A double ear infection is when both ears become infected by bacteria or a virus. Double ear infections are not always more serious than single ear infections, but their symptoms are often more severe.

Early diagnosis and treatment may lead to a quicker recovery and reduce the risk of complications.

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Read on to learn more about identifying and treating a double ear infection.

What are the symptoms?

Woman holding head in pain due to double ear infection
Symptoms of double ear infection may include pain in ears, fatigue, a headache, and problems hearing.

The symptoms of a double ear infection are similar to those of a single ear infection, but they may be more severe when both ears are infected.

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Symptoms may include:

  • pain in the ear
  • difficulty sleeping
  • drainage from the ears
  • fatigue
  • a headache
  • a fever that lasts for 2 or more days
  • problems hearing

How to spot symptoms in toddlers and infants

Signs in infants and toddlers include:

  • crying more than usual
  • increased irritability, especially when lying down
  • loss of interest in feeding
  • pulling on the ears (this may not be a symptom of an earache in infants who are otherwise well)
  • persistent fever, or a fever that goes away and then returns during the same illness

When to see a doctor

People should see their doctor if symptoms continue for more than 24 hours.

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People who have pus or bloody discharge coming from one or both ears will likely require more urgent treatment.

When a parent or carer notices the signs of an ear infection in an infant under 6 months old, they should take the child to a doctor as soon as possible.

Older children should see a doctor if symptoms are severe or last for more than 24 hours, especially if they have a fever or discharge from the ear.

What are the causes?

Bacteria or viruses in the middle ear cause ear infections.

A person who has, or had, an upper respiratory infection may also develop an ear infection. Ear infections are not contagious. However, the respiratory infections that might accompany an ear infection are.

Enlarged adenoids, which are pads of tissue at the back of the nose, may also contribute to a double ear infection, especially in children.

An infection affecting only one ear may also occasionally develop into a double ear infection.

Complications

Man cupping hand to ear due to double ear infection
Recurrent infections may lead to hearing problems.

Hearing difficulties are probably the most common short-term complication of a double ear infection.

A person’s hearing will typically return to normal once the infection clears up.

Persistent or recurrent infections can lead to:

  • Hearing problems: Permanent damage to structures within the ear can cause hearing loss of varying degrees.
  • Ruptured eardrum: A torn eardrum may occur after severe ear infections. It will usually heal within a few weeks.
  • Delays in speech and development: Infants and toddlers who experience a prolonged hearing loss may experience delays in their speech and development.
  • Spread of infection: As with all infections, there is a risk that a double ear infection will spread to other areas of the body.

Long-term complications following ear infections are uncommon.

How is it diagnosed?

A doctor will usually diagnose a double ear infection by checking a person’s medical history and asking about their symptoms.

The doctor will examine both ears using a device called an otoscope. It comprises a light and a magnifying lens. Doctors typically look for redness, swelling, and signs of fluid behind the eardrum, which indicates infection.

A doctor may also use another device, called a pneumatic otoscope, to test how much the eardrum moves in response to pressure. If the eardrum does not respond to this pressure, it suggests fluid buildup behind the ear.

Treatments

Many single ear infections clear up on their own. But double infections are more likely to require treatments such as:

Antibiotics

A bacterial infection can be treated with antibiotics, such as amoxicillin. A doctor may also prescribe antibiotic eardrops.

Antibiotic medications will not work for a viral infection, so a virus will have to run its course.

Ear tubes

Children with recurrent ear infections may require surgery that involves fitting small ear tubes. The tubes help to ventilate the middle ear and prevent fluid buildup.

Some tubes are designed to remain in the ear for up to 12 months before falling out on their own. Other types of tubes stay in place for longer and must be surgically removed.

Home remedies

Home remedies aim to lessen the pain rather than treat the underlying infection. Home treatments include:

  • Warm compresses: To make a compress, soak a washcloth in warm water. Wring out the excess liquid and place the cloth over the affected ear or ears.
  • Pain medications: Some over-the-counter pain (OTC) relievers may reduce ear pain. Options include acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB). If giving medication to infants and children, always use age-appropriate doses. Aspirin should not be given to children as it has been linked with a serious condition called Reye’s syndrome.

How can they be prevented?

Frequent hand washing can help to prevent infections
Washing hands frequently may help to prevent colds and flu.

It is difficult to prevent ear infections in young children completely.

Steps to reduce the frequency or severity of infections include the following simple tips and habits:

  • washing hands frequently to help prevent colds and flu
  • avoiding people who are sick
  • keeping children away from childcare settings when they are ill
  • teaching children to avoid sharing their utensils with others
  • avoiding exposure to cigarette smoke
  • staying up to date on all immunizations, including the flu shot

Where possible, breast-feed infants, as breast milk provides additional protection from ear infections. Try to hold the infant in an upright position when feeding.

Also, avoid prolonged bottle-feeding at bedtime, as research suggests it can increase ear and sinus infections, acid reflux, and cough.

Takeaway

A double ear infection should begin to heal within a few days of treatment. But symptoms may not fully resolve until a person has completed the full course of antibiotics, which can take up to 10 days.

Home remedies can reduce pain and discomfort in the meantime.

Anyone who notices the symptoms of an ear infection should seek prompt medical treatment for the best outlook.