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Middle Ear Infection What to Do – Tips & Treatment

For a middle ear infection, pain relievers, decongestant nasal drops, and warmth can help. Learn what to do at home and when to see a doctor.

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For a middle ear infection, pain relievers, decongestant nasal drops, and warmth can help. Learn what to do at home and when to see a doctor.

What Is a Middle Ear Infection?

A middle ear infection (medically known as otitis media) is an inflammation of the middle ear, the space located behind the eardrum. It is one of the most common conditions, especially in children. It is usually caused by bacteria or viruses, often following a cold or upper respiratory tract infection. Swelling of the lining of the Eustachian tube (the connection between the throat and the middle ear) prevents fluid from draining properly, leading to pressure build-up, pain, and inflammation.

Symptoms

Common signs of a middle ear infection include:

Severe, throbbing ear pain, often on one side
Feeling of pressure in the ear
Reduced or muffled hearing
Fever (especially in children)
General feeling of illness, irritability
Occasional discharge from the ear (if the eardrum has ruptured)

What to Do – Immediate Measures

Pain Relief

Over-the-counter pain relievers such as ibuprofen or paracetamol (acetaminophen) can effectively reduce ear pain and fever. Always follow the recommended dosage and use weight-appropriate doses for children. Aspirin should not be given to children under 16 years of age.

Warmth

Applying gentle warmth – such as a warm grain pillow or a slightly warmed cloth held against the ear – can help ease pain and improve circulation in the area. Avoid direct or excessive heat.

Decongestant Nasal Drops

Decongestant nasal drops or sprays (e.g. containing xylometazoline) help reduce swelling of the nasal and throat mucosa. This allows the Eustachian tube to ventilate more effectively, relieving pressure in the middle ear. These products should not be used for more than 5 to 7 consecutive days.

Rest and Sleep

Physical rest and sufficient sleep support the immune system in fighting the infection. Slightly elevating the head during sleep may also help reduce pressure in the ear.

When to See a Doctor

Medical attention should be sought in the following situations:

Symptoms do not improve after 2 to 3 days or worsen
High fever (above 39 degrees Celsius / 102 degrees Fahrenheit) or fever lasting more than 2 days
Severe pain that does not respond to pain medication
Discharge from the ear (possible eardrum perforation)
Infants under 6 months or children with underlying health conditions
Persistent hearing loss even after other symptoms resolve
Swelling, redness, or pain behind the ear (possible sign of mastoiditis)

Medical Treatment

Antibiotics

Not every middle ear infection requires immediate antibiotic treatment. In uncomplicated cases in older children and adults, a watchful waiting approach is often recommended first. If a bacterial infection is confirmed, symptoms are severe, or the condition does not improve on its own, a doctor will typically prescribe an antibiotic – most commonly amoxicillin. It is important to complete the full course of antibiotics to prevent resistance.

Ear Drops

Prescription or over-the-counter ear drops with pain-relieving or anti-inflammatory properties may be used as a complementary measure, provided the eardrum is intact.

Myringotomy

In cases of severe pressure pain or chronic fluid build-up, an ear, nose, and throat (ENT) specialist may perform a myringotomy – a small incision in the eardrum to drain the accumulated fluid.

Special Considerations for Children

Children are significantly more prone to middle ear infections because their Eustachian tube is shorter and more horizontal than in adults. Breastfed children have a lower risk. Children in daycare settings or exposed to secondhand smoke are more frequently affected. In cases of recurrent middle ear infections, an ENT specialist may recommend the insertion of tympanostomy tubes (small ventilation tubes placed in the eardrum) to improve drainage and ventilation.

What to Avoid

Keep water out of the ear – avoid swimming and diving
Do not insert cotton swabs into the ear canal
Avoid forceful nose blowing, as it can increase pressure in the middle ear
Avoid smoking and protect children from secondhand smoke

References

Deutsche Gesellschaft fur Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC): Guideline on Otitis Media – AWMF, 2019.
World Health Organization (WHO): Chronic suppurative otitis media – burden of illness and management options. Geneva, 2004.
Lieberthal AS et al.: The Diagnosis and Management of Acute Otitis Media. Pediatrics, 2013; 131(3): e964-e999.

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