Ear Infections

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

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This topic covers infections of the middle ear, commonly called ear infections. For information on outer ear infections, see the topic Ear Canal Problems (Swimmer's Ear). For information on inner ear infections, see the topic Labyrinthitis.

What is a middle ear infection?

The middle ear is the small part of your ear just inside your eardrum. It can get infected when germs from the nose and throat are trapped there.

What causes a middle ear infection?

A small tube connects your ear to your throat. A cold can cause this tube to swell. When the tube swells enough to become blocked, it can trap fluid inside your ear. This makes it a perfect place for germs to grow and cause an infection.

Ear infections happen mostly to young children because their tubes are smaller and get blocked more easily.

What are the symptoms?

The main symptom is an earache. It can be mild, or it can hurt a lot. Babies and young children may be fussy. They may pull at their ears and cry. They may have trouble sleeping. They may also have a fever.

You may see thick, yellow fluid coming from their ears. This happens when the infection has caused the eardrum to burst and the fluid flows out. This is not serious and usually makes the pain go away. The eardrum usually heals on its own.

When fluid builds up but does not get infected, children often say that their ears just feel plugged. They may have trouble hearing, but their hearing usually returns to normal after the fluid is gone. It may take weeks for the fluid to drain away.

How is a middle ear infection diagnosed?

Your doctor will talk to you about your child's symptoms. Then he or she will look into your child's ears. A special tool with a light lets the doctor see the eardrum and tell whether there is fluid behind it. This exam is rarely uncomfortable. It bothers some children more than others.

How is it treated?

Most ear infections go away on their own. You can treat your child at home with an over-the-counter pain reliever like acetaminophen (such as Tylenol or Tempra), a warm washcloth or heating pad on the ear, and rest. Do not give aspirin to anyone younger than 20. Your doctor may give you eardrops that can help your child's pain.

Sometimes after an infection, a child cannot hear well for a while. Call your doctor if this lasts for 3 to 4 months. Children need to be able to hear in order to learn how to talk.

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

Minor surgery to put tubes in the ears may help if your child has hearing problems or repeat infections.

Can ear infections be prevented?

There are many ways to help prevent ear infections. Do not smoke. Ear infections happen more often to children who are around cigarette smoke. Even the fumes from tobacco smoke on your hair and clothes can affect them. Handwashing and having your child immunized can help, too.

Also, make sure your child does not go to sleep while sucking on a bottle. And try to limit the use of group child care.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I give my child antibiotics for an ear infection?
	Should I have my child treated for chronic fluid behind the eardrum?

Middle ear infections are caused by bacteria and viruses.

During a cold, sinus, or throat infection or an allergy attack, the eustachian tubes, which connect the middle ear to the throat, can become blocked. This stops fluid from draining from the middle ear. This fluid is a perfect breeding ground for bacteria or viruses to grow into an ear infection.

• Bacterial infections. Bacteria cause most ear infections.¹ The most common types are Streptococcus pneumoniae (also called pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis.
• Viral infections. Viruses can also lead to ear infections. The respiratory syncytial virus (RSV) and influenza (flu) virus are the most frequent types found. These viruses account for the rise in ear infections from January to May each year.²

Causes of fluid buildup

When swelling from an upper respiratory infection or allergy blocks the eustachian tube, air can't reach the middle ear. This creates a vacuum and suction, which pulls fluid and germs from the nose and throat into the middle ear. The swollen tube prevents this fluid from draining. An ear infection begins when bacteria or viruses in the trapped fluid grow into an infection.

Inflammation and fluid buildup can occur without infection and cause a feeling of stuffiness in the ears. This is known as otitis media with effusion.

Symptoms of a middle ear infection (acute otitis media) often start 2 to 7 days after a cold or other upper respiratory infection. Symptoms of an ear infection may include:

• Ear pain (mild to severe). Babies often pull or tug at their ears when they have an earache.
• Fever.
• Drainage from the ear that is thick and yellow or bloody. If this occurs, the eardrum has probably burst (ruptured). The hole in the eardrum often heals by itself in a few weeks.
• Loss of appetite, vomiting, and grumpy behavior.
• Trouble sleeping.
• Trouble hearing.

Symptoms of fluid buildup may include:

• Popping, ringing, or a feeling of fullness or pressure in the ear. Children often have trouble describing this feeling. Children may rub their ears trying to relieve pressure.
• Loss of hearing. Children with hearing loss may seem dreamy or inattentive, or they may appear grumpy or cranky.
• Balance problems and dizziness.

