An acute or chronic infection of the middle ear occurring mostly in children <2years


  • Bacterial infection, e.g., Streptococcus pneumoniae, Haemophilus influenzae
  • Commonly follows an acute infection of the upper respiratory tract

Clinical features

  • Acute onset of pain in the ear, redness of the ear drum
  • Fever
  • Pus discharge for <14 days
  • Bulging of the eardrum

In chronic otitis media

  • On and off pus discharge from one or both ears for >14 days
  • No systemic symptoms

Differential diagnosis

  • Foreign body in the ear
  • Otitis externa and media with effusion
  • Referred ear pain, e.g. from toothache


  • Good history and physical examination are important in making a diagnosis
  • Pus swab for microscopy, C&S


Acute infection

  • Amoxicillin 500 mg every 8 hours for 5 days
    Child: 15 mg/kg per dose
  • Or erythromycin 500 mg every 6 hours in penicillin allergy
    Child: 10-15 mg/kg per dose
  • Give analgesics, e.g. Paracetamol as required
  • Review after 5 days

Chronic infection

  • Systemic antibiotics are NOT recommended: they are not useful and can create resistance
  • Aural irrigation 2-3 times a day
    • 1 spoon of hydrogen peroxide in ½ glass of clean lukewarm water
    • Gently irrigate ear using a syringe without needle
    • Avoid directing the flow towards the tympanic membrane
  • Dry by wicking 3 times daily for several weeks, until the ear stays dry
  • Each time after drying, apply 2-4 drops of ciprofloxacin ear drops 0.5% into the ear
  • Do NOT allow water to enter the ear
  • Refer if complications occur, e.g., meningitis, mastoid abscess (behind the ear), infection in adjacent areas, e.g.,
    tonsils, nose


  • Health education, e.g. advising patients on recognizing the discharge of otitis media (believed by some to be “milk in the ear”)
  • Early diagnosis and treatment of acute otitis media and upper respiratory tract infections
  • Treat infections in adjacent area, e.g. tonsillitis