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A child with a cold develops severe ear pain at night — acute otitis media. Viral URI swells the Eustachian tube shut → middle-ear fluid trapped → bacteria (pneumococcus, H. influenzae) multiply → bulging red drum, fever, night pain (lying flat worsens pressure). Most resolve; amoxicillin for severe/persistent. Chronic (perforation + discharge): safe (central perforation — tubotympanic) vs unsafe (attic — cholesteatoma: trapped skin eroding bone toward brain). The night pain is pressure — trapped fluid behind a swollen shut door.