Otitis media (middle ear infection)
Key facts
- Otitis media (middle ear infection) is common, especially in children.
- It often starts with a cold and will usually go away by itself without antibiotics.
- Symptoms include ear pain, fever and sometimes also fluid leakage from the ear.
- Risk factors include exposure to smoke, day care attendance and dummy use.
- Reduce your child's risk of otitis media by breastfeeding, limiting their dummy use and exposure to cigarette smoke.
What is otitis media?
Otitis media is an infection of the middle ear. This is the part of your ear behind the eardrum. It usually happens when fluid builds-up, often due to a cold.
Otitis media is common in children but can also affect adults. Most children have at least one middle ear infection before they reach school age. Children usually get fewer middle ear infections as they get older.
What are the symptoms of otitis media?
Otitis media often starts with a cold. You may have a sore throat and a runny nose.
When the infection spreads to your ear, you may notice symptoms such as:
- earache
- fever
- trouble hearing
- headache
- loss of balance
Babies and young children may:
- cry more at night
- pull or rub their ears
- be irritable
- lose their appetite or vomit
Sometimes, the pressure in the middle ear can cause the eardrum to burst. If it does, the pain may improve straight away. You will see yellow fluid coming from the ear. A burst eardrum usually heals on its own.
CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.
What causes otitis media?
Otitis media is often caused by bacteria or viruses.
The middle ear is connected to the throat by a tube called the Eustachian tube. This tube can become blocked during an infection. This blockage traps fluid in the ear and may lead to infection.
Middle ear infections are common in young children due to their smaller Eustachian tubes. Adults with smaller Eustachian tubes may also have regular infections.
Risk factors for middle ear infections may include:
- exposure to cigarette smoke
- attending day care
- using a dummy
Aboriginal and/or Torres Strait Islander children are also at higher risk of getting infections.
When should I see my doctor?
If you notice redness, pain or swelling of the bone behind your ear or if your ear is pushed forward, you may have mastoiditis. Seek urgent medical advice or go to your nearest hospital emergency department.
You should see your doctor if you or your child experience any symptoms of a middle ear infection. It's important to get medical attention if you have symptoms such as:
If you are planning to travel by airplane and recently had an ear infection, speak to your doctor first.
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How is otitis media diagnosed?
To diagnose otitis media, your doctor or a nurse will use an otoscope to check for signs of a middle ear infection. An otoscope is a small instrument that has a magnifying lens and light to help your doctor see your eardrum.
If your child has had several ear infections, they may need a hearing test. Your doctor may refer them to an ear, nose and throat (ENT) specialist or audiologist.
Adults with repeated ear infections should also see an ENT specialist to rule out any serious causes.
ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.
How is otitis media treated?
Otitis media usually goes away on its own within a week.
You or your child may need medicine for pain relief. Always check with your doctor or pharmacist for the right dose for your child. Your doctor may also suggest anaesthetic ear drops for pain relief. Don't use ear drops without checking with your doctor first.
Antibiotics are usually not needed unless there are signs that your child is very unwell, such as fever or vomiting. Take your child back to the doctor if your child is not feeling better after 1 to 2 days.
Antihistamines or decongestants don't help you get better faster.
Why don't doctors give antibiotics for otitis media just in case?
Otitis media will often get better by itself. Antibiotics provide only a slight reduction in pain, but they may lead to side effects and increase the risk of antibiotic resistance. This means the antibiotics may not work in future.
Because of these risks, doctors usually prescribe antibiotics only when there's a higher risk of complications. This may include:
- children under 2 years of age
- Aboriginal and/or Torres Strait Islander children
- children with certain medical conditions
What are the complications of otitis media?
If you notice redness, pain or swelling of the bone behind your ear or if your ear is pushed forward, you may have mastoiditis. Seek urgent medical advice or go to your nearest hospital emergency department.
Otitis media can lead to complications, such as glue ear, burst ear drum or mastoiditis.
Glue ear (otitis media with effusion)
After the infection clears, sticky fluid may stay in the middle ear. This can affect your child's hearing, balance and sleep. It usually isn't painful. Glue ear usually goes away by itself, but your doctor may recommend treatment if it persists for more than 3 months.
Ruptured (burst) eardrum
A ruptured eardrum will usually heal by itself. Ear pain usually stops once the eardrum bursts. You may notice thick yellow liquid coming out of your ear.
See your doctor after 6 weeks to make sure the rupture has healed. It's also important not to get your ear wet while your eardrum is healing.
Mastoiditis
In rare situations, otitis media can spread to the mastoid bone behind your ear. This is serious. It may lead to severe problems such as permanent hearing loss or inflammation around your brain.
Can otitis media be prevented?
Otitis media often comes from catching a cold. While it may be hard to prevent a cold, good hygiene can help lower your chance of getting sick.
To lower your child's chances of getting otitis media:
- keep them away from cigarette smoke
- if your child uses a dummy, try to stop them from using it or try to limit dummy use
- breastfeed your baby if you can
- hold your baby upright when feeding them and don't give them a bottle in bed
It's also important to ensure your child has all their vaccinations on time, to help prevent illness.
Resources and support
Australian Government Department of Health and Aged Care provides information about ear health.
Read the decision aid Should my child take antibiotics, developed by the Australian Commission on Safety and Quality in Health Care.
Find a nearby hearing centre on the Hearing Australia website.
You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.
If your child has symptoms of otitis media or ear pain, the Pregnancy, Birth and Baby video call service allows you to speak face-to-face with a maternal child health nurse. Video call is a free service and is available from 7am to midnight (AET), 7 days a week (including public holidays).
Looking for information for Aboriginal and/or Torres Strait Islander people?
Australian Government Department of Health and Aged Care provides resources for Aboriginal and/or Torres Strait Islander children about how to prevent ear disease.
PLUM and HATS are tools you can use the to check your child's hearing.
Otitis Media Guidelines includes education for children on how to keep their ears healthy.
Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: October 2024