Some children don't have any symptoms with this condition.

Middle ear infection (acute otitis media)

Middle ear infections usually occur along with an upper respiratory infection (URI), such as a cold. During a URI, the lining of the eustachian tube can swell and block the tube. Fluid builds up in the middle ear, creating a perfect breeding ground for bacteria or viruses to grow into an ear infection.

Pus develops as the body tries to fight the ear infection. More fluid collects and pushes against the eardrum, causing pain and sometimes a loss of hearing. Fever generally lasts about 1 to 2 days; pain and crying usually last for 3 to 4 hours. After that, most children have some pain on and off for up to 4 days, although young children may have pain that comes and goes for up to 9 days. Treating children with antibiotics shortens these symptoms by about 1 day, according to a study of 240 children ages 6 months to 2 years.³ However, about 80% of the time the immune system can fight infection and heal the ear infection without the use of these medicines.⁴

In severe cases, too much fluid can increase pressure on the eardrum until it ruptures, allowing the fluid to drain. When this happens, fever and pain usually go away and the infection clears. The eardrum usually heals on its own, often in just a couple of weeks.

Sometimes complications, such as a condition called chronic suppurative otitis media (an ear infection with chronic drainage), can arise from repeat ear infections.

Middle ear fluid buildup (otitis media with effusion)

Most children who have ear infections still have some fluid behind the eardrum 2 weeks after treatment for an ear infection. In most cases, the fluid clears in 1 month. However, about 10% of children still have fluid buildup (effusion) 3 months after an ear infection clears.¹ Hearing problems can result because the fluid affects how the middle ear works. This condition is called otitis media with effusion. Usually, infection does not occur.

Otitis media with effusion may occur even if a child has not had an obvious ear infection or upper respiratory infection. This is due to some other cause of eustachian tube blockage.

In rare cases, complications can arise from middle ear infection or fluid buildup. Examples include hearing loss and ruptured eardrum.

Some factors that increase the risk for middle ear infection (acute otitis media) are out of your control. These include:

• Age. Children age 3 years and younger are most likely to get ear infections. Also, young children get more colds and upper respiratory infections. Most children have at least one ear infection before they are 7 years old.
• Birth defects or other medical conditions. Babies with cleft palate or Down syndrome are prone to ear infections.
• Weakened immune system. Children with severely impaired immune systems have more ear infections than healthy children.
• Family history. Children are more likely to have repeat middle ear infections if a parent or sibling had repeat ear infections.
• Allergies. Allergies may be a risk factor for ear infections. Allergies cause long-term stuffiness in the nose that can affect how the eustachian tube works. Blocking this tube, which connects the back of the nose and throat with the middle ear, can cause fluid to build up in the middle ear.

Other factors that increase the risk for ear infection include:

• Repeat colds and upper respiratory infections. Most ear infections develop from colds or other upper respiratory infections.
• Exposure to cigarette smoke. Babies who are around cigarette smoke are more likely to have ear infections than babies who are not. Also, ear infections seem to last longer in children who are near cigarette smoke.²
• Bottle-feeding. Babies who are bottle-fed are more likely to develop ear infections within the first year of life than are babies who are breast-fed. Also, bottle-fed babies may be more likely to get ear infections if they drink their bottles lying down rather than being held in an upright position.⁵
• Child care centers. Children who are around many other children, such as in child care centers, are more likely to have ear infections than children who are not exposed to many other children.⁴
• Pacifier use. A young child who uses a pacifier is more likely to get ear infections.⁴

Factors that increase the risk for repeated ear infections also include:

• Ear infections at an early age. Babies who have their first ear infection before 6 months of age are more likely to have other ear infections.
• Persistent fluid in the ear. Fluid behind the eardrum that lasts longer than 2 to 10 weeks after an ear infection increases the risk for repeated infection.
• Prior infections. Children who had an ear infection within the previous 3 months are more likely to have another ear infection, especially if the infection was treated with antibiotics.

Call your health professional immediately if:

• Your child has a severe injury to the ear.
• Your child has sudden hearing loss, severe pain, drainage from the ear, or dizziness.
• Your child seems to be very sick with symptoms such as a high fever and stiff neck.
• You notice redness, swelling, or pain behind or around your child's ear, especially if your child does not move the muscles on that side of his or her face.

