Acute Otitis Media (i.e. ear infection) is characterized by:

recent, often abrupt, onset of illness

presence of middle ear fluid or pus

symptoms of middle ear inflammation which include pain and/or fever

During an earache, the air-containing chamber behind the eardrum fills with fluid or pus. Pressure builds up against the eardrum causing pain. Pain may be associated with the congestion that is part of the common cold. Instead of rushing to the ER, the important immediate treatment is pain relief. This can include:  acetaminophen (Tylenol) or ibuprofen (Motrin/Advil), sleeping upright, and applying a warm washcloth or heating pad over the ear. If no evidence of bloody/pus discharge, OTC drops (i.e. sweet oil) may provide local relief.

60% of ear infections are caused by viruses and will not respond to antibiotic therapy. Most bacterial ear infections will resolve without antibiotics. Evidence suggests that pain symptoms are only shortened by 1 day when treating with antibiotics. Due to rising rates of antibiotic resistance, the American Academy of Pediatrics has recommended an observation period without antibiotic use for uncomplicated ear infections in otherwise healthy children over 6 months old. Defer antibiotics for 2 to 3 days while managing discomfort with pain medications. If pain persists and/or fever is present after the observation period, antibiotic therapy may be started.