Ear Infection - Viral

Definition

A viral infection of the middle ear (the space behind the eardrum)

Call or Return If

Fever lasts more than 3 days
Ear pain becomes worse
Ear discharge occurs
You think your child needs to be seen
Your child becomes worse

About This Topic

Symptoms

Mild or moderate earache
Younger children may act fussy or poke at their ear
The main symptom may be ear congestion
Symptoms of a common cold also present. This includes a runny or congested nose, and a cough.

Diagnosis

A doctor can diagnose a viral ear infection by looking at the eardrum. It will be red but not bulging.

Cause

Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat. Blockage results in middle ear fluid (called viral otitis).
A viral ear infection sometimes turns into a bacterial one. If the fluid becomes infected, the fluid turns to pus (bacterial otitis).
This causes the eardrum to bulge out and can cause lots of pain.

After Care Advice

Overview:

Most viral ear infections get better on their own.
Your main job is to control the pain.
Here is some care advice that should help.

Pain Medicine:

To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.

Fever:

For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.

Antibiotic Not Needed:

Antibiotics don't help viral infections.
They can only kill bacteria.

Nasal Washes To Open a Blocked Nose:

STEP 1: Use saline nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use warm tap water. Put 3 drops in each nostril. (If age under 1 year old, use 1 drop. Also, do 1 side at a time.)
STEP 2: Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
How often: Do nasal washes when your child can't breathe through the nose. Limit: No more than 4 times per day.
Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
Saline nose drops can also be made at home. Use 1/2 teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of warm water.
Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
For young children, can also use a wet cotton swab to remove sticky mucus.

Medicines for Colds:

Age Limit. Before 4 years, never use any cough or cold medicines. Reason: Unsafe and not approved by the FDA. Also, do not use products that contain more than one medicine.
Cold Medicines. They are not advised. Reason: They can't remove dried mucus from the nose. Nasal washes are the answer.
Decongestants. Decongestants by mouth (such as Sudafed) are not advised. They may help nasal congestion in older children. But, decongestant nasal spray is preferred after age 12.
Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough.

What to Expect:

Most children get better slowly over 2 to 3 days.
Ear congestion may last until the cold is gone.

Return to School:

Your child can return to school or child care when any fever is gone.
Your child should feel well enough to join in normal activities.
Ear infections cannot be spread to others.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2021 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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