Ear Infections - Treatment Overview

Treatment Overview

Treatment for middle ear infections (acute otitis media) involves home treatment for symptom relief. Antibiotics are prescribed in some cases.

If a child with an ear infection appears very ill, is younger than age 2, or is at risk for complications from infection, the doctor may prescribe antibiotics.

In children age 2 and older with simple ear infections, more options are available. Some doctors prescribe antibiotics for all ear infections because it's hard to tell which ear infections will clear up on their own. Other doctors ask parents to watch their child's symptoms for a couple of days, since more than 80% of ear infections get better without treatment. Antibiotic treatment has only minimal benefits in reducing pain and fever. The cost of medication and possible side effects are factors doctors consider before giving antibiotics. Also, many doctors are concerned about the growing number of bacteria that are developing resistance to antibiotics because of frequent use of antibiotics.

Follow-up exams with a health professional are important to check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections.

• If your child has ongoing ear pain, a fever [101° (38.33°) or higher], or is grumpy or vomiting after 48 hours of treatment, see your health professional.
• Children younger than 3 should have a follow-up visit in about 4 weeks, even if they seem well. If fluid behind the eardrum persists for 3 months, the child should have his or her hearing tested.²

Initial treatment

The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess the child for risk of complications. If your child has an ear infection, does not seem very sick, and is not at risk for complications, your doctor may ask you to watch your child's symptoms for a couple days before deciding whether to give antibiotics.

If your child has an ear infection and appears very ill, is younger than 2, or is at risk for complications from the infection, your doctor may give antibiotics right away.

If your child's condition improves in the first couple of days, treating the symptoms at home may be all that is needed. Up to 80% of all ear infections get better without treatment. Some steps you can take at home to treat ear infection include:

• Using pain relievers. Pain relievers such as nonsteroidal anti-inflammatory medicines (such as Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol and Tempra) can help make your child more comfortable. Giving your child something for pain before bedtime is especially important. Do not give aspirin to anyone younger than 20 because its use has been linked to Reye's syndrome, a serious illness that needs emergency treatment.
• Applying heat to the ear, which may help relieve the earache. Use a warm washcloth or a heating pad. Do not allow your child to go to bed with a heating pad, because he or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
• Encouraging rest. Encourage your child to rest to let his or her body fight the infection. Arrange for quiet play activities.
• Using eardrops. Doctors often prescribe pain-relieving eardrops for earache. Don't use eardrops without a health professional's advice, especially if your child has ear tubes. For more information, see the safest way to insert eardrops.

If your child isn't better after a couple of days of home treatment, call your health professional. He or she will probably prescribe antibiotics.

Should I give my child antibiotics for an ear infection?

Decongestants, antihistamines, and other nonprescription cold remedies do not often work for treating or preventing ear infection. Antihistamines that cause sleepiness may thicken fluids, which can make your child feel worse.

If your child with an ear infection must take an airplane trip, talk with your doctor about how to cope with ear pain during the trip.

Fluid behind the eardrum after an ear infection is normal, and in most children, the fluid clears up within 3 months without treatment. Test your child's hearing if the fluid persists past that point. If hearing is normal, you may choose to continue monitoring your child without treatment.

Ongoing treatment

If a child has repeat ear infections (three or more ear infections in a 6-month period or four in 1 year), you may want to consider treatment to prevent future infections.

One option used a lot in the past is long-term oral antibiotic treatment. There is debate within the medical community about using antibiotics on a long-term basis to prevent ear infections. Many doctors don't want to prescribe long-term antibiotics because they are unsure that they really work. Also, when antibiotics are used too often, bacteria can become resistant to antibiotics. One study showed no difference between using antibiotics and fake treatments to prevent ear infections.⁴ Having tubes put in the ears is another option for treating repeat ear infections.

