Acute Bacterial Otitis Media
Acute bacterial otitis media is a bacterial infection behind the eardrum, often following a cold, that causes ear pain, fever and sometimes reduced hearing.
Key takeaways
- Symptoms alone cannot always distinguish bacterial infection from viral otitis media or fluid without infection.
- Age, symptom severity, eardrum findings and risk factors determine whether observation or antibiotics are appropriate.
- Pain relief and review for worsening symptoms matter even when an antibiotic is prescribed.
The listings below do not establish a bacterial cause; ear examination is important before antimicrobial treatment.
Recognising middle-ear infection
Young children may pull at an ear, sleep poorly, feed less or become irritable. Clinicians look for a bulging inflamed eardrum and middle-ear fluid. Discharge may occur if the eardrum perforates; hearing is often temporarily muffled.
Treatment decisions
Many uncomplicated cases improve without antibiotics. Immediate treatment is more likely for severe symptoms, very young children or higher-risk cases. When antibiotics are used, choice and duration depend on age, allergy history, recent treatment and local guidance. Persistent fluid after pain resolves does not automatically mean ongoing infection.
When to seek urgent care
Seek prompt care for swelling or redness behind the ear, a protruding ear, facial weakness, severe headache, neck stiffness, high fever, marked drowsiness or a child who appears very unwell.