Middle ear infection (acute otitis media)

A middle ear infection (also called acute otitis media) is an infection behind the eardrum.

These infections are very common in young children because they have smaller tubes (called Eustachian tubes) that connect the middle ear to the throat.

When children get a cold, germs from the throat can travel up to the middle ear and cause an infection.

Signs and symptoms

• Earache
• Pulling or rubbing the ear especially when lying down (babies and young children)
• Irritability (feeling angry and annoyed), crying a lot
• Fever (temperature higher than 38°C)
• Runny nose, sore throat or cough
• Fluid or blood coming from the ear (this is a sign of a burst ear drum).

Treatment

Paracetamol (Panadol or Dymadon) and Ibuprofen (Nurofen) is usually the only treatment for a middle ear infection. Follow the instructions on the bottle or package for the correct dosage. Do not give your child more than what is recommended for the day. The pain from middle ear infection usually goes away in one to two days even without treatment.

If your child is still in pain after 48 hours, your GP may give stronger pain medicine or antibiotics to treat the infection. Antihistamines and decongestants will not help your child.

Care at home

Give your child pain medicine, as needed. Follow the instructions on the bottle or package for the recommended amount of medicine to give your child. Do not give more than what is recommended for a day.

If your child has a ruptured ear drum, they should not get any water in their ear for at least 10 days or until it has healed. Your doctor will need to check your child’s ear to be sure it has healed.

Visit your child’s GP as soon as they finish their antibiotics to make sure that the infection has gone.

Children are usually safe to travel on a plane 2 weeks after the pain has gone.

When to seek help

See a GP if your child:

• has signs and symptoms of a middle ear infection and is less than 6 months old
• has symptoms for more than 2 days
• has symptoms that are getting worse
• has swelling and redness behind the ear
• has fluid coming from the ear
• is an Aboriginal or Torres Strait Islander person (because they have a higher risk of getting infections)
• is travelling by airplane 1 week after getting an infection.

Your GP will look inside your child’s ear using a special instrument with a magnifying lens and a torch to help diagnose the infection.

Your child should see their GP 3 months after the infection to make sure all the fluid behind the eardrum has gone.

If your child has a lot of ear infections, you should get their hearing tested by a hearing specialist (an audiologist).

Your GP may also refer them to see a paediatrician or an ear, nose and throat (ENT) specialist.

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by the Emergency Department, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS166. Reviewed: July 2022.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.