Springdale Mason Pediatrics

Ear Infection - Viral


  • 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


  • 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.


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


  • 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

  • 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.
  • 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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