Ear infection (middle ear) | Pokenga taringa

 Key points about middle ear infections

  • A middle ear infection (pokenga taringa) occurs when bacteria or viruses infect the middle ear, causing pain and discomfort. It is also known as acute otitis media.
  • Ear pain and concerns about hearing are one of the most common reasons parents take their young children to the doctor.
  • Ear infections are very common in young children.
  • They can cause pain, and often fever.
  • If you think your child has an ear infection, take them to your family doctor.
  • Most children outgrow ear infections and will have perfect, undamaged ears and normal hearing.
Young girl with finger in her right ear
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(St. Louis Children’s Hospital, 2018)

There are 2 common types of middle ear problems:

  • an ear infection (acute otitis media) – discussed on this page
  • glue ear (otitis media with effusion).

You can read more detailed information about ear infections.(external link)


The pain from an ear infection comes on rapidly and doesn't last long. It usually wears off within 24 hours.

Symptoms in older children

Older children will complain of significant ear pain and may have a fever. They may also feel unwell and complain of reduced hearing in the affected ear. They may complain of problems with balance.

Symptoms in babies and younger children

In babies and younger children, sometimes the only sign of an ear infection is a fever.

Younger children may also:

  • cry and become very upset, distressed, irritable and hard to settle
  • have very disturbed sleep at the beginning of the infection
  • become ‘clingy’ and ‘grizzly’ 

Burst ear drum

Occasionally, the ear drum will burst and pus will come out of the ear. See your family doctor if this happens.

Pain relief

Regular pain relief is important to help your child feel more comfortable. Paracetamol and/or ibuprofen can help reduce pain, and also lower fever which can make your child feel better. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

Antibiotics are often not needed

Your doctor may either:

  • wait to see whether the infection will clear up by itself, or
  • recommend treatment with antibiotics, if your child is unwell and feverish.

Go to your doctor if you suspect your child has an ear infection

If you think your child has an ear infection, take them to your family doctor.

Take your child back to your doctor if your child doesn't improve in 24 to 48 hours

Once an ear infection is diagnosed, your child should start to improve within 24 to 48 hours. If the symptoms are no better or are getting worse, or you are worried about your child, take them back to your family doctor.

Go to your doctor again 4 to 6 weeks after the ear infection

Always take your child to your family doctor for an ear check after any ear infection, to make sure the ear fluid has gone. Go to your doctor again 4 to 6 weeks after the ear infection.

It isn't easy to prevent ear infections, but the following may help reduce the risk:

  • making sure your child's environment is smoke-free
  • breastfeeding your baby for at least 3 to 6 months is thought to be protective against the early development of ear infections - this may be because breastfeeding boosts the infection-fighting system (immune system)
  • keeping your child's room warm and dry
  • making sure your child has all their immunisations on time.

Continuing professional development

Common ENT infections – Bruce Arroll (21 minutes) PHARMAC seminar: Ear, nose and throat (ENT) update, 1 of 5. Common ENT infections(external link) (PHARMAC, NZ, 2019)

For more videos of the same series, visit PHARMAC seminars(external link).

Clinical updates

Otitis media – a common childhood illness(external link) Best Practice Journal, NZ, 2012
Antibiotics guide(external link) BPAC, NZ, 2017
Acute otitis media in children(external link) Patient Info Professional, UK, 2016
Acute otitis media in adults(external link) Patient Info Professional, UK, 2016
Chronic suppurative otitis media(external link) Patient Info Professional, UK, 2018
Acute otitis media(external link) The Royal Children’s Hospital Melbourne, Australia, 2018
The tympanic membrane – diagnostic picture tests(external link) BMJ Learning, UK, 2014

Down syndrome and increased risk of ear infections

Children with Down syndrome or cleft palate disorders are at much higher risk of ear infections and glue ear. They get it at a younger age and are less likely to clear it themselves. Refer early and they often need ongoing specialist review. Assessment and surgical management of otitis media with effusion in children(external link) National Institute of Healthcare Excellence, UK

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