Middle Ear Infection FAQs (Acute Otitis Media)
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 half of all infants 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 include:
- What are the symptoms of an ear infection?
- How do you diagnose an ear infection?
- At what age do children get ear infections?
- Do ear infections always need an antibiotic?
- Are ear infections contagious?
- Why does my child always get ear infections?
- Does my child need ear tubes?
- Can you prevent 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 rapidly. This is in contrast to a Chronic Ear Infection that may last a longer time, come and go, and lead to permanent hearing damage.
- Acute otitis media (AOM) is a swelling and infection of the middle ear. The middle ear is located just behind the eardrum. The eustachian tube in the middle ear drains fluid away from the middle ear.
- When fluid builds up in the eustachian tube, it can lead to an increase in pressure on the eardrum, which results in pain. The ear can become infected with bacteria, which can grow in the trapped fluid behind the eardrum.
- Ear infections are common in infants and children because the eustachian tubes are more narrow and horizontal and can become easily clogged.
Image: Harvard Health Guide, June 2020
Ear infections can be more common in children who also have a cold due to a virus. Symptoms of an ear infection may begin during the 3rd to 7th day of a cold. 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.
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:
- tugging on the ears, ear pain, especially when lying down
- fever over 100 degrees F (38 degrees C)
- temporary hearing loss
- trouble sleeping
- dizziness or loss of balance
- fluid draining from ear
- irritability, fussiness, inconsolable crying
- loss of appetite
- vomiting, diarrhea (in infants)
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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:
- the common cold
- excess mucus and saliva produced during teething
- infected or overgrown adenoids
- tobacco smoke or other irritants
Other factors that may increase your child’s chances of developing an ear infection include:
- age: acute otitis media peaks between 6 and 24 months of age
- family history of acute otitis media
- Alaska Native heritage
- day care attendance
- seasonal factors: fall and winter months
- child not breastfed
- drinking from bottle or sippy cup while lying on back
- use of a pacifier
- children who have cleft palates
- a recent ear infection
- lack of access to medical care
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.
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.
- Your healthcare provider can look into your child’s ear to see if there is an infection. An instrument called an otoscope, a cone-shaped tool with a light, is used to view the eardrum.
- Your healthcare provider may look for areas of dullness or redness, fluid behind the eardrum, blood or pus inside the middle ear, or a perforated eardrum (a hole in the eardrum).
- The doctor may use a puff of air to see if the eardrum moves or do a test called a tympanogram that measures how the eardrum moves.
- Sometimes wax (cerumen) may block the ear and this will need to be removed.
- A hearing test or other more advanced tests may rarely be needed in more hard-to-treat cases.
What medicines 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.
The American Academy of Pediatrics and the American Academy of Family Physicians recommend a "wait-and-see" approach for children:
- 6 to 23 months of age with a temperature less than102.2 F (39 C) and middle ear pain in one ear for less than 48 hours
- 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
Parents will follow-up with the doctor in 2 to 3 days with the “wait-and-see” approach. Some doctors will still prescribe antibiotics in children under 2 years with AOM. 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. Talk with your doctor about the potential benefits and risks of using antibiotics.
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.
When needed, antibiotics recommended for otitis media (ear infection) treatment include:
When antibiotic therapy is recommended, the following therapies are suggested:
Amoxicillin or Amoxicillin-Clavulanate
High dose amoxicillin (80 to 90 milligrams (mg) per kilogram (kg) per day in 2 divided doses) 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 are treated 5 to 7 days. A suggested maximum dose of amoxicillin is 3 grams per day.
An alternative first-line treatment is amoxicillin-clavulanate (90 mg/kg/day amoxicillin and 6.4 mg/kg/day clavulanate in 2 divided doses). 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:
- ceftriaxone injection
If there is a severe (immediate) penicillin allergy, which also includes a severe allergy with cephalosporins, select from these macrolide options, or clindamycin:
If these treatments are not effective within 2 to 3 days, alternative antibiotics or an appointment with a pediatric ear-nose-throat specialist doctor may be needed.
Treatments recommended for ear pain include:
- acetaminophen (brand: Tylenol)
- ibuprofen (brand: Advil, Motrin)
- Ask your doctor about the best dose for your child's age and weight.
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 cause serious problems with brain and liver.
You should talk to your doctor first if you decide to use ear drops to treat ear pain in your child. Some ear drops may not be safe to use.
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 within a year.
Risk factors that may increase the frequency of ear infections include:
- male gender
- winter season
- exposure to passive smoke
- symptoms lasting longer than 10 days
The insertion of tympanostomy tubes (ear tubes) may be recommended in these 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:
- benzocaine and antipyrine
- benzocaine, antipyrine, and zinc acetate
- benzocaine, chloroxylenol, and hydrocortisone
- chloroxylenol and pramoxine
- chloroxylenol, pramoxine, and hydrocortisone.
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Can I prevent an ear infection?
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 and Haemophilus vaccines. In addition, most children 6 months and older should receive a seasonal influenza vaccine each year.
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.
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:
- Otitis media with effusion (OME) refers to middle ear fluid build-up that is NOT infected. Fluid may remain after an ear infection has cleared up or due to a blocked eustachian tube. Antibiotics are NOT required for this condition. In most children the fluid build-up will resolve on its own within 4 to 6 weeks and treatment is not usually needed.
- Chronic suppurative otitis media is a persistent ear infection that results in tearing or perforation of the eardrum.
- Otitis externa (Swimmer’s ear) is an infection in the outer ear canal that goes from the outside of the ear to the eardrum.
Join the Drugs.com otitis media support group
While you should only follow the medical advice of your doctor, 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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Symptoms and treatments
Medicine.com guides (external)
- American Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Lieberthal AS, Carroll AE, T Chonmaitree, et al. Pediatrics 2012-3488; published ahead of print February 25, 201. ,doi:10.1542/peds.2012-3488.
- Up to Date. Acute otitis media in children: Treatment. Accessed June 7, 2021 at https://www.uptodate.com/contents/acute-otitis-media-in-children-treatment
- Ear Infections. Kaiser Permanente. Accessed April 30, 2019 at https://m.kp.org/georgia/health-wellness/health-encyclopedia/he.hw184385
- Ahmed S, Shapiro N, Bhattacharyya N. Incremental health care utilization and costs for acute otitis media in children. Pediatrics. Accessed April 30, 2019 at https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.24190
- Acute Otitis Media with Effusion (OME). Children's Hospital of Philadelphia (CHOP). Accessed June 7, 2021 at https://www.chop.edu/conditions-diseases/otitis-media-effusion-ome
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.