A double ear infection refers to the infection of both ears simultaneously. This condition can exacerbate symptoms and complicate recovery. Ear infections are one of the most common reasons kids go to the doctor. In fact, acute otitis media (AOM) accounts for approximately 13.6 million doctor visits each year in the U.S., according to the American Academy of Family Physicians (AAFP).
Untreated, a double ear infection can lead to hearing loss, rupturing an eardrum, or cause other ear problems that linger for a long time. But the good news is that early treatment can reduce pain and prevent complications.
This guide will be covering symptoms, causes, treatments, and tips for prevention to help you or your child get better quicker — and stay ear infection-free.
What Is a Double Ear Infection?
An ear infection happens when fluid builds up behind the eardrum and gets infected. When that happens in both ears at the same time, it is known as a double ear infection or a bilateral ear infection.
This type of infection is more painful than a mere ear infection. It often comes with a higher fever, stronger symptoms, and a longer recovery time. Because both ears are affected, it can also cause temporary hearing problems, making it harder to listen or respond.
Doctors typically treat double ear infections more aggressively to ward off complications. If untreated, these infections could lead to hearing loss or even more serious health consequences.
Symptoms of a Double Ear Infection
One ear infection is annoying, but a double ear infection can make you twice as miserable. Because both ears are affected, symptoms are typically more severe and difficult to overlook.
Here’s what to watch for:
- Ear Pain—Shooting pain in both ears.
- High fever—Temperature of 100.4°F (38°C) or more for more than two days
- Hearing Problems—Sounds may appear muffled or far away.
- Fluid Drainage—Pus, or yellow fluid leaking from one or both ears.
- Balance Problems—A feeling of dizziness or unsteadiness.
- Irritability—Children may cry more, be fussy, or have difficulty sleeping.
- Tugging at the Ears—Babies and toddlers may tug at their ears if they are in discomfort.
Since young children can’t always articulate what’s wrong, parents need to be on the lookout for these signs. If you act quickly, you can avoid serious complications.
What Causes a Double Ear Infection?
There are various causes for a double ear infection. The common causes are listed below:
1. Bacteria and Viruses
Most double ear infections happen after a cold, flu, or sinus infection. These illnesses can cause fluid to get trapped behind the eardrum, creating the perfect place for bacteria or viruses to grow.
2. Blocked Eustachian Tubes
The Eustachian tubes connect the middle ear to the back of the throat. Their job is to drain fluid and balance ear pressure. If these tubes get swollen or blocked, fluid builds up, leading to infection.
3. Age and Anatomy
- Children under 3 get more ear infections because their Eustachian tubes are shorter and flatter, making it easier for germs to travel into the ear.
- Babies and toddlers also have weaker immune systems, so their bodies struggle to fight off infections as quickly as adults.
4. Environmental Factors
- Smoke Exposure—Cigarette smoke irritates the nasal passages, increasing the risk of infections.
- Allergies—Allergies cause swelling and fluid buildup, which can lead to ear infections.
- Daycare & School—Kids in group settings are exposed to more germs, increasing their risk of infections.
5. Repeated Ear Infections
If someone gets frequent ear infections, their ears may not fully drain, leaving behind trapped fluid. This leftover fluid can turn into a double ear infection if new germs enter the ears.
Are Ear Infections Contagious?
Ear infections themselves aren’t contagious, but the viruses and bacteria that cause them can spread. For example, the common cold, flu, or respiratory infections can pass from person to person through sneezing, coughing, or touching contaminated surfaces. These infections can lead to fluid buildup in the ears, increasing the risk of an ear infection.
Young children in daycare, where germs spread easily, are more likely to develop ear infections. Frequent handwashing and avoiding close contact with sick individuals can help lower the risk.
Possible Complications of a Double Ear Infection
One of the most common short-term effects of a double ear infection is hearing problems. Fluid accumulating behind the eardrum can cause sounds to feel muffled, but hearing tends to come back after the infection goes away.
But in some cases, chronic or untreated infections can lead to:
Hearing Loss and Delayed Speech
Hearing loss caused by a double ear infection is usually temporary, but ongoing infections can lead to long-term problems. When fluid accumulates behind the eardrum for a long time, it can muffle sounds and hinder a child’s ability to learn language skills. If these issues are not addressed, they can lead to speech delays and learning difficulties.
Damage to the Eardrum (tympanic membrane perforation)
Infection can exert pressure on the eardrum, sometimes rupturing it. Symptoms of a ruptured eardrum may include:
- Sudden ear pain that goes away after the eardrum ruptures
- Drainage of pus or fluid from the ear
- Temporary hearing loss
Most of the time, a torn eardrum will heal without intervention, usually within a few weeks. But if it doesn’t, surgery (tympanoplasty) might be required to repair the damage.
Mastoiditis (Infection of the Skull Bone)
The mastoid is a bony area behind the ear that can become infected if a severe ear infection spreads. This condition, called mastoiditis, is serious and requires immediate treatment. Symptoms include:
- Swelling and redness behind the ear
- Fever
- Ear sticking out or pushed forward
- Severe ear pain
If left untreated, mastoiditis can cause bone damage, form abscesses, or spread to the brain or blood.
Meningitis and Brain Abscess
Very rarely, a double ear infection can go on to infect the brain itself, causing either meningitis (inflammation of the lining of the brain) or a brain abscess. These conditions are medical emergencies that can lead to
- Severe headaches
- Neck stiffness
- Confusion or seizures
- High fever
Facial Nerve Damage
The infection may also impact the facial nerve, causing weakness or paralysis on one side of the face. This rare complication may necessitate treatment with special care and, in some instances, surgery.
