otitis media (earache)

Advice for professionals to be used with parents and carers

The middle ear is the small space behind the eardrum; this space is usually filled with . Otitis media is an infection of the middle ear that causes inflammation and a build-up of fluid. It is often extremely painful and be be associated with high fever. 

Otitis media can be hard to diagnosis in children younger than 6 months of age as there may be coexisting illness such as bronchiolitis. The symptoms can be non-specific and the tympanic membrane can be hard to visualise (it lies in an oblique position, the ear canal is small and tends to collapse)

Symptoms of otitis media:

  • Earache
  • Fever may be present
  • Misery
  • Pulling, tugging or rubbing ear
  • Slight hearing loss

In most cases the symptoms of a middle ear infection develop quickly and resolve in a few days. In some cases, pus may run out of the ear, this is the fluid that had built up behind the ear drum causing a small hole in the eardrum; this tends to heal up by itself.


Most cases of earache/otitis media in young children (under 5 years of age) are caused by viral infections; your child may also have a runny nose and cough. The Eustachian tube is a small tube that links the middle ear to the back of the throat. Its main job is to regulate air pressure in the ear. Its other function is to drain any fluid or mucus that builds up. The common 'cold' can cause the Eustachian to become blocked, causing a build up of fluid or mucus and resulting in earache.

When should you worry?

If your child has any of the following:

  • Is going blue around the lips
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern
  • Too breathless to talk/eat or drink
  • Becomes pale, mottled and feels abnormally cold to touch
  • Has a fit/seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (the 'Glass Test')
  • Is under 1 month of age with a temperature of 38°C / 100.4°F or above

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Has pus coming out of the ear
  • Develops swelling behind the ear or increasing pain / redness behind the ear
  • Develops dizziness or is losing their balance
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle down with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
  • Is complaining of a severe headache and neck stiffness/pain or discomfort with bright lights (photophobia)
  • Is having breathing problems, such as rapid breathing, shortness of breath or laboured breathing (drawing in of muscles below the lower ribs when they breath in)
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Has extreme shivering or complains of muscle pain
  • Is between 1-3 months of age with a temperature of 38°C / 100°F or above; or 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations).
  • Continues to have a fever of 38.0°C or above for more than 5 days
  • Is getting worse or if you are worried

You need to contact your GP Surgery today

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

If none of the above features are present

Pharmacy/ Self care

Pharmacists can advise and treat a range of common symptoms. No appointment is needed and most pharmacies have a private consulting area. Click on this link to find a Pharmacy near to you

If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk

This guidance has been reviewed and adapted by healthcare professionals across the Black Country Integrated Care System.


Most children with otitis media (earache) do no require treatment with antibiotics. Antibiotics rarely speed up recovery and often cause side effects such as rash and diarrhoea. They will also promote the development of antibiotic resistant bacteria in your child.

Image of an infographic about antibiotics that reads 'antibiotics don't usually speed up recovery. 8 out of 10 children with otitis media (earache)  who do not take antibiotics feel better within 2-3 days. Earache generally improves without the need for antibiotics in otherwise healthy, vaccinated children. Antibiotic resistance - using antibiotics also drives the development of antibiotic resistant bacteria (which means that they are harder to treat with antibiotics). Healthcare staff and patients need to work together to make sure that we use antibiotics more wisely so that they remain effective when your child needs them most. Antibiotics should only be used if their benefits are likely to outweigh their harms.


Antibiotics are usually only considered if your child:

  • Is between 6 months and 2 years of age with infection in both ears, or with associated symptoms such as altered sleep, fever and overwhelming misery
  • Has pus draining from their ear
  • Has a serious health condition that makes them more vulnerable to serious infection

In addition, if your child has any features of severe infection (amber or red features above), they will need to be urgently assessed by a healthcare professional

You can help relieve symptoms by:

  • Giving your child paracetamol or ibuprofen to help relieve pain
  • Encouraging your child to drink plenty of fluids


Is it not possible to prevent ear infections; however, you can do things that may reduce your child's chances of developing the condition:

  • Ensure your child is up-to-date with their immunisations
  • Avoid exposing your child to smoky environments (passive smoking)