When to worry about fever with a middle ear infection

A middle ear infection can cause ear pain, pressure, reduced hearing, irritability, and fever. Children may pull at the ear or sleep poorly, while adults may describe fullness or muffled sound. The fever should be considered with pain, alertness, drinking, and the appearance of the ear rather than by itself.

A clinician may need to look at the eardrum to distinguish infection from fluid or another cause of discomfort. Never put cotton buds or unprescribed drops into a painful or draining ear.

Offer fluids and rest. A warm cloth over the outer ear may feel soothing. Use a suitable pain or fever medicine only according to the label or a clinician's advice, taking account of age, allergies, pregnancy, and other medicines.

Note whether pain, fever, drainage, hearing, or balance is improving. Keep water out of an ear that is draining until it has been assessed.

Seek urgent care for swelling or redness behind the ear, the ear being pushed outward, severe headache, stiff neck, facial weakness, confusion, repeated vomiting, a seizure, or marked drowsiness. Arrange prompt medical review if pain is severe, fluid or pus drains from the ear, hearing suddenly worsens, balance is affected, or fever and discomfort are worsening instead of easing.

Ask whether the eardrum is intact, whether antibiotics or observation is appropriate, how to manage pain, and when hearing or persistent fluid should be checked again.