Call your health professional if:

• You can't quiet your child who has a severe earache with home treatment over several hours.
• Your baby pulls or rubs his or her ear and appears to be in pain (crying, screaming).
• Your child's ear pain increases even with treatment.
• Your child has a fever over 102°F (38.89°C) with other signs of ear infection.
• You suspect that your child's eardrum has burst, or fluid that looks like pus or blood is draining from the ear.
• Your child has an object stuck in his or her ear.
• Your child with an ear infection continues to have symptoms (fever and pain) after 48 hours of treatment with an antibiotic.
• Your child with an ear tube develops an earache or has drainage from his or her ear.

Watchful Waiting

Watchful waiting is when you and your health professional watch symptoms to see if the health problem improves on its own. If it does, no treatment is necessary. If the symptoms don't get better or get worse, then it’s time to take the next treatment step.

If your child is age 6 months or older and has a mild earache, you might try watchful waiting. Most ear infections get better without antibiotics. However, if your child's pain doesn't get better with nonprescription children's pain reliever (such as acetaminophen) or the symptoms continue after 48 hours, call a health professional.

Who To See

Health professionals who can diagnose and treat ear infections (acute otitis media) include:

• Pediatricians.
• Family medicine doctors.
• Nurse practitioners.
• Physician assistants.
• Internal medicine doctors.
• Otolaryngologists.
• Pediatric otolaryngologists.

Children who have ear infections often may need to see one of these specialists:

• Otolaryngologist
• Pediatric otolaryngologist
• Audiologist

To prepare for your appointment, see the topic Making the Most of Your Appointment

Middle ear infections are usually diagnosed using a health history, a physical exam, and an ear exam.

With a middle ear infection, the eardrum, when seen through a pneumatic otoscope, is red or yellow and bulging. In the case of fluid buildup without infection (otitis media with effusion), the eardrum can look like it's bulging or sucking in. In both cases, the eardrum doesn't move freely when the pneumatic otoscope pushes air into the ear.

Other tests can include:

• Tympanometry, which tests the movement of the eardrum. The tip of a hand-held tool is placed just inside the ear. It changes the air pressure inside the ear. Then, the tool measures how the eardrum responds.
• Hearing tests. A hearing test is recommended for children who have had fluid in one or both ears (otitis media with effusion) for a total of 3 months. Hearing tests may be done sooner if hearing loss is suspected.
• Tympanocentesis. When fluid stays behind the eardrum (chronic otitis media with effusion) or infection continues even with antibiotics, tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for culture and sensitivity. These tests reveal what kind of bacteria is causing the infection and which medicine is best for treatment.
• Blood tests, which are done if there are signs of immune problems.

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°F (38.33°C) 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

You may be able to prevent your child from getting middle ear infections by:

• Not smoking. Ear infections are more common in children who are around cigarette smoke in the home. Even fumes from tobacco smoke on your hair and clothes can affect the child.
• Breast-feeding your baby. There is some evidence that breast-feeding helps reduce the risk of ear infections, especially if ear infections run in your family. If you bottle-feed your baby, don't let your baby drink a bottle while he or she is lying down.
• Washing your hands often. Hand-washing stops infection from spreading by killing germs.
• Having your child immunized. Current immunizations don't specifically prevent ear infections. However, they can prevent illnesses, such as Haemophilus influenzae (Hib) and flu (influenza) that may lead to ear infections. Have your child immunized at the ages suggested by national guidelines. For more information, see the topic Immunizations.
• Having your child immunized with the pneumococcal conjugate vaccine (PCV)(What is a PDF document?) may help reduce the risk of ear infection.¹⁰
• Taking your child to a smaller child care center. Fewer children means less contact with bacteria and viruses. Children in child care settings can easily spread germs to each other. Try to limit the use of any group child care. For more information, see the topic Choosing Child Care.
• Not giving your baby a pacifier. Try to wean your child from his or her pacifier before about 6 months of age. Babies who use pacifiers after 12 months of age are more likely to develop ear infections.

Rest and care at home is often all children with ear infections need. Up to 80% of ear infections get better without treatment.⁴ If your child is mildly ill and home treatment takes care of the earache, you may choose not to seek treatment for the ear infection.