If your child has fluid buildup without infection, you may try watchful waiting. Fluid behind the eardrum after an ear infection is normal. In most children, the fluid clears up within a few months without treatment. Have your child's hearing tested if the fluid persists past 3 months. If hearing is normal, you may choose to continue monitoring your child without treatment.

If a child has fluid behind the eardrum for more than 3 months and has significant hearing loss, treatment is needed. Hearing loss may delay speech and language development in children younger than 2 years of age. This is why hearing loss, even brief hearing loss, in this age group needs treatment, such as inserting tubes.

Should I have my child treated for chronic fluid behind the eardrum?

Treatment if the condition gets worse

Health professionals may consider surgery for children with repeat ear infections or those with persistent fluid behind the eardrum. Procedures include inserting ear tubes or removing adenoids and, rarely, the tonsils.

Inserting tubes Inserting tubes into the eardrum (myringotomy or tympanostomy with tube placement) allows fluid to drain from the middle ear. The tubes keep fluid from building up and may prevent repeat ear infection. These tubes stay in place for 6 to 12 months and then fall out on their own. If necessary, tubes are inserted again if more fluid builds up. About 80% of children need no further treatment after tube insertion for otitis media with effusion.⁶

You can use antibiotic eardrops for ear infections while tubes are in place. In some cases, antibiotic eardrops seem to work better than antibiotics by mouth when tubes are present.⁷

While tubes are in place, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear.

Removing adenoids and/or tonsils As a treatment for chronic ear infections, experts advise removing adenoids and tonsils only after tubes and antibiotics have failed. Removing adenoids may improve air and fluid flow in nasal passages. This may reduce the chance of fluid collecting in the middle ear, which can lead to infection. Tonsils are removed if they are frequently infected. Experts do not recommend tonsil removal alone as a treatment for ear infections.⁸ See an illustration of the adenoids and tonsils.

Ruptured eardrums If your child has a ruptured eardrum, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.

If a ruptured eardrum hasn't healed in 3 to 6 months, your child may need surgery (myringoplasty or tympanoplasty) to close the hole. This surgery is rarely done because the eardrum usually heals on its own within a few weeks. If a child has had many ear infections, you may delay surgery until the child is 6 to 8 years old to allow time for eustachian tube function to improve. At this point, there is a better chance that surgery will work.

Should I have my child treated for chronic fluid behind the eardrum?

What To Think About

If amoxicillin—the most commonly used antibiotic for ear infections—does not improve symptoms in 48 hours, your doctor may try a different antibiotic.

Studies show that antibiotic treatment for less than 10 days may work as well as a 10-day treatment to clear up an ear infection.¹ For children older than 2 years of age and not in child care, 5 days of antibiotics often works well.²

When taking antibiotics for ear infection, it is very important that your child take all of the medicine as directed, even if he or she feels better. Do not use leftover antibiotics to treat another illness. Misuse of antibiotics can lead to drug-resistant bacteria.

Most studies find that decongestants, antihistamines, and other nonprescription cold remedies usually do not help prevent or treat ear infections or fluid behind the eardrum.

Children who have fluid behind the eardrum longer than 3 months (chronic otitis media with effusion) usually have trouble hearing and need a hearing test. If there is a hearing problem, your doctor may also prescribe antibiotics to clear the fluid. But that usually doesn't help. The doctor might also suggest placing tubes in the ears to drain the fluid and improve hearing.

If your child is age 2 or younger, your doctor may not wait 3 months to start treatment, because hearing problems at this age could affect your child's speaking ability. This is also why children in this age group are closely watched when they have ear infections.

Tubes can help young children who have fluid that stays behind the eardrum. But child development is not helped by having tubes inserted before age 3.⁹

Children who get rare but serious problems from ear infections, such as infection in the tissues around the brain and spinal cord (meningitis) or infection in the bone behind the ear (mastoiditis), need treatment right away.

When used along with other treatments, removing adenoids (adenoidectomy) can help some children with repeat ear infections.⁶ But taking out the tonsils (adenotonsillectomy) is not very helpful.⁸