Red flags & when to go in person for Ear Infection (Otitis Media) - Triage

Audience: pediatric

Ear infections, also called otitis media, are common in children and often cause ear pain, fever, and fussiness. Many ear infections improve on their own or with treatment that can be guided through telemedicine. However, some signs mean your child needs to see a healthcare provider in person quickly. These include severe pain, swelling around the ear, high fever, or signs of hearing loss. Telemedicine can help assess symptoms, provide advice, and recommend treatments, but it cannot perform physical exams or procedures like ear cleaning or drainage. Knowing when to seek in-person care helps keep your child safe and comfortable. This guide explains red flags to watch for, how telemedicine can assist, and what to expect before and after a virtual visit. Remember, this information is educational and not a substitute for professional medical evaluation.

Red flags — go in person / ER

• Severe ear pain not relieved by painkillers — seek urgent in-person care.
• Swelling, redness, or tenderness around the ear or face — go to a healthcare facility promptly.
• High fever above 39°C (102°F) lasting more than 48 hours — get medical attention quickly.

What telemedicine can do

• Initial symptom assessment and medical history review.
• Advice on pain relief and home care.
• Determining if in-person care is needed.
• Prescribing medications when appropriate.

What telemedicine cannot do

• Physical examination of the ear including otoscopy.
• Procedures such as ear cleaning or drainage.
• Diagnosing complications like mastoiditis or hearing loss.
• Emergency interventions for severe symptoms.

What is an Ear Infection (Otitis Media)?

An ear infection happens when the middle ear, the space behind the eardrum, becomes inflamed and often filled with fluid. It is common in young children and can cause pain, fever, and trouble hearing. Ear infections may be caused by viruses or bacteria and often follow a cold or respiratory infection.

Common Symptoms of Ear Infection in Children

Look for signs such as ear pain or pulling at the ear, irritability, difficulty sleeping, fever, fluid draining from the ear, or trouble hearing. Young children may not be able to describe their discomfort, so watch for fussiness or changes in behavior.

Red Flags: When to Seek In-Person Care Immediately

Certain symptoms require urgent medical attention:

If your child has any of these signs, go to a healthcare facility promptly.

How Telemedicine Can Help

Telemedicine allows you to consult a healthcare provider remotely. Providers can:

However, telemedicine cannot replace a physical ear exam or perform procedures.

Preparing for a Telemedicine Visit

Before your virtual visit:

This helps the provider make the best assessment.

After the Telemedicine Visit

Follow the provider's instructions carefully. Monitor your child's symptoms closely. If symptoms worsen or red flags appear, seek in-person care immediately. Keep any prescribed medications on schedule and attend any recommended follow-up appointments.

How to prepare for your tele-visit

• Ensure a stable internet connection and a charged device.
• Find a quiet, well-lit room for the visit.
• Have your child's symptom details and medical history ready.
• Prepare a list of current medications and allergies.
• Be ready to describe your child's symptoms clearly and answer questions.

After your tele-visit

• Follow the healthcare provider's instructions carefully.
• Administer any prescribed medications as directed.
• Watch for any worsening symptoms or new red flags.
• Schedule and attend any recommended follow-up visits.
• Seek in-person care if red flags or severe symptoms develop.

FAQs

Can telemedicine diagnose an ear infection in my child?

Telemedicine can help assess symptoms and guide care, but it cannot replace a physical ear exam needed to confirm an ear infection.

What should I do if my child’s ear pain gets worse after a telemedicine visit?

If your child's pain worsens or new red flags appear, seek in-person medical care promptly.

Are antibiotics always needed for ear infections?

Not always. Many ear infections improve without antibiotics. A healthcare provider can advise if antibiotics are necessary based on symptoms and age.

How can I help relieve my child's ear pain at home?

You can give age-appropriate pain relievers like acetaminophen or ibuprofen, ensure your child rests, and keep them hydrated. Avoid putting anything inside the ear.

When should I be worried about hearing loss?

If your child seems to have trouble hearing, does not respond to sounds, or has balance problems, seek medical evaluation promptly.

Sources

1. Ear Infection (Middle Ear) — MedlinePlus, U.S. National Library of Medicine.
2. Otitis Media — Centers for Disease Control and Prevention (CDC).
3. Ear Infection (Otitis Media) — Mayo Clinic.
4. Otitis Media in Children: Diagnosis and Treatment — American Academy of Pediatrics (AAP).

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your child has severe symptoms or red flags, please seek immediate evaluation by a healthcare professional in person.