At home, try:

• Using pain relievers. Pain relievers such as nonsteroidal anti-inflammatory medicines (such as Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol and Tempra) will help your child feel better. Giving your child something for pain before bedtime is especially important. Do not give aspirin to anyone younger than 20 because it is linked to Reye's syndrome, a serious illness that needs emergency care.
• Applying heat to the ear, which may help with pain. Use a warm washcloth or a heating pad. Do not allow children to go to bed with a heating pad, because they 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. Resting will help the body fight the infection. Arrange for quiet play activities.
• Using eardrops. Doctors often suggest eardrops for earache pain. Don't use eardrops without a health professional's advice, especially if your child has tubes in his or her ears. For more information, see the safest way to insert eardrops.

Decongestants, antihistamines, expectorants, and other nonprescription cold remedies usually do not work for treating or preventing ear infections. 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 help your child cope with ear pain during the trip.

If your child isn't better after a few days of home treatment, call your doctor.

If your child has a ruptured eardrum or has ear tubes 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. 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.

Antibiotics can treat ear infections. However, most children with ear infections get better without them. If the care you give at home relieves pain, and a child's symptoms are getting better after a few days, you may not need antibiotics.

In the United States, many doctors use antibiotics for middle ear infections in children age 2 and younger. This is often because children this young are at higher risk for complications. For children age 2 and older, many doctors wait for a few days to see if the ear infection will get better on its own. When doctors do prescribe antibiotics, they most often use amoxicillin (Amoxil) because it works well and is less expensive than other brands.¹¹

Should I give my child antibiotics for an ear infection?

Experts suggest a hearing test if a child has had fluid behind his or her eardrum longer than 3 months. Normal hearing is critical during the first 2 years when your child is learning to talk. Your doctor may prescribe antibiotics to clear the fluid. But that usually doesn't help. The doctor may also suggest placing tubes in the ears to drain fluid and improve hearing.

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

Other medications that can treat symptoms of ear infection include:

• Acetaminophen (for example, Tylenol and Tempra) and nonsteroidal anti-inflammatory medications (for example, Advil, Motrin, and Aleve), for pain and fever. Do not give aspirin to anyone younger than 20 because of its link to Reye's syndrome, a serious illness that needs emergency care.
• Pain medications such as codeine and some eardrops, which help with severe earache. But, do not use eardrops if the eardrum is ruptured. For more information, see the safest way to insert eardrops.
• Sometimes corticosteroids, known as steroids, are given with antibiotics to get rid of fluid behind the eardrum (otitis media with effusion). Steroids are not a good choice for treating otitis media. Do not use steroids if a child has been around someone with chickenpox within the last 3 weeks.

Decongestants, antihistamines, expectorants, and other nonprescription cold remedies usually do not work well for treating or preventing ear infections. Antihistamines that may make your child sleepy can thicken fluids and may actually make your child feel worse.

Medication Choices

Antibiotics may help cure ear infections caused by bacteria.

What To Think About

Some doctors prefer to treat all ear infections with antibiotics. Some things to consider before your child takes antibiotics include:

• Risk for antibiotic-resistant bacteria. The greatest problem with using antibiotics to treat ear infections is the possibility of creating bacteria that can't be killed by the usual antibiotics (antibiotic-resistant bacteria). Using antibiotics only when they're needed can slow down this process.
• Side effects of antibiotics. Mild side effects, such as diarrhea and rash, from taking antibiotics are common. Severe side effects are rare.
• Expense. Most antibiotics are expensive. You may want to weigh the expense against the fact that most ear infections clear up without treatment.

If your child still has symptoms (fever and earache) longer than 48 hours after starting an antibiotic, a different antibiotic may work better. Call your doctor if your child isn't feeling better within 48 hours after starting treatment.

Ear infections are often successfully treated with a 5-day course of antibiotics.¹ But if your child is younger than 2, he or she may need a longer course of antibiotics.

Surgery for middle ear infections (acute otitis media) often means placing a drainage tube into the eardrum of one or both ears. It's one of the most common childhood operations. While the child is under general anesthesia, the surgeon cuts a small hole in the eardrum and inserts a small plastic tube in the opening (myringotomy or tympanostomy with tube placement).

The tubes will ventilate the middle ear after the fluid is gone. They help relieve any hearing loss. Children who have ear infections often develop fluid behind their eardrum (otitis media with effusion) and hearing loss. The hearing loss is usually temporary, but it's more of a concern in children age 2 and younger. Normal hearing is important when young children are learning to talk.

Doctors consider tube placement for children who have had repeat infections or fluid behind the eardrum in both ears for 3 to 4 months and have hearing loss. Sometimes they consider tubes for a child who has fluid in only one ear but also has hearing loss.

