Pediatric Associates of the NW Blogs

Ear Infections: How Worried To Be?

Scott Spencer, MD, MPH
December 23, 2015 01:00AM

Your 9-month-old son has been crying since he went to bed. He has had a cold for one week and this evening he just began a low-grade fever. What is going on? Could it be an ear infection? You give him some acetaminophen and he seems to calm down after 30 minutes and eventually goes to sleep for the night. Whew! You bring your child to their clinic provider at PANW the next day, and sure enough he has his first ear infection. So what do you need to know about this common illness, what are some common signs, how urgent is it and how is it treated?

Ear infections (or suppurative otitis media) affect the part of the ear called the middle ear space. The middle ear is a space behind the ear drum that is usually filled with air.  The air is important to produce sound. With an ear infection, fluid can build up in the middle ear space from a cold, or sometimes from allergies. The fluid then can become trapped inside the middle ear, because it is too thick to drain out. This fluid puts pressure on the ear drum – which causes pain.  

Identifying a child with an ear infection at home can be tricky. Pulling on ears, or ear tugging are obvious signs, but increased fussiness or a new fever especially after a cold, may be the only signs. The first step in managing a possible ear infection at home is to attempt to control the pain, typically with ibuprofen or acetaminophen. If you can control the pain, then it is not urgent. You can wait for an appointment until the next day. However, if the discomfort is a little better the next day, it is worth waiting a day or more to see if the ear pain improves. Even if your child does have an ear infection, it may get better without antibiotics. In children over 2, more than half of ear infections don’t need antibiotics to get better (1)

When you see your provider at PANW and they diagnose an ear infection, they will take time to explain your treatment options. Often in children over 2, they may give you a SNAP (Safety Net Antibiotic Prescription) to hold on to and start if the ear pain is not getting better. We at PANW are concerned about antibiotics being overprescribed, which can unnecessary side effects and resistant (stronger) bacteria. 

If you wait on seeking care or wait on treating an ear infection, what is the worst-case scenario?  The first is an extremely rare emergency, called mastoiditis. Mastoiditis is a spreading ear infection to the bone behind the ear.  If there is a tender bump on the bone behind the ear your child may need care right away. The other worst case scenario is if the ear drum bursts. You will know this if you see liquid coming out of the ear canal. The liquid can be clear but usually thick, smelly, frothy or even bloody. But unlike mastoiditis – this is NOT an emergency. Bring your child to see their provider the next day. Once treated with antibiotics, the ear drum will heal up almost all the time. 

The take home message:  ear infections are almost never an emergency. If you can control the pain, then seeking care outside our clinic is rarely necessary. If you have any questions, please call our on-call providers or nurses that are available 24 hours a day, 7 days a week to answer your questions.

One final note, there is a product called antipyrine benzocaine which are prescribed ear pain drops.  This product was just discontinued, because of the risk of using it with a burst ear infection. Other remedies for ear infections, such as garlic oil in the ear are unproven. However, they are typically safe as long as there is no signs of a burst ear drum. Talk to your provider if you have more questions.


  1. The Diagnosis and Management of Acute Otitis Media, Pediatrics 2013;131:e964–e999