Acute Otitis Media (Middle Ear Infection)

Acute otitis media, or middle ear infection, is one of the most common illnesses of childhood. Two thirds of all children will have at least one middle ear infection by their second birthday. Ear infections are more common among children in daycare, children who are bottle fed, and children exposed to second hand smoke. Ear infections are rare in children less than six months or older than six years. 

Usually, a middle ear infection is preceded by a viral cold. During the cold, the eustachian tube, which runs from the middle ear to the nose and upper throat, gets swollen and congested. This leads to impaired drainage of fluid from the middle ear, allowing viruses or bacteria from the nose and throat to build up in the middle ear and cause an infection.

Middle ear infections can cause ear pain, fever, poor sleeping, or hearing problems.  Sometimes, you might see blood-tinged yellow fluid draining from the infected ear. This drainage means that the eardrum has developed a small hole, called a perforation, which usually heals by itself without complications. If your child has ear pain that is made worse by touching the ear, it is more likely an outer ear infection, also known as otitis externa or swimmer’s ear (click to link to this topic). 

An ear infection is not an emergency. If you suspect your child has an ear infection, give her acetaminophen or ibuprofen.  Applying a warm compress to the ear may also help with pain relief.  If this does not relieve her discomfort, she should come in to the office. 

Middle ear infections are sometimes treated with antibiotics. Doctors used to prescribe antibiotics for most ear infections, but more recent scientific evidence shows that most ear infections will resolve on their own. Now we only prescribe antibiotics for severe infections or for very young patients. Occasionally, we may give you a prescription to fill if your child does not get better with ibuprofen within 48 hours. If you do begin a course of antibiotics, make sure to use them as directed and to complete the entire course. Never save antibiotics for later use with a subsequent infection. For more information regarding the use of antibiotics in ear infections please see

Ear infections are not contagious. If your child does not have a fever and is feeling well, she may return to school or daycare. 

Children who get very frequent or severe ear infections may get referred to an ear, nose, and throat specialist (also known as an otolaryngologist or ENT). Sometimes, the ENT will recommend that temporary ear tubes be surgically inserted in the eardrum to prevent the buildup of fluid and bacteria in the middle ear. 

As children grow older, they are less likely to get ear infections, both because they are less susceptible to viral upper respiratory infections and because of the changing anatomy of their eustachian tubes. Most children stop getting ear infections by age six.

Image 1: Anatomical diagram of ear to help you understand how an ear infection develops.  The yellow is pus, trapped in the small space of the middle ear after the Eustachian tube collapses.

Image 2: What the doctors  see when your child has normal tympanic membrane (eardrum; left picture) or an ear infection (right picture).

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Silver Spring Pediatrics
Drs. DeConcini, Schooler, Zang, Wang, Yee & Marcus