An ear infection is usually caused by bacteria or viruses. It forms when infected fluid builds up in the middle ear. When the infection occurs in both ears, it’s called a double ear infection or bilateral ear infection.

A double ear infection is considered more serious than an infection in one ear. Symptoms can be more intense, and the recommended treatment is usually more aggressive than for a unilateral (single) ear infection.

If your child has a fever, shows signs of an ear infection, and tugs on or rubs both ears, they may have a double ear infection. Responding quickly can usually resolve the problem within a few days.

A unilateral ear infection can turn into a bilateral ear infection. However, symptoms of a double ear infection usually develop in both ears at the same time. That’s why your child may be complaining of pain in both ears.

Apart from more frequent and higher fevers, standard symptoms of a bilateral ear infection are like those of a unilateral ear infection.

Symptoms of a double ear infection can include:

  • a recent upper respiratory infection
  • fever of 100.4°F (38°C) or greater that lasts for 48 hours or more
  • drainage or pus from the ears
  • tugging, rubbing, or pain in both ears
  • trouble sleeping
  • irritability and fussiness
  • lack of interest in feeding
  • difficulty hearing

These signs are important, especially if your child is an infant and young toddler who can’t tell you what’s bothering them.

An ear infection usually develops after a viral upper respiratory infection. The infection can cause inflammation and swelling of the Eustachian tubes. These thin tubes run from the ears to behind the nose at the upper part of the throat. They help maintain healthy pressure in the ears.

When the tubes become swollen and blocked, fluid can build up behind the eardrum. Bacteria can grow quickly in this fluid, causing infection and inflammation of the middle ear. Children are more prone to ear infections because their Eustachian tubes are less vertical than those of adults.

In many cases, hearing is affected only temporarily and returns when the infection goes away and the fluid clears. Permanent hearing loss and long-term speech difficulties are the greatest concerns related to serious and ongoing ear infections. Children who get repeated ear infections or who go long periods with untreated ear infections may experience some hearing loss. Hearing loss often impedes speech development.

In more serious cases, the eardrum may be damaged. A torn eardrum may repair itself within a few days. Other times, it may require surgery.

Like any infection, a double ear infection can spread to other parts of the body. The part that is most in danger is the mastoid, which is the part of the skull bone behind the ear. Infection of this bone, called mastoiditis, causes:

  • ear pain
  • redness and pain behind the ear
  • fever
  • a sticking out of the ear

This is a dangerous complication of any ear infection. It can cause serious effects, such as:

  • injury to the skull bone
  • more serious infections
  • severe complications to the brain and circulatory system
  • permanent hearing loss

If you suspect a double ear infection, seek medical attention right away. The pain and discomfort of a double ear infection can be worse than having a single ear infection. You should also seek immediate medical attention if your child appears to have severe pain or if they have pus or discharge from one or both ears.

If your baby is 6 months or younger, call their pediatrician as soon as you notice symptoms of an ear infection.

In older children, see a doctor if symptoms last for a day or two without improvement. This is especially true if your child has a fever.

The doctor will review your child’s medical history and symptoms. Then, they’ll use an otoscope to look inside both ears. An otoscope is a lighted device with a magnifying lens that allows the doctor to take a closer look at the inside of the ear. An eardrum that is red, swollen, and bulging indicates an ear infection.

The doctor might also use a similar device called a pneumatic otoscope. It emits a puff of air against the eardrum. If no fluid is behind the eardrum, the surface of the eardrum will move back and forth easily when air hits it. However, fluid buildup behind the eardrum makes it difficult for the eardrum to move.

A mild unilateral ear infection may disappear without treatment, depending on the age of the child. A double ear infection, however, is more serious. If it’s caused by a virus, then no medication can help. Instead, you’ll have to let the infection run its course. If it’s a bacterial infection, treatment usually requires antibiotics.

A common antibiotic used for young children with ear infections is amoxicillin. Antibiotics should typically be taken for a week or more. It’s important to take the full course of antibiotics exactly as prescribed to heal the infection. Your doctor can look inside the ears during a follow-up visit. They’ll determine whether the infection has cleared up.

To help ease the pain, your doctor may recommend acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Ibuprofen is not recommended for children who are younger than 6 months, however. Medicated ear drops may also be helpful.

For children who have recurrent double or single ear infections, small ear tubes can be placed in the ear to help improve drainage. A child with improperly formed or immature Eustachian tubes may require ear tubes for several months or longer to decrease ear infections.

With proper treatment, your child’s infection should heal. A double ear infection may begin to clear up within a few days of beginning treatment. Still, your child should take the full course of antibiotics, which may be a week or 10 days.

Also, don’t be alarmed if your child’s infection heals more slowly than expected. A double ear infection will take a little longer to heal than a single ear infection. During this time, sleeping may be more difficult for your child because of pain in both ears.

Overall, it’s almost impossible to prevent your child from getting ear infections in their early years. Be aware of your child’s symptoms so you can identify possible ear infection and seek proper treatment.

Bilateral ear infections are less common than single-ear infections, though if you leave a unilateral infection untreated, problems can develop in the other ear. So, preventing a double ear infection includes getting treatment quickly when an infection develops in one ear.

Studies have found that prolonged bedtime or naptime feeding with a bottle may:

  • aggravate a child’s respiratory system
  • increase ear infections, sinus infections, and cough
  • increase acid reflux from the stomach

Instead, allow your child to finish feeding before putting them down to sleep.

Tips

  • Wash hands frequently to minimize the spread of germs.
  • Don’t let your children be exposed to cigarette smoke.
  • Limit your child’s exposure to other children who are sick.
  • Make sure your child gets a seasonal flu vaccine. If you have questions about the risks and benefits of a flu shot, talk with your doctor.
  • Make sure your child receives all of their regular and routine vaccinations.