How Doctors Diagnose a Double Ear Infection
To diagnose a double ear infection, doctors rely on a combination of symptom review and physical exams. Here’s what you can expect during a doctor’s visit:
1. Symptom Assessment
The doctor will ask about symptoms such as ear pain, fever, hearing difficulties, and irritability (particularly in young children). They’ll also check if the infection follows a recent cold or respiratory illness.
2. Otoscope Examination
Using an otoscope (a small lighted tool), the doctor looks inside both ears for signs of infection, such as:
- Redness or swelling of the eardrum
- Fluid buildup behind the eardrum
- Pus or drainage indicating a ruptured eardrum
3. Pneumatic Otoscopy
A special tool called a pneumatic otoscope blows a small puff of air into the ear to test eardrum movement. If the eardrum moves well, it indicates fluid buildup, which confirms an infection.
4. Tympanometry (If Needed)
Sometimes a doctor will do a tympanometry test that measures how the eardrum responds to pressure change. It helps assess whether there is fluid trapped in the middle ear.
How to Treat a Double Ear Infection
Double ear infections are worse than single ear infections, so treatment tends to be more aggressive. The aim is to eliminate the infection, ease pain, and avoid further complications.
1. Antibiotics (For Bacterial Infection)
If the infection is bacterial, they often prescribe antibiotics, such as amoxicillin. It’s crucial to complete the full course, even if symptoms improve early, to prevent antibiotic resistance and recurrence.
2. Pain Management
Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) help reduce fever and discomfort. Aspirin should not be given to children due to the risk of Reye’s syndrome, a rare but serious condition.
3. Ear Drops
In the case of intense pain or drainage of fluid, your doctor may prescribe an antibiotic or numbing ear drops for immediate comfort.
4. Warm Compresses
Using a large, warm washcloth on the ears is beneficial to minimize pain and reduce swelling.
5. Hydration and Rest
If a lot of fluids are drunk and enough rest is granted, the body can overcome the infection more quickly.
6. Ear Tubes (For Recurrent Infections)
If a child gets repeated ear infections, a doctor may suggest a small ear tube be placed, which helps drain fluid and prevents future infections. These tubes typically remain in place for six to 12 months before falling out on their own.
With appropriate treatment, most double ear infections resolve in 10 to 14 days. Follow-up visits may need to be scheduled to assure that it healed appropriately.
What to Expect After a Double Ear Infection: Your Outlook
Recovering from a double ear infection takes time, but with the right treatment, most people—especially children—heal without lasting issues. Here’s what you need to know about the recovery process:
1. Healing Timeline
- First Signs of Improvement: Symptoms often start to improve within 48 to 72 hours after beginning treatment. However, the infection itself doesn’t disappear overnight.
- Full Recovery: Most double ear infections resolve within 7 to 14 days. In some cases, mild symptoms like ear pressure or muffled hearing may persist for a bit longer.
If your child has been prescribed antibiotics, it’s crucial they complete the full course—usually 7 to 10 days—even if they start feeling better. Stopping too soon can allow the infection to return, sometimes more aggressively.
2. Managing Symptoms During Recovery
Healing from a double ear infection can be uncomfortable, especially for young children. Here’s how to ease the process:
- Pain & Sleep Troubles: Having both ears infected can make sleep difficult. Try propping up the head with an extra pillow (for older children and adults) to relieve ear pressure.
- Lingering Hearing Issues: It’s normal for hearing to feel “blocked” for a while. This happens due to fluid buildup behind the eardrum. If it lasts more than a few weeks, follow up with a doctor.
- Recurrent Infections: Some children and adults are prone to repeated infections. If infections keep coming back, your doctor may recommend ear tubes to prevent fluid buildup.
How to Lower the Risk of a Double Ear Infection
It’s not always easy to prevent a double ear infection, especially since they’re more common in children. However, there are certain strategies that can help lower the chances of infection:
1. Wash Hands Often
Practicing good hygiene is one of the most effective ways to prevent germs from spreading. Wash hands (before meals and after coming from any public place) to avoid any infection that may lead to ear problems.
2. Avoid Sick People
Colds and flu viruses can also cause ear infections. Avoid close contact with sick people if you can. Host your child at home from daycare or faculty if they’re sick, too, to cut back on the spreading of infections.
3. Keep Up with Vaccinations
Routine vaccinations, such as the flu shot and the pneumococcal vaccine, can lower the risk of infections that may cause ear problems. Research finds lower rates of ear infections in vaccinated than in unvaccinated children.
4. Avoid Secondhand Smoke
Exposure to cigarette smoke irritates the lining of the ear and throat, making ear infections more likely. A smoke-free home and car can protect you and your children.
5. Breastfeed When Possible
Breastfeeding helps strengthen a baby’s immune system. Research suggests that breastfed babies are less likely to develop ear infections compared to formula-fed babies. If bottle-feeding, try to hold the baby in an upright position rather than lying flat.
6. Limit Pacifier Use
Using a pacifier for too long—especially past 12 months—can increase the risk of ear infections. If your child regularly uses a pacifier, consider weaning them off gradually to help prevent issues.
7. Manage Allergies
Allergies can cause swelling and fluid buildup in the ear, leading to infections. Treating allergies properly—whether through medication, avoiding triggers, or using air purifiers—can help lower the risk.
8. Avoid Prolonged Bottle-Feeding at Bedtime
Research has found that allowing babies to doze off while holding a bottle can lead to an increased risk of ear and sinus infections, acid reflux, and coughing. If your baby must have a bottle right before bedtime, try feeding them while being upright, rather than lying down.
While no method is 100% foolproof, adopting good habits can go a long way in keeping ears healthy.
Last Words
A double ear infection can be tricky to experience, but in many cases, it resolves after treatment. Symptoms usually improve within a few days, but full recovery can take two weeks or longer.
