one or both ears. An “acute” ear infection is a short-term and painful ear infection that may come on quickly. This is in contrast to a Chronic Ear Infection that may last a longer time, come and go, and lead to permanent hearing damage.

Image: Harvard Health Guide

Ear infections can be more common in children who also have a cold or flu due to a virus. Symptoms of an ear infection may begin during the 3rd to 7th day of a viral infection. Children with an ear infection usually also have a runny nose and nasal congestion.

Mild hearing loss may occur, but it is usually temporary. However, if hearing loss lasts an extended period of time, it may cause problems with speech, language and learning.

1. What are the symptoms of an ear infection?

If you think your child has an ear infection, see your pediatrician. They can make an accurate diagnosis, look for complications, and prescribe the appropriate medications, if needed. Keep in mind treatment for an acute ear infection is not always needed.

A telltale sign of an ear infection is a bulging tympanic membrane (ear drum), as visualized by your doctor with an otoscope (a medical device that looks into the ears), and ear pain. Older children may also experience hearing loss.

In younger children and infants, the symptoms of an ear infection may include:

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2. What are the risk factors for acute otitis media?

Anything that causes the eustachian tubes to become swollen or blocked can lead to ear infections. These might include:

Other factors that may increase your child’s chances of developing an ear infection include:

Ear infections are not contagious. However, colds are contagious and may spread through a daycare center or school and increase the risk of getting an ear infection.

Drainage of green or yellow fluid out of the ear may indicate that there is a ruptured eardrum.

3. How is acute otitis media diagnosed?

First, your doctor will ask about how long symptoms have been present, presence of ear pain, any discharge from the ear, and if there has been a fever. Your doctor may also inquire about a previous history of ear infections.

4. Which medicines are used to treat otitis media?

Some children will get better without specific antibiotic treatment, as many ear infections are viral in nature and do not need an antibiotic. However, doctors typically prescribe antibiotics in infants under 6 months of age, and for recurrent ear infections or severe symptoms. However, using antibiotics too often can cause bacteria to become resistant to the medicine.

Antibiotics are commonly given to children under 24 months of age or with high fever or infections in both ears. These children get better more quickly with antibiotics. 

In more serious cases in older children, when there is recent high fever, both ears are affected, or ear drainage, an antibiotic treatment may be appropriate. 

Antibiotic choice should be based on effectiveness, patient-specific needs like allergies, taste or dosage form preference, dosing convenience and cost. It’s important to remember that although most antibiotics used for ear infections are very safe, there may still be side effects such as diarrhea or rash from antibiotic use.

Some doctors may recommend a "wait-and-see" approach for certain children, for example:

Parents will usually follow-up with the doctor in 2 to 3 days with the “wait-and-see” or observation approach. 

Talk with your doctor about the potential benefits and risks of using antibiotics. When needed, antibiotics recommended for otitis media (ear infection) treatment may include:

First-line treatment

When antibiotic therapy is recommended, the following therapies are suggested:

Amoxicillin or Amoxicillin-Clavulanate

Oral amoxicillin given for 5 to 10 days is the treatment of choice in most cases. Younger children, those with a perforated eardrum, and recurrent cases are treated for 10 days, and those over 2 years of age are treated 5 to 7 days. Follow your doctor's dosing instructions.

An alternative first-line treatment is oral amoxicillin-clavulanate (Augmentin). This alternative treatment is recommended in patients who have been treated with amoxicillin in the previous month, in those with purulent conjunctivitis, or who have recurrent AOM and have failed previous amoxicillin treatment.

If the patient has a mild (delayed) penicillin allergy (without anaphylaxis, bronchospasm, or angioedema), one of these cephalosporins may be an option, usually given for either 10 days or 5-7 days:

Ceftriaxone intramuscular (IM) injection may also be used (for one to three doses, based on symptom improvement).

If there is a severe (immediate) or serious delayed penicillin allergy, which also includes a severe allergy with cephalosporins, select from these oral macrolide options, or oral clindamycin:

If these treatments are not effective within 2 to 3 days, alternative antibiotics or an appointment with a pediatric ear-nose-throat (ENT) specialist doctor may be needed.

Treatments recommended for ear pain include:

Ask your doctor about the best dose for your child's age and weight. Follow your doctor's directions or the directions found on the Drug Facts Label of any over-the-counter (OTC) product. 

Do NOT give aspirin to a child or teenager with a fever, flu symptoms, or chickenpox. Use of aspirin in children can lead a dangerous condition known as Reye's Syndrome which can lead to serious problems with brain and liver.

You should talk to your doctor first if you decide to use any ear drops to treat ear pain in your child. Some ear drops may not be safe to use.

5. What if my child has frequent middle ear infections?

Recurrent ear infections can be a problematic for both parent and child. A child is considered “otitis prone” when they have 3 ear infections within a 6 month period or 4 infections within a year.

Risk factors that may increase the frequency of ear infections include:

The insertion of tympanostomy tubes (ear tubes) may be recommended in recurrent cases. While there are inherent risks with any surgical procedure, they are infrequent with ear tube insertion. The benefits of ear tubes include fewer ear infections and the ability to treat future infections with topical antibiotic therapy (ear drops) instead of oral drugs.

In July 2015, the FDA announced they were targeting 16 unapproved ear drop ingredients often used in infants and young children. These drugs, prescribed and sold for years to relieve ear pain and swelling, had not been evaluated for safety, quality and effectiveness. The agency notified the manufacturers to stop marketing the drops following reports of local allergic reactions of the ear, eye, face, neck and mouth. The drops can also cause itching, stinging, burning and irritation of the ear.

The products covered by this action include:

6. Plane travel: What to do?

Airplane ear (also called ear barotrauma) is the stress on your eardrum that occurs when there's a difference in the air pressure in your middle ear and the outside air. You or your child might get airplane ear during takeoff or when landing during a flight. It can occur in one or both ears, and may lead to feeling of fullness, ear pain, or a slight hearing loss or muffled sound.

To help young children:

Here's more information on what to do if you or your child has upcoming plane travel.

7. How can I prevent an ear infection in my child?

Vaccines are available to help minimize ear infections in children, and are part of the normal routine vaccine schedule for pediatrics. Children should be immunized against the common bacteria that cause middle ear infections.

Be sure your child gets the required pneumococcal conjugate vaccines. In addition, most children 6 months and older should receive a seasonal influenza vaccine each year (usually in Sept or Oct), as recommended by the CDC. Follow your pediatrician's directions for COVID-19, Respiratory Syncytial Virus (RSV), Haemophilus and other childhood vaccines, as well.

Wash your hands and your child's hands frequently. Teach them to wash hands with soap and water for 20 seconds after bathroom use and before eating food. Adults should also wash hands after a diaper change.

Also:

In some cases, the placement of ear tubes may be recommended for children who have frequent ear infections.

8. Are there alternative treatments for otitis media?

Complementary and alternative medical treatments are NOT recommended for ear infections in children. Home remedies for ear infections, such as olive oil and herbal extracts have not been proven to have any effect.

Get a diagnosis from your pediatrician to help prevent further complications in your child.

9. Related ear conditions

Similar conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include the following:

10. Join the Drugs.com Otitis Media support group

While you should always follow your doctor's medical advice, you might consider joining the Drugs.com Otitis Media Support group to ask questions and share experiences with those who have similar questions and concerns about ear infections.

You can also keep up with the latest ear infection news and approvals in the Drugs.com Otitis Media Support Group.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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