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Treatments and drugs
By Mayo Clinic staffMost ear infections don't need treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve with the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 48 to 72 hours for anyone who is otherwise healthy and who is:
- Six months to 2 years of age with mild symptoms and an uncertain diagnosis
- More than 2 years old with mild symptoms or an uncertain diagnosis
Treating pain
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
- A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
- Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others) to relieve pain. Use the drugs as directed on the label. Because aspirin has been linked with Reye's syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
- Eardrops. Prescription eardrops such as antipyrine-benzocaine (Aurodex) may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up. Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.
Antibiotic therapy
Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
- Children under 6 months old with a probable diagnosis of ear infection
- Children 6 months to 2 years old with a certain diagnosis of ear infection
- Anyone with a probable ear infection and moderate to severe ear pain
- Anyone with a probable ear infection and a fever over 102.2 F (39 C) or higher
Even after symptoms have improved, be sure to use all of the antibiotic pills as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose.
Ear tubes
If your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops.
Monitoring
Children with frequent or persistent infections or with persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
- Otitis media (ear infection). National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/hearing/otitism.asp. Accessed June 21, 2010.
- Ramakrishnan K, et al. Diagnosis and treatment of otitis media. American Family Physician. 2007;76:1650.
- Gould JM, et al. Otitis media. Pediatrics in Review. 2010;31:102.
- Diagnosis and management of acute otitis media. Pediatrics. 2004;113:1451.
- Otitis media with effusion. Pediatrics. 2004;113:1412.
- Ear tubes. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/Ear-Tubes.cfm. Accessed June 30, 2010.
- Benzocaine topical products: Sprays, gels and liquids — risk of methemoglobinemia. U.S. Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm250264.htm. Accessed Apr. 8, 2011.
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