How is an ear infection treated?

Treatment of ear infections depends on age, severity of the infection, the nature of the infection (is the infection a first-time infection, ongoing infection or repeating infection) and if fluid remains in the middle ear for a long period of time.

Your healthcare provider will recommend medications to relieve you or your child’s pain and fever. If the ear infection is mild, depending on the age of the child, your healthcare provider may choose to wait a few days to see if the infection goes away on its own before prescribing an antibiotic.

Antibiotics

Antibiotics may be prescribed if bacteria are thought to be the cause of the ear infection. Your healthcare provider may want to wait up to three days before prescribing antibiotics to see if a mild infection clears up on its own when the child is older. If your or your child’s ear infection is severe, antibiotics might be started right away.

The American Academy of Pediatrics has recommended when to prescribe antibiotics and when to consider waiting before prescribing based on your child’s age, severity of their infection, and your child’s temperature. Their recommendations are shown in the table below.

American Academy of Pediatrics Treatment Guide for Acute Otitis Media (AOM)

Child’s AgeSeverity of AOM /
Temperature
Treatment
6 months and older;
in one or both ears
Moderate to severe for at least 48 hours or temp of 102.2° F or higherTreat with antibiotic
6 months through 23 months;
in both ears
Mild for < 48 hours and
temp < 102.2
Treat with antibiotic
6 months to 23 months;
in one ear
Mild for < 48 hours and
temp < 102.2° F
Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms
24 months or older;
in one or both ears
Mild for < 48 hours and
temp < 102.2° F
Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms

If your healthcare provider prescribes an antibiotic, take it exactly as instructed. You or your child will start feeling better a few days after starting treatment. Even if you feel better and when pain has gone away, don’t stop taking the medication until you were told to stop. The infection can come back if you don’t take all of the medication. If the antibiotic prescribed for your child is a liquid, be sure to use a measuring spoon designed for liquid medications to be sure that you give the right amount.

A hole or tear in your eardrum caused by a severe infection or an ongoing infection (chronic suppurative otitis media) is treated with antibiotic eardrops and sometimes by using a suctioning device to remove fluids. Your healthcare provider will give you specific instructions about what to do.

Pain-relieving medications

Over-the-counter acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) can help relieve earache or fever. Pain-relieving eardrops can also be prescribed. These medications usually start to lessen the pain within a couple hours. Your healthcare provider will recommend pain-relieving medications for you or your child and provide any additional instructions.

Never give aspirin to children. Aspirin can cause a life-threatening condition called Reye’s Syndrome.

Earaches tend to hurt more at bedtime. Using a warm compress on the outside of the ear may also help relieve pain. (This is not recommended for infants.)

Ear tubes (tympanostomy tubes)

Sometimes ear infections can be ongoing (chronic), frequently recurring or the fluid in the middle ear can even remain for months after the infection has cleared (otitis media with effusion). Most children will experience an ear infection by age 5 and some children may have frequent ear infections. Telltale signs of an ear infection in a child can include pain inside the ear, a sense of fullness in the ear, muffled hearing, fever, nausea, vomiting, diarrhea, crying, irritability and tugging at the ears (especially in very young children). If your child has experienced frequent ear infections (three ear infections in six months or four infections in a year), had ear infections that weren’t resolved with antibiotics, or experienced hearing loss from fluid buildup behind the eardrum, you may be a candidate for ear tubes. Ear tubes can provide immediate relief and are sometimes recommended for small children who are developing their speech and language skills. You may be referred to an ear, nose and throat (ENT) specialist for this outpatient surgical procedure, which is called a myringotomy with placement of tube. During the procedure, a small metal or plastic tube is inserted through a tiny incision (cut) in the eardrum. The tube lets air into the middle ear and allows fluid to drain. The procedure is very short — approximately 10 minutes — and there’s a low complication rate with this procedure. This tube usually stays in place from six to 12 months. It often falls out on its own, but it can also be removed by your doctor. The outer ear will need to be kept dry and free of dirty water, like lake water, until the hole in the eardrum heals completely and closes.

What are the harms of fluid buildup in your ears or repeated or ongoing ear infections?

Most ear infections don’t cause long-term problems, but when they do happen, complications can include:

  • Loss of hearing: Some mild, temporary hearing loss (muffling/distortion of sound) usually occurs during an ear infection. Ongoing infections, infections that repeatedly occur, damage to internal structures in the ear from a buildup of fluid can cause more significant hearing loss.
  • Delayed speech and language development: Children need to hear to learn language and develop speech. Muffled hearing for any length of time or loss of hearing can significantly delay or hamper development.
  • Tear in the eardrum: A tear can develop in the eardrum from pressure from the long-lasting presence of fluid in the middle ear. About 5% to 10% of children with an ear infection develop a small tear in their eardrum. If the tear doesn’t heal on its own, surgery may be needed. If you have drainage/discharge from your ear, do not place anything into your ear canal. Doing so can be dangerous if there is an accident with the item touching the ear drum.
  • Spread of the infection: Infection that doesn’t go away on its own, is untreated or is not fully resolved with treatment may spread beyond the ear. Infection can damage the nearby mastoid bone (bone behind the ear). On rare occasions, infection can spread to the membranes surrounding the brain and spinal cord (meninges) and cause meningitis.

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