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Otitis media

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Otitis media is inflammation, usually due to an infection of the middle ear; common in children. It can be acute middle ear infection when it is called acute otitis media or chronic. Another condition that affects the middle ear is called otitis media with effusion. It occurs when fluid builds up in the middle ear without being infected and without causing fever, ear pain, or pus build-up in the middle ear. When the outer ear canal is infected, the condition is called swimmer’s ear, which is different from a middle ear infection. For more information, visit “Swimmer’s ear” (Otitis externa).

Otitis Media
Otitis Media


A middle ear infection may be caused by:

Bacteria, like Streptococcus pneumoniae and Haemophilus influenzae (nontypeable)—the two most common bacterial causes Viruses, like those that cause colds or flu What antibiotics treat and won’t treat


Common symptoms of middle ear infection in children can include:

Otitis Media Mastoiditis
Otitis Media Mastoiditis
  • Ear pain
  • Fever
  • Fussiness or irritability
  • Rubbing or tugging at an ear
  • Difficulty sleeping

More serious symptoms

  • A fever of 102.2°F (39°C) or higher
  • Pus, discharge, or fluid coming from the ear
  • Worsening symptoms
  • Symptoms of a middle ear infection that last for more than 2–3 days
  • Hearing loss


A doctor will determine what type of illness your child has by asking about symptoms and doing a physical examination. Your doctor can make the diagnosis of a middle ear infection by looking inside your child’s ear to examine the eardrum and see if there is pus in the middle ear.

Antibiotics are often not needed for middle ear infections because the body’s immune system can fight off the infection on its own. However, sometimes antibiotics, such as amoxicillin, are needed to treat severe cases right away or cases that last longer than 2–3 days.

For mild cases of middle ear infection, your doctor might recommend watchful waiting or delayed antibiotic prescribing.

Otitis media
Otitis media

Watchful waiting: Your child’s doctor may suggest watching and waiting to see if your child needs antibiotics. This gives the immune system time to fight off the infection. If your child doesn’t feel better after 2–3 days of rest, extra fluids, and pain relievers, the doctor may write a prescription for an antibiotic. Delayed prescribing: Your child’s doctor may give an antibiotic prescription but suggest that you wait 2–3 days to see if your child is still sick before filling it.

Adult Serous Otitis Media
Adult Serous Otitis Media

Clinical course

Some ways to feel better—whether or not antibiotics are needed for an ear infection:

  • Rest.
  • Drink extra water or other fluids.
  • Take acetaminophen or ibuprofen to relieve pain or fever. Ask your doctor or pharmacist about over-the-counter medicines that can help you feel better. Always use over-the-counter medicines as directed.
  • Over-the-Counter Medicine and Children
  • Be careful about giving over-the-counter medicines to children. Not all over-the-counter medicines are recommended for children of certain ages.
Otitis media acuta - Myringitis bullosa
Otitis media acuta - Myringitis bullosa

Pain relievers:

  • Children younger than 6 months: only give acetaminophen.
  • Children 6 months or older: it is OK to give acetaminophen or ibuprofen.
  • Never give aspirin to children because it can cause Reye’s syndrome, a rare but very serious illness that harms the liver and brain.
  • Cough and cold medicines:
  • Children younger than 4 years old: do not use unless a doctor specifically tells you to. Use of over-the-counter cough and cold medicines in young children can result in serious and potentially life-threatening side effects.
  • Children 4 years or older: discuss with your child’s doctor if over-the-counter cough and cold medicines are safe to give to your child for temporary symptom relief.
  • Be sure to ask your doctor or pharmacist about the right dosage of over-the-counter medicines for your child’s age and size. Also, tell your child’s doctor and pharmacist about all prescription and over-the-counter medicines they are taking.


You can help prevent ear infections by doing your best to stay healthy and keep others healthy, including:

  • Receive recommended vaccines, such as flu vaccine and pneumococcal vaccine. Pneumococcal vaccine protects against a common cause of middle ear infections, Streptococcus pneumonia.
  • Clean your hands.
  • Breastfeed exclusively until your baby is 6 months old and continue to breastfeed for at least 12 months.
  • Don’t smoke and avoid exposure to secondhand smoke.
  • Dry your ears thoroughly after swimming.

Latest research - Otitis media

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