What's the difference between an ear infection and fluid in the ear?
Acute otitis media comes on suddenly after a cold with ear pain, fever, fussiness and ear tugging; the eardrum bulges and looks red. Otitis media with effusion is fluid without infection—no pain, but kids may not hear well or turn the TV up. Children's short, flat eustachian tubes let germs from the nose reach the ear.
Does my child need antibiotics?
For kids 2 and older with mild symptoms, the American Academy of Pediatrics allows watchful waiting for 48–72 hours with pain relief (Lieberthal et al., 2013). Infants under 6 months, high fever, severe pain or infection in both ears usually get antibiotics right away. Ear tubes are considered for fluid lasting 3+ months with hearing loss or frequent infections. Vaccines, avoiding secondhand smoke and not bottle-feeding lying down help prevent them. Long-lasting nasal symptoms may point to sinusitis.
This article is general health information and is not a substitute for diagnosis or treatment. If symptoms persist, see a doctor.
FAQ
- Can swimming cause middle ear infections?
- No—that's swimmer's ear, an outer ear infection. Middle ear infections come from the nose and throat.
- Are ear infections contagious?
- The ear infection itself isn't, but the cold that triggers it is.
Sources reviewed: 2026-10-25
References
- Lieberthal, A. S., et al. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999.