Ear infection – acute : Treatment

Treatment

Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

• Apply a warm cloth or warm water bottle.
• Use over-the-counter pain relief drops for ears.
• Take over-the-counter medications for pain or fever, like ibuprofen or acetaminophen. Do NOT give aspirin to children.
• Ask the doctor about ear drops to relieve pain.

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:

• A fever higher than 102 °F
• More severe pain or other symptoms
• Other medical problems

If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.

ANTIBIOTICS

A virus or bacteria can cause ear infections. Antibiotics will not not help an infection caused by a virus. Many doctors no longer prescribe antibiotics for every ear infection.

Your doctor is more likely to prescribe antibiotics if your child is under age 2, has a fever, is acting sick (beyond just the ear), or is not improving over 24 to 48 hours. All children younger than 6 months with an ear infection are treated with antibiotics.

Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.

Amoxicillin is commonly the first choice. Other antibiotics that may be given are azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.

Side effects of antibiotics include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.

Some children who have repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.

SURGERY

If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

• In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily down the eustachian tube. Tympanostomy tube insertion is done under general anesthesia.
• Usually the tubes fall out by themselves. Those that don’t fall out may be removed in your doctor’s office.

If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.

Prognosis (Expectations)

Ear infections are curable with treatment but may recur. They are not life threatening but may be quite painful.

Complications

Generally, an ear infection is a simple, nonserious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.

Fluid can remain behind the eardrums even after the infection has cleared.

See also: Otitis media with effusion

Other potential complications from otitis media include:

• Ruptured or perforated eardrum
• Chronic, recurrent ear infections
• Enlarged adenoids or tonsils
• Mastoiditis (an infection of the bones around the skull)
• Meningitis (an infection of the brain)
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

Calling Your Health Care Provider

Call your child’s doctor if:

• Pain, fever, or irritability do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting — this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

• Ear infection – acute : Overview, Causes, & Risk Factors

• Ear infection – acute : Symptoms & Signs, Diagnosis & Tests

• Ear infection – acute : Treatment

Review Date : 6/2/2009
Reviewed By : Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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