Acute otitis media: middle ear infection symptoms and treatment

The NHS explains that ear infections can affect the inner, middle or outer ear. A middle ear infection (otitis media) usually affects children and is caused by viruses like colds and flu; it affects the eustachian tube, which connects the area behind the eardrum to the back of the nose. NICE describes acute otitis media as a self-limiting infection mainly affecting children, which can be caused by viruses and bacteria that are difficult to tell apart, with complications such as mastoiditis being rare.

The NHS says symptoms start quickly and include earache, a high temperature, difficulty hearing, discharge from the ear and a feeling of pressure or fullness. Babies and young children may also rub or pull the ear, not react to some sounds, be irritable or restless, be off their food, or keep losing their balance.

Most ear infections clear within 3 days, although symptoms can last up to a week. If you or your child have a high temperature or do not feel well enough for normal activities, the NHS suggests staying at home and avoiding other people until better.

The NHS suggests painkillers such as paracetamol or ibuprofen (children under 16 should not take aspirin) and wiping away any discharge with cotton wool. It advises not putting anything inside the ear, including cotton buds or fingers, not letting water or shampoo get in, not swimming during the infection and not using decongestants or antihistamines, because there is no evidence they help.

NICE recommends regular paracetamol or ibuprofen at the correct dose for the age or weight, using maximum doses for severe pain, and says anaesthetic and analgesic ear drops can be considered when an immediate antibiotic is not prescribed and the eardrum is not perforated and there is no discharge.

NICE says to consider no antibiotic or a back-up prescription for most children, because antibiotics make little difference to symptoms or to complications such as short-term hearing loss, perforation or recurrence, and can cause diarrhoea and nausea. A back-up prescription is used if symptoms do not start to improve within 3 days or if they worsen rapidly. Children who may benefit more include those of any age with ear discharge and those under 2 with infection in both ears, in whom an immediate antibiotic may be considered. Review is advised if symptoms have not improved within 7 days or worsen at any time.

The NHS adds that a pharmacist can give children aged 1 to 17 years the same treatments as a GP for an ear infection.

The NHS says to ask for an urgent GP appointment or call NHS 111 if you or your child feel generally unwell, have a very high temperature or feel hot, cold or shivery, have swelling around the ear, have fluid coming out of the ear, have a change in hearing or new hearing loss, are being sick, feel dizzy or have a severe sore throat, or if a child under 12 months has earache in both ears. The same applies if you have diabetes, a heart, lung, kidney or neurological condition, or a weakened immune system. For a child under 5, call 111 for advice.

The NHS advises seeing a GP if ear infections keep happening. NICE notes that symptoms can sometimes reflect other diagnoses, such as otitis media with effusion (glue ear), and says to reassess if symptoms worsen rapidly or significantly. Persistent hearing difficulty after an infection should be checked, because it can affect speech and school progress in children.

Most middle ear infections are managed through a pharmacist or GP. Children with frequent infections or persistent hearing loss may be referred to ENT or audiology. Private ENT and audiology can provide assessment and hearing tests sooner; ask what the assessment involves and how results will be shared with the GP.