Prompt resolution of pain occurs in almost all cases once antibiotic treatment has begun. Fever (if present) should resolve in 48 hours. Restoration of hearing results from drainage or reabsorption of middle-ear fluid, healing and when the eardrum returns to its normal shape and position. A hearing test is often advised to assess the slight possibility of long-term (permanent) effects on hearing.
A number of devices are now commercially available to screen for middle-ear infection, however, these devices are difficult to use. A child’s small ear canals are angled in such a way that the eardrum is difficult to see. Note that ear infection is best detected by looking for fever, fussiness, ear tugging and loss of sleep and appetite, especially after a cold or sore throat.
Patients should return to the doctor if the pain worsens or fails to resolve; if muffling of hearing persists; if sudden blurring of vision, dizziness, or loss of balance develops; or if drainage of pus, fluid or blood occurs. In children, muffled hearing may be indicated by delayed development of speech, particularly the ability to produce crisp-sounding consonants.