Most ear infections resolve without treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:
- Children 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C)
- Children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than102.2 F (39 C)
Some evidence suggests that treatment with antibiotics might be beneficial for certain children with ear infections. Talk to your doctor about the benefits of antibiotics weighed against the potential side effects and concern about overuse of antibiotics creating strains of resistant disease.
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
- A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
- Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin IB, Advil, others) to relieve pain. Use the drugs as directed on the label. Use caution when giving aspirin to children or teenagers. Because aspirin has been linked with Reye's syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
- Eardrops. Prescription eardrops, such as antipyrine-benzocaine-glycerin (Aurodex), may provide additional pain relief for those whose ear drums are intact (not torn or perforated). To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up. Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.
Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
- Children 6 months and older with moderate to severe ear pain in one or both ears for at least 48 hours or a temperature of 102.2 F (39 C) or higher
- Children 6 to 23 months with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
- Children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
Even after symptoms have improved, be sure to use all of the antibiotic as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose.
If your child has recurrent otitis media — three episodes in six months or four episodes in a year with at least one occurring in the past six months — or otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum usually closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops.
Children with frequent or persistent infections or with persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
Apr. 20, 2013
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- Gould JM, et al. Otitis media. Pediatrics in Review. 2010;31:102.
- Ear tubes. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/Ear-Tubes.cfm. Accessed Jan. 9, 2013.
- Benzocaine topical products: Sprays, gels and liquids — risk of methemoglobinemia. U.S. Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm250264.htm. Accessed Jan. 9, 2013.
- Hoberman A, et al. Treatment of acute otitis media in children under 2 years of age. New England Journal of Medicine. 2011;364:102.
- Tahtinen PA, et al. A placebo-controlled trial of antimicrobial treatment for acute otitis media. New England Journal of Medicine. 2011;364:116.
- Ear infections. Centers for Disease Control and Prevention. http://www.cdc.gov/getsmart/antibiotic-use/uri/ear-infection.html. Accessed Jan. 9, 2013.
- Coker TR, et al. Diagnosis, microbial epidemiology and antibiotic of acute otitis media in children. Journal of the American Medical Association. 2010;304:2161.
- American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics. 2013;131:e964. http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488
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