Surgery Choices

Inserting ear tubes (myringotomy or tympanostomy with tube placement) often restores hearing and helps prevent buildup of pressure and fluid in the middle ear.

Adenoid removal (adenoidectomy) or adenoid and tonsil removal (adenotonsillectomy) may help some children who have repeat ear infections or fluid behind the eardrum. However, doctors tend to suggest these surgeries only after tubes have failed to prevent repeat ear infections.¹ Children younger than 4 don't usually have their adenoids taken out unless they have severe nasal blockage. Taking out the tonsils alone is not very helpful.⁸

What To Think About

Most tubes stay in place for about 6 to 12 months, after which they usually fall out on their own. After the tubes are out, the hole in the eardrum will close in 3 to 4 weeks. Some children need tubes put back in their ears because fluid behind the eardrum returns.

In rare cases, tubes may scar the eardrum and lead to permanent hearing loss.

Doctors suggest tubes if fluid behind the ear or ear infections keep coming back. Learn the pros and cons of this surgery. Before deciding, ask how the surgery can help or hurt your child and how much it will cost.

Surgeons will sometimes operate to close a ruptured eardrum that hasn't healed in 3 to 6 months, though this is rare. The eardrum usually heals on its own within a few weeks.

If your child has a ruptured eardrum or has ear tubes 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. 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 child with an ear infection has a bad earache, a doctor may perform tympanocentesis. A needle goes through the eardrum to remove fluid from behind the eardrum. It helps ease pain. The fluid is sometimes sent to a lab for testing. A culture and sensitivity test may find out what is causing the infection. Then, your doctor can choose the antibiotic that will work best for your child.

Allergy treatment can help children who have allergies with frequent ear infections. Allergy testing isn't suggested unless children have signs of allergies.

Some people use herbal remedies, such as echinacea and garlic oil capsules, to treat ear infections. There is no scientific evidence that these therapies work. If you are thinking about using these therapies for your child's ear infection, talk with your doctor.

Online Resource

Organizations

• Ear Canal Problems (Swimmer's Ear)
• Ear Problems and Injuries, Age 11 and Younger
• Ear Problems and Injuries, Age 12 and Older
• Labyrinthitis
• Respiratory Syncytial Virus (RSV) Infection

Citations

1. Klein JO, Bluestone CD (2004). Otitis media. In RD Feigin et al., eds, Textbook of Pediatric Infectious Diseases, vol. 1, 5th ed., pp. 215–234. Philadelphia: Saunders.

2. Kelley PE, et al. (2007). Ear, nose, and throat. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 459–492. New York: Lange Medical Books/McGraw-Hill.

3. Damoiseauz RA, et al. (2000). Primary care-based, randomised, double-blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. BMJ, 320(7231): 350–354.

4. O'Neill P, et al. (2006). Otitis media in children (acute), search date January 2006. Online version of Clinical Evidence (15): 1–11.

5. American Academy of Pediatrics and American Academy of Family Physicians (2004). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 113(5): 1451–1465.

6. Rowe LD (2006). Otitis media with effusion section of Otolaryngology—Head and neck surgery. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 943–944. New York: Lange Medical Books/McGraw-Hill.

7. Macfadyen CA, et al. (2006). Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

8. Rovers MM, et al. (2004). Otitis media. Lancet, 363(9407): 465–473.

9. Paradise JL, et al. (2007). Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. New England Journal of Medicine, 356(3): 248–261.

10. Pneumococcal vaccine (Prevnar) for otitis media (2003). Medical Letter on Drugs and Therapeutics, 45 (W1153B): 27–28.

11. Werkhaven JA (2004). Otitis media. In RE Rakel, ET Bope, eds., Conn's Current Therapy, pp.196–199. Philadelphia: Saunders.

Other Works Consulted

• Glasziou PP, et al. (2006). Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

• National Guideline Clearinghouse (2006). Guideline Synthesis: Acute Otitis Media. Available online: http://www.guideline.gov/compare/synthesis.aspx.

• National Guideline Clearinghouse (2006). Guideline Synthesis: Otitis Media With Effusion. Available online: http://www.guideline.gov/compare/synthesis.aspx.

• Paradise JL (2004). Otitis media. In R Behrman et al., eds., Nelson Textbook of Pediatrics, 17th ed., pp. 2138–2149. Philadelphia: Saunders.