Laura's ear pain was not on the agenda for her day.

Let me introduce you to "Laura" (not her real name), Tom's older sister. Laura is a 45-year-old busy professional who prides herself on staying active and maintaining a packed schedule. So when she woke up with sharp pain in her left ear after a few days of battling cold symptoms, which she blamed her brother for sharing with her over the holidays, she was not happy.

“It’s an ear infection,” she told herself as she pressed a warm compress to the side of her face. By the time she arrived at my office later that afternoon, she was convinced she needed antibiotics.

Laura’s Symptoms: Unraveling the Cause

Laura described the progression of her symptoms:

• A few days earlier, she’d noticed a runny nose and mild congestion.
• Yesterday, her ears began to feel “full,” like she’d been on a plane.
• This morning, the fullness turned into a sharp pain in one ear, and she also felt mild dizziness.

“But I don’t have time for this,” she said, frustration creeping into her voice. “Can we just get ahead of it and start antibiotics?”

Understanding Ear Pain: Is It Bacterial or Viral?

I explained to Laura that not all ear pain is caused by bacterial infections. In her case, her symptoms were likely due to a viral upper respiratory infection causing eustachian tube dysfunction—a fancy way of saying the tubes that connect the middle ear to the back of the throat weren’t draining properly.

When this happens, fluid can build up behind the eardrum, leading to discomfort, pressure, and sometimes pain. However, this fluid buildup, or effusion, is usually caused by the virus that triggered her congestion, not bacteria.

When Ear Infections Need Antibiotics

To reassure Laura, I explained the key differences between viral ear effusion and bacterial ear infections:

• Viral Ear Effusion: This is common with colds and usually resolves on its own. Symptoms include fullness, mild to moderate pain, and muffled hearing but no fever or severe symptoms.
• Bacterial Ear Infections: These are less common and often come with more severe symptoms, such as:
  • Intense, throbbing pain
  • High fever (over 101°F)
  • Fluid drainage from the ear
  • Severe hearing loss
  • Symptoms lasting longer than 48–72 hours without improvement

“Laura, your symptoms don’t suggest a bacterial infection,” I said. “Your ear pain is more likely due to fluid buildup from your cold, and the good news is that this usually gets better on its own within a few days.”

Laura’s Reaction: Frustrated but Reassured

Laura wasn’t thrilled. “So you’re telling me there’s nothing we can do?” she asked, crossing her arms.

“Not nothing,” I said. “We can do a lot to manage the discomfort and help your body heal. But antibiotics won’t help in this case—and they could cause unnecessary side effects.”

My Recommendations for Laura

I outlined a plan to help Laura feel better:

1. Pain Relief: Use ibuprofen or acetaminophen to reduce pain and inflammation.
2. Warm Compresses: Apply a warm compress to the affected ear for comfort.
3. Decongestants or Nasal Sprays: Use an over-the-counter saline spray to reduce nasal congestion and help the eustachian tubes drain. Flonase (a nasal steroid) and Astepro (a nasal antihistamine) can aso help.
4. Hydration: Drink plenty of fluids to thin mucus and support overall recovery.
5. Steam Therapy: Sit in a steamy bathroom or use a humidifier to keep airways moist and relieve sinus pressure.

When to Follow Up

I also gave Laura clear guidelines for when to come back:

• If her ear pain worsened or didn’t improve within 48–72 hours
• If she developed a high fever or significant drainage from the ear
• If she experienced severe dizziness or balance problems

The Takeaway

Laura left the office still a bit skeptical but armed with a better understanding of her symptoms and a plan to manage them. Over the next few days, her ear pain gradually eased, and she didn’t need antibiotics after all.

Her story is a reminder that not all ear pain requires antibiotics. In many cases, supportive care and patience are all that’s needed for recovery. By understanding when antibiotics are appropriate—and when they’re not—we can protect our health and prevent unnecessary treatments.

Be well,

Amy Loden Tiffany, MD, FACP

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