Acute otitis media is a bacterial or viral infection of the middle ear.

Acute otitis media results from infection by viruses or bacteria, often as a complication of the common cold or of allergies. Acute otitis media is more common among children than adults (see Ear, Nose, and Throat Disorders in Children: Acute Middle Ear Infection). Symptoms and treatment are similar in adults and older children.

The infected ear is painful, with a red, bulging eardrum. Most people with acute otitis media get better without treatment. However, because it is hard to predict whose symptoms will not lessen, some doctors treat all people with antibiotics, such as amoxicillin. Other doctors give antibiotics only if the illness is severe or if symptoms do not lessen after 72 hours. Pain relief is important. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain. Decongestants containing phenylephrine may help adults (but not children), and antihistamines are useful for people who have allergies but not for those with colds.

Acute Otitis Media

If a person has severe or persistent pain and fever, and the eardrum is bulging, a doctor may perform a myringotomy, in which an opening is made through the eardrum to allow fluid to drain from the middle ear. The opening, which does not affect hearing, usually heals without treatment. People who have repeated bouts of otitis media may need to have drainage tubes (tympanostomy tubes) placed in their eardrums (see Ear, Nose, and Throat Disorders in Children: Ventilating Tubes: Treating Recurring Ear Infections).

When the Ear Aches
An earache is pain that seems to originate in the ear. The actual source of pain may be within the ear or in nearby structures that share the same nerves to the brain. This type of pain is called referred pain. Pain originating in the ear is most likely the result of infection. Infection of the middle ear (otitis media) is the most common cause of earaches in children. Infection of the ear canal (otitis externa) is also very painful and occurs in both children and adults. Ear pain also occurs when blockage of the eustachian tube (the tube that connects the middle ear and back of the nose) prevents pressure in the middle ear from equalizing with outside pressure. Pressure mainly causes symptoms during airplane flights and undersea diving. Swallowing or blowing the nose sometimes relieves the pressure and pain. Ear pain that originates outside the ear may come from infections or tumors of many areas of the nose and throat. If a person with an earache has no apparent ear disorder, doctors look for problems with the nose, sinuses, teeth, gums, jaw joint (temporomandibular joint), tongue, tonsils, throat (pharynx), voice box (larynx), windpipe (trachea), esophagus, and salivary glands in the cheek (parotid glands). Sometimes, the first symptom of cancer in any of these structures is pain that feels like an earache.

Last full review/revision February 2008 by Richard T. Miyamoto, MD