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Kids Health Info

Middle ear infection (otitis media)

  • Go to outer ear infection (otitis externa)

    Key points

    • A middle ear infection happens when the space behind the eardrum gets infected – usually due to a virus or bacteria.
    • Middle ear infections are very common in early childhood.
    • The best treatment for most middle ear infections is rest.
    • If a virus causes the middle ear infection, antibiotics will not help.

    What is a middle ear infection?

    A middle ear infection is when the space behind the eardrum, called the middle ear, gets infected. It is also known as otitis media. Viruses and bacteria cause most middle ear infections.

    It is common for small children to have several ear infections in one year – sometimes as often as once every month. Most infections get better quickly and are not usually serious.

    Otitis_Media_Middle_Ear_Infection_Shutterstock

    Figure one: Diagram showing a middle ear infection (otitis media).

    Signs and symptoms of middle ear infections

    Middle ear infections often start with the common cold. Your child may have symptoms such as:

    • Sore throat
    • Runny or blocked nose
    • Cough.

    The middle ear can get infected when germs from the throat and nose travel into the middle ear. Fluid and infection that builds up behind the eardrum cause it to bulge, leading to pressure and pain (earache).

    Other symptoms of middle ear infections include:

    • Fever (temperature of 38°C or more)
      • Sometimes a fever is the only symptom of a middle ear infection – especially if your child is young and cannot tell you they have an earache.
    • Irritability due to the pain
    • Muffled hearing
    • Balance problems.

    The fluid in the middle ear usually takes a few weeks to go away. During this time, your child will have less hearing from the infected ear.

    Occasionally, the pressure in the ear will cause a small hole or ‘perforation’ in the eardrum. This can cause pus – a yellow, milky fluid – to leak from the ear. While this may look alarming, it will often make your child feel better. The hole will heal over time.

    How to care for a middle ear infection

    The best treatment for most ear infections is rest; they tend to get better without antibiotics.

    Here are some simple ways to make your child more comfortable while they are healing:

    • If your child is in pain, you can give them pain relief medicine, such as paracetamol or ibuprofen.
    • Comfort your child and make sure they drink plenty of fluids to keep them hydrated.
      • A mouthful of fluid every 15 minutes or so is a good guide.
      • Your child may sleep better at night if they are propped up on two or more pillows.
      • Only do this if your child is old enough to use pillows. Do not put pillows in a cot.
    • Take your child to see a doctor or health professional if they are still in pain or have a fever (temperature of 38°C or more) after 48 hours.
      • This could be a sign that their ear infection is bacterial and needs treatment with antibiotic medicine.
      • They may prescribe antibiotics if they think there is a risk of bacterial infection, or if the infection is more severe.
    • If your child still has hearing problems two weeks after a middle ear infection or they are still acting irritable, you should take them to a doctor or health professional.

    When to get help

    Call an ambulance (000) if:
    • your child is lethargic and not waking up properly or interacting – for example, they seem very drowsy.

    Go to a hospital if:
    • your child has swelling building up, redness or tenderness behind the infected ear on the head itself.
    • your child has a fever (temperature of 38°C or more) and is lethargic or drowsy.
    • your child’s infected ear is red and swollen.
    • your child is very irritable, and pain-relief medicine like paracetamol or ibuprofen does not help.

    See a doctor or health professional if:
    • your child is still in pain or has a fever (temperature of 38°C or more) after 48 hours.
    • your child gets ear infections more than four times in one year.
    • your child still has hearing problems two weeks after a middle ear infection.
    • your child is still acting irritable two weeks after a middle ear infection.

    Look after your child at home if:
    • pain-relief medicine helps with their pain, and they start to recover within 48 hours.

    Common questions about middle ear infections

    What causes a middle ear infection?

    Most middle ear infections are triggered by a virus like the common cold. When your child has a cold, germs from their throat and nose travel to the middle ear through a tube called the eustachian tube. This causes fluid and infection to build behind the eardrum.

    Are middle ear infections contagious?

    The viruses that lead to most ear infections are contagious, much like other cold viruses.

    How can a doctor tell if my child’s middle ear infection is caused by a virus or bacteria?

    It can be hard for a doctor to tell if a middle ear infection is due to a virus or bacteria. However, most viral infections get better on their own and do not need antibiotics. If the infection does not seem to get better, it is more likely to be bacterial.

    How long does a middle ear infection usually last?

    Most middle ear infections last between two and four days. Other symptoms, such as a cough and blocked nose, can last up to three weeks. Hearing may not return to normal until fluid in the ear clears; this may take up to a month.

    Why do babies and young children get more middle ear infections?

    Babies and young children get more middle ear infections because they have smaller and more horizontal eustachian tubes, which do not drain well. This means fluid is more likely to build up in their middle ear and cause an infection.

    How can I prevent my child from getting a middle ear infection?

    Middle ear infections are common, and most children will have at least a few in their first few years of life. As they are often linked to the common cold, they can be hard to avoid. Two things you can do to help reduce your child’s risk of middle ear infections are to get them vaccinated and keep your home smoke-free.

    How can I tell if my baby has a middle ear infection if they cannot speak?

    Your baby cannot tell you how they are feeling with words, but they may fuss, cry or have a fever (temperature of 38°C or more) when they have an infection. Rubbing or playing with their ears is not usually a sign of an ear infection unless they have the other symptoms.

    Will my child grow out of ear infections?

    As children grow, their eustachian tubes grow with them. This usually means they will have fewer – and less severe – ear infections over time. Older children also tend to get fewer viruses, meaning less chance of a viral ear infection.

    Can middle ear infections cause any long-term problems?

    Fluid in the middle ear can cause muffled hearing for a month or two. If this fluid lasts longer, it could be a condition called glue ear. Rarely, children who get repeated ear infections can have longer term hearing loss.

    Can my child still go to childcare or school if they have a middle ear infection?

    Your child can go to childcare or school with a middle ear infection if they are otherwise well. However, if they are in pain or have a fever (temperature of 38°C or more), you should keep them home so they can rest and recover.

    Can my child go swimming with a middle ear infection?

    Your child should not swim or go underwater in the bath if they have pus coming from their ear. This is because the pus is a sign of a hole in the eardrum; this needs to heal before it is safe to go underwater. If your child does not have any pus, and they do not have other symptoms like a fever (temperature of 38°C or more) or irritability, it is usually okay to swim. It is best to speak with your child’s doctor if you are not sure.

    Should I clean the wax from my child’s ears to stop middle ear infections?

    There is no need to remove the wax in your child’s ears. The body can usually do this by itself. You can remove large clumps of wax visible at the opening of the ear, but you should never use cotton buds as they push wax further in and can damage the ear.

    Ear wax drops are a safer option for removing ear wax. Speak with your child’s doctor or a pharmacist for more information.

    For more information


    Developed by The Royal Children’s Hospital Emergency department, with input from Otolaryngology. We acknowledge the input of RCH consumers and carers.

    Reviewed March 2026

    Please always seek the most recent advice from a registered and practising clinician.


Disclaimer

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.

Updated July 2025

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