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Otitis Media (Acute)


Taha A. Jan

, MD, Vanderbilt University Medical Center

Reviewed/Revised Jan 2024
Topic Resources

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

  • Acute otitis media often occurs in people with a cold or allergies.

  • The infected ear is painful.

  • Doctors examine the eardrum to make the diagnosis.

  • Certain routine childhood vaccinations can reduce the risk of acute otitis media.

  • The infection is sometimes treated with antibiotics.

Acute otitis media results from infection by viruses or bacteria, often as a complication of the common cold or of allergies. Although acute otitis media can occur at any age, it is most common between the ages of 3 months and 3 years. Acute otitis media often occurs during this age range because structures in the middle ear (such as the eustachian tube The Eustachian Tube: Keeping Air Pressure Equal The Eustachian Tube: Keeping Air Pressure Equal ) are immature and function less efficiently than in adults. Symptoms and treatment are similar in adults and older children (for acute otitis media in younger children, see Acute Middle Ear Infection in Children Acute Middle Ear Infection in Children 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... read more Acute Middle Ear Infection in Children ).

The Ears

Conditions that increase the risk of otitis media (risk factors) include

  • Living in a household where people smoke

  • Having many relatives who have had otitis media

  • Living in an area with heavy air pollution

  • Being bottle fed, rather than breastfed

  • Being in a day care center

Symptoms of Acute Otitis Media

In people with acute otitis media, the infected 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 ), with a red, bulging eardrum. Many people have hearing loss. Infants may simply be cranky or have difficulty sleeping. Fever, nausea, vomiting, and diarrhea often occur in young children. The bulging eardrum sometimes ruptures, causing pus to drain from the ear, sometimes with relief of ear pain.

If the infection spreads, people may have a severe headache, confusion, or impaired brain function.

Diagnosis of Acute Otitis Media

  • A doctor's evaluation

Doctors use an otoscope (a handheld light) to examine the ear canal and eardrum. If otitis media is present, pus may be visible in the middle ear behind the eardrum.

Treatment of Acute Otitis Media

  • Pain relievers

  • Antibiotics if needed

Most people with acute otitis media get better without treatment. However, because it is hard to predict whose symptoms will not lessen, some doctors in the United States treat all people with antibiotics, such as amoxicillin. Other doctors may give antibiotics only in the following circumstances:

  • Children are young (for example, younger than 6 months).

  • Symptoms are severe.

  • Symptoms do not lessen after 72 hours.

  • Otitis media recurs frequently.

Some experts say that children age 6 to 23 months with acute otitis media that is in only one ear and is not severe and older children can start treatment with or without antibiotics. If antibiotics are not used initially, they are given if the child is worse or does not feel better after 48 to 72 hours have passed since symptoms began.

Pain relief is important. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can relieve pain. Adults may be given decongestant nasal sprays containing medications such as oxymetazoline or decongestants taken by mouth such as pseudoephedrine. Antihistamines are useful for people who have allergies but not for those with colds. Decongestants and antihistamines are not helpful for children and may cause bothersome and possibly dangerous side effects, particularly in children younger than 2 years.

If a person has severe or persistent pain and fever and the eardrum is bulging, myringotomy may be done. For this procedure, 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 figure ).

Myringotomy: Treating Recurring Ear Infections

During a myringotomy, doctors make a small opening in the eardrum to allow fluid to drain from the middle ear. Then they place a tiny, hollow plastic or metal tube (tympanostomy tube, or ventilating tube) in the eardrum through the opening. These tubes balance the pressure in the environment with that in the middle ear. Doctors recommend ventilating tubes for some children who have had recurring ear infections (acute otitis media) or recurring or persistent collections of fluid in their middle ears (chronic serous otitis media).

Placement of ventilating tubes is a common surgical procedure that is done in a hospital or doctor’s office. General anesthesia or sedation is usually required. After the procedure, children usually go home within a few hours. Antibiotic ear drops are sometimes given after the procedure for about a week. The tubes usually come out on their own after about 6 to 12 months, but some types stay in longer. Tubes that do not come out on their own are removed by the doctor, sometimes under general anesthesia or sedation. If the opening does not close on its own, it may need to be closed surgically.

Children with ventilating tubes may wash their hair and go swimming, but some doctors recommend children do not submerge their head in deep water without using earplugs.

Drainage of fluid from the ears indicates an infection, and the doctor should be notified.

Myringotomy: Treating Recurring Ear Infections

Prevention of Acute Otitis Media

Drugs Mentioned In This Article

Generic Name Select Brand Names
Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox
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
12 Hour Nasal , Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal , Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief , Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, Rhinase D, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Visine L.R., Zicam Extreme Congestion Relief, Zicam Intense Sinus
Contac Cold 12 Hour, Dimetapp Decongestant, Drixoral, ElixSure Cold, ElixSure Congestion, Entex, Genaphed , KidKare , Myfedrine, NASAL Decongestant, Nasofed, Nexafed, PediaCare Infants' Decongestant, Pseudo-Time, Silfedrine, Sudafed, Sudafed 12 Hour, Sudafed 24 Hour, Sudafed Children's Nasal Decongestant, Sudafed Congestion, Sudafed Sinus Congestion, Sudogest, Sudogest 12 Hour, Sudogest Children's , Tylenol Children's Simply Stuffy, Zephrex-D
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