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Ear Infections (cont.)

Treatment Overview

Treatment for middle ear infections (acute otitis media) involves home treatment for symptom relief.

Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you use antibiotics will depend on how old your child is and how bad the infection is.

Follow-up exams with a doctor 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°F (38.33°C) or higher], or is grumpy or vomiting after 48 hours of treatment, see your doctor.
  • Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young. If fluid behind the eardrum persists for 3 months, the child should have his or her hearing tested.1

Initial treatment

The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess your child for any risk of complications.

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 will likely give antibiotics right away.

If your child has cochlear implants, your doctor will probably prescribe antibiotics, because bacterial meningitis is more common in children who have cochlear implants than in children who do not have cochlear implants.

For children ages 2 and older, 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 most ear infections get better without treatment. Antibiotic treatment has only minimal benefits in reducing pain and fever. The cost of medicine and possible side effects are factors doctors consider before giving antibiotics. Also, many doctors are concerned about the growing number of bacteria that are becoming resistant to antibiotics because of frequent use of antibiotics.

If your child's condition improves in the first couple of days, treating the symptoms at home may be all that is needed. 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) can help make your child more comfortable. Giving your child something for pain before bedtime is especially important. Follow all instructions on the label. If you give medicine to your baby, follow your doctor's advice about what amount to give. Do not give aspirin to anyone younger than 20, because its use has been linked to Reye syndrome, a serious illness.
  • 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 doctor's advice, especially if your child has ear tubes. For more information, see the safest way to insert eardropsClick here to see an illustration..

If your child isn't better after a couple of days of home treatment, call your doctor. He or she may prescribe antibiotics.

Click here to view a Decision Point.Ear Infection: Should I Give My Child Antibiotics?

Decongestants, antihistamines, and other over-the-counter 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. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.

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 not sure that they really work. Also, when antibiotics are used too often, bacteria can become resistant to antibiotics. 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 keep watching your child without treatment.

If a child has fluid behind the eardrum for more than 3 months and has significant hearing problems, treatment is needed. Sometimes short-term hearing loss occurs, which is especially a concern in children ages 2 and younger. Normal hearing is very important when young children are learning to talk.

Click here to view a Decision Point.Ear Problems: Should My Child Be Treated for Fluid Buildup in the Middle Ear?

Treatment if the condition gets worse

Doctors may consider surgery for children with repeat ear infections or those with persistent fluid behind the eardrum. Procedures include inserting ear tubes or removing adenoidsClick here to see an illustration. and, in rare cases, 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 infections. These tubes stay in place for 6 to 12 months and then fall out on their own. If needed, tubes are inserted again if more fluid builds up. About 8 out of 10 children need no further treatment after tubes are inserted for otitis media with effusion.3

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.4

While tubes are in place, your doctor will recommend ear protection, including caution with water. 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 recommend 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.5

Caring for 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.

Click here to view a Decision Point.Ear Problems: Should My Child Be Treated for Fluid Buildup in the Middle Ear?

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.

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) may have trouble hearing and need a hearing test. If there is a hearing problem, your doctor may also prescribe antibiotics to help 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 younger than 2, 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.

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.3 But taking out the tonsils (adenotonsillectomy) is not very helpful.5

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