Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Acute Middle Ear Infection in Children

(Acute Otitis Media)


Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Reviewed/Revised Apr 2022 | Modified Aug 2023
Topic Resources

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

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 Chronic Middle Ear Infection in Children Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection. Chronic middle ear... read more Chronic Middle Ear Infection in Children .


An acute middle ear infection is most often caused by the same viruses that cause the common cold Common Cold The common cold is a viral infection of the lining of the nose, sinuses, and throat. Many different viruses cause colds. Usually, colds are spread when a person's hands come in contact with... read more . Acute infection may also be caused by bacteria that sometimes normally reside in the mouth and nose. Bacteria that affect the ears of 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. Routine childhood vaccinations have decreased the risk of ear infection.

A main risk factor for acute middle ear infection is

  • Exposure to cigarette smoke in the household

Other risk factors include a strong family history of ear infections, bottle-feeding (instead of breastfeeding), attending a day care center, and living in an area where resources are low or air pollution is high.

Did You Know...

  • Letting an infant sleep with a bottle can result in an 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 Earache Earache usually occurs in only one ear. Some people also have ear discharge or, rarely, hearing loss. Ear pain may be due to a disorder within the ear itself or a disorder in a nearby body part... read more ), 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.


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 Ear Discharge Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have... read more ). Also, nearby structures may become infected, cause symptoms, and require emergency treatment:

If infections come back, abnormal skinlike tissue called a cholesteatoma Complications Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection. Chronic middle ear... read more Complications 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.


  • 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.


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.

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 Treatment Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection. Chronic middle ear... read more Treatment ).

Did You Know...

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


  • 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 and should not be used.

If the eardrum is bulging and the child has severe or persistent pain, fever, vomiting, or diarrhea, ear specialists may puncture the eardrum (called myringotomy ) to allow the infected fluid to drain. Sometimes ear specialists 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
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Aphen, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox
Bidhist, Bromax , BroveX, BroveX CT, B-Vex, J-Tan, J-Tan PD, Lodrane, Lodrane XR, LoHist-12, Respa-BR, TanaCof-XR, Vazol
AHIST, Aller-Chlor , Allergy , Allergy Relief, Allergy Time , Chlorphen SR, Chlor-Pheniton, ChlorTan, Chlor-Trimeton, Chlor-Trimeton Allergy , Chlor-Trimeton Allergy 12 Hour, Diabetic Tussin Allergy Relief, ED Chlorped Jr., Ed ChlorPed Pediatric, ED-ChlorPed , ED-Chlortan, ED-Chlor-Tan , PediaPhyl , PediaTan, Pediox-S, P-Tann , Qdall AR, TanaHist-PD, Teldrin HBP
quiz link

Test your knowledge

Take a Quiz!