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Acute Middle Ear Infection in Children

(Acute Otitis Media)


Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Sep 2020| Content last modified Sep 2020

Acute middle ear infection is a bacterial or viral infection of the middle ear, usually accompanying a cold.

  • Bacteria and viruses can infect the middle ear.
  • Children with ear infections may have a fever and trouble sleeping and may cry, become irritable, and pull on their ears.
  • Doctors use a handheld light called an otoscope to check the eardrum for redness or bulging and to look for fluid behind the eardrum.
  • Acetaminophen or ibuprofen can relieve fever and pain, and antibiotics are usually used when children do not get better quickly or get worse.

A Look Inside the Ear

A Look Inside the Ear

Acute middle ear infection (also called acute otitis media) usually develops and resolves relatively quickly. Middle ear infections that come back frequently or last for a long time are called chronic middle ear infections.

(See also Overview of Middle Ear Infections in Young Children and Otitis Media (Acute) in adults.)

Causes of Acute Middle Ear Infection

An acute middle ear infection is most often caused by the same viruses that cause the common cold. Acute infection may also be caused by bacteria that sometimes normally reside in the mouth and nose. Bacteria that affect newborns include Escherichia coli and Staphylococcus aureus. Bacteria that affect older infants and children include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. An infection initially caused by a virus sometimes leads to a bacterial infection.

Symptoms of Acute Middle Ear Infection

Infants with acute middle ear infections have a fever and trouble sleeping. They cry or become irritable for no apparent reason. They may also have a runny nose, cough, vomiting, and diarrhea. The ear is painful (see Earache), and hearing may be decreased. Infants and children who cannot communicate verbally may pull at their ears. Older children are usually able to tell parents that their ear hurts or that they cannot hear well.

Commonly, fluid accumulates behind the eardrum and remains after the acute infection has resolved. This disorder is called secretory otitis media.


Rarely, an acute middle ear infection leads to more serious complications. The eardrum may rupture, causing blood or fluid to drain from the ear (see Ear Discharge). Also, nearby structures may become infected, cause symptoms, and require emergency treatment:

If infections come back, abnormal skinlike tissue called a cholesteatoma may grow in the middle ear and potentially through the eardrum. A cholesteatoma can damage the bones of the middle ear and cause hearing loss.

Did You Know...

  • Most acute middle ear infections resolve without use of antibiotics.

Diagnosis of Acute Middle Ear Infection

  • A doctor's examination

Doctors diagnose acute middle ear infections by using a handheld light called an otoscope to look for bulging and redness of the eardrum and for fluid behind the eardrum. They may need to clean wax from the ear first so they can see more clearly. Doctors may use a rubber bulb and tube attached to the otoscope to squeeze air into the ear to see if the eardrum moves. If the eardrum does not move or moves only slightly, fluid in the middle ear, which is one sign of infection, may be present.

Prevention of Acute Middle Ear Infection

The pneumococcal conjugate vaccine, Haemophilus influenzae type b (Hib) vaccine, and influenza (flu) virus vaccine decrease the risk of acute middle ear infections. These vaccines are given to children according to a standard schedule.

Infants should not sleep with a bottle because drinking from a bottle while going to sleep tends to cause fluid to collect in the eustachian tubes. Fluid in the eustachian tubes traps secretions in the middle ear and prevents air from reaching the middle ear, both of which make infection more likely. Smoking should be eliminated from the household or minimized.

Recurring acute otitis media may be prevented by inserting tiny tubes into the eardrum (tympanostomy tubes). These tubes balance the pressure on both sides of the eardrum so fluid is less likely to accumulate (see treatment of chronic middle ear infections).

Did You Know...

  • Letting an infant sleep with a bottle can result in an acute middle ear infection.

Treatment of Acute Middle Ear Infection

  • Drugs to relieve pain
  • Sometimes antibiotics
  • Rarely tympanic membrane perforation

Acetaminophen or ibuprofen is effective for fever and pain.

Most acute middle ear infections resolve without antibiotics. Thus, many doctors use antibiotics only when children are very young or very ill, do not improve after a brief period of time, when there are signs that the infection is getting worse, or when children have frequent infections. Antibiotics, such as amoxicillin (with or without clavulanate), may be used.

For children, antihistamines (such as brompheniramine or chlorpheniramine) and vasoconstrictors (drugs that constrict blood vessels, also sometimes called decongestants) are not helpful.

If the eardrum is bulging and the child has severe or persistent pain, fever, vomiting, or diarrhea, a doctor may puncture the eardrum (called myringotomy ) to allow the infected fluid to drain. Sometimes doctors then also insert tympanostomy tubes. After this procedure, symptoms usually resolve quickly, hearing returns, and the eardrum heals on its own.

Drugs Mentioned In This Article

Generic Name Select Brand Names
chlorpheniramine CHLOR-TRIMETON
brompheniramine VELTANE
Acetaminophen TYLENOL
amoxicillin AMOXIL
ibuprofen ADVIL, MOTRIN IB

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