Topic Overview
Is this topic for you?
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 behind 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. These two tubes are called eustachian tubes (say "yoo-STAY-shee-un"). 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, although antibiotics are recommended for children under the age of 2 and for children at high risk for complications. You can treat your child at home with an
over-the-counter pain reliever like acetaminophen
(such as Tylenol), 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. Hand-washing 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
Learning about ear infections: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Helping a sick child: | |
Cause
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 ears 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. 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
flu (influenza) virus are the most frequent types
found.
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
Symptoms of a
middle ear infection (acute otitis media) often start
2 to 7 days after the start of 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.
- Trouble
hearing. Children who have problems hearing 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.
What Happens
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 problems hearing. Fever generally lasts
a few days. And pain and crying usually last for several hours. After
that, most children have some pain on and off for several days, although young
children may have pain that comes and goes for more than a week.
Antibiotic treatment may shorten some
symptoms. But most of the time the
immune system can fight infection and heal the ear
infection without the use of these medicines. Children under 2 are treated with antibiotics, because they are more likely to have complications from the ear infection.
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 a few weeks after the infection is gone. For some children, the fluid
clears in about a month. And a few children still have fluid buildup (effusion) several
months after an ear infection clears. This fluid
buildup in the ear is called otitis media with effusion. Hearing problems can
result, because the fluid affects how the middle ear works. Usually, infection
does not occur.
Otitis media with fluid buildup (effusion) may occur even if a child
has not had an obvious ear infection or upper respiratory infection. In these
cases, something else has caused
eustachian tube blockage.
In rare cases,
complications can arise from middle ear infection or fluid buildup. Examples
include hearing loss and ruptured eardrum.
What Increases Your Risk
Some factors that increase
the risk for
middle ear infection (acute otitis media) are out of
your control. These include:
- Age. Children ages 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
babies who are near cigarette smoke.1
- 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.2
- Child care centers.
Children who are around many other children, such as in child care centers, are
more likely to have repeat ear infections than children who are not exposed to
many other children.
- Pacifier use. A young child who uses a
pacifier is more likely to get ear infections.
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 a few 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.
When To Call a Doctor
Call your doctor immediately if:
- Your child has sudden hearing loss, severe pain, 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 doctor 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 of
101°F (38.3°C) or higher 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 doctor
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.
Your doctor may recommend watchful waiting if your child is 2 years of age or older, has mild ear pain, and is otherwise healthy. Most
ear infections get better without antibiotics. But 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 doctor.
Who To See
Health professionals who can diagnose and treat
ear infections (acute otitis media) include:
Children who have ear infections often may need to see
one of these specialists:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
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 handheld 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 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 eardrops.
If your child isn't better after a couple of days of home
treatment, call your doctor. He or she may prescribe antibiotics.
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.
- 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
adenoids 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 See a picture of the
adenoids and tonsils.
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.
- 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
Prevention
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. But they can prevent illnesses, such as
Haemophilus influenzae type b (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.6
- 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.
Home Treatment
Rest and care at home is often all children 2 years of age or older with ear infections need. Most ear infections get better without treatment. 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) will help your child feel better. 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 it is linked to Reye syndrome, a serious illness.
- 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. 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 doctor'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 over-the-counter 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. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than age 2.
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.
Medications
Antibiotics can treat ear infections. But 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.
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. For children ages 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 because it works well and costs less than other brands.
- Ear Infection: Should I Give My Child Antibiotics?
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 help 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.
- Ear Problems: Should My Child Be Treated for Fluid Buildup in the Middle Ear?
Other medicines that can treat symptoms of ear infection include:
- Acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory medicines (for example, Advil, Motrin, and Aleve), for pain and fever. 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 of its link to Reye syndrome, a serious illness.
- Pain medicines 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 ear infections. Do not use steroids if a child has been around someone with chickenpox within the last 3 weeks.
Decongestants, antihistamines, expectorants, and other over-the-counter 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. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.
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.
- Cost. Most antibiotics are expensive. You may want to weigh the cost 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 after 2 days of antibiotic treatment.
Surgery
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. And they help relieve hearing problems.
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 trouble hearing. Sometimes they consider tubes for a child who has fluid in only one ear but also has trouble hearing.
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. 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 usually done unless a child has another reason to have them removed.
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 usually closes 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 eardrum 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 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, 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. 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.
Other Treatment
Allergy treatment can help children who have allergies and who also have 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.
Other Places To Get Help
Organizations
| American Academy of Family
Physicians |
| P.O. Box 11210 |
| Shawnee Mission, KS 66207-1210 |
| Web Address: | www.familydoctor.org |
| |
The American Academy of Family Physicians produces a
variety of health-related educational materials. Its Web site offers a health
library and bulletin board, news, and comments sections. |
|
| American Academy of Otolaryngology—Head and Neck Surgery
(AAO-HNS) |
| 1650 Diagonal Road |
| Alexandria, VA 22314-2857 |
| Phone: | (703) 836-4444 |
| Web Address: | www.entnet.org |
| |
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders. |
|
| American Academy of Pediatrics |
| 141 Northwest Point Boulevard |
| Elk Grove Village, IL 60007-1098 |
| Phone: | (847) 434-4000 |
| Fax: | (847) 434-8000 |
| Email: | kidsdocs@aap.org |
| Web Address: | www.aap.org |
| |
The American Academy of Pediatrics (AAP) offers a
variety of educational materials, such as links to publications about parenting
and general growth and development. Immunization information, safety and
prevention tips, AAP guidelines for various conditions, and links to other
organizations are also available. |
|
| KidsHealth for Parents, Children, and
Teens |
| 10140 Centurion Parkway North |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Fax: | (904) 697-4125 |
| Web Address: | www.kidshealth.org |
| |
This Web site is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This Web site
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly e-mails about your area of interest. |
|
| National Institute on Deafness and Other Communication
Disorders |
| 31 Center Drive, MSC 2320 |
| Bethesda, MD 20892–2320 |
| Phone: | 1-800-241-1044 |
| TDD: | 1-800-241-1055 |
| Email: | nidcdinfo@nidcd.nih.gov |
| Web Address: | www.nidcd.nih.gov |
| |
The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The Web site has information about hearing,
balance, smell, taste, voice, speech, and language. |
|
References
Citations
- Kelley PE, et al. (2009). Ear, nose, and throat.
In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 437–470. New York: McGraw-Hill.
- 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.
- Weinberger PM, Terris DJ (2010). Otitis media section of Otolaryngology-Head and neck surgery. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 228–229. New York: McGraw-Hill.
- 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.
- Rovers MM, et al. (2004). Otitis media.
Lancet, 363(9407): 465–473.
- Pneumococcal vaccine (Prevnar) for otitis media
(2003). Medical Letter on Drugs and Therapeutics, 45
(W1153B): 27–28.
Other Works Consulted
- Bradley-Stevenson C, et al. (2007). AOM in
children (acute), search date January 2007. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
- Glasziou PP, et al. (2004). Antibiotics for acute
otitis media in children. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
- Kerschner JE (2007). Otitis media. In RM Kliegman et
al., eds., Nelson Textbook of Pediatrics, 18th ed., pp.
2632–2646. Philadelphia: Saunders Elsevier.
- Klein JO, Bluestone CD (2009). Otitis media. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 216–236. Philadelphia: Saunders Elsevier.
- Yates PD, Anari S (2008). Otitis media. In AK Lalwani,
ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, pp. 655–665. New York: McGraw-Hill.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Michael J. Sexton, MD - Pediatrics |
|---|
| Specialist Medical Reviewer | Charles M. Myer, III, MD - Otolaryngology |
|---|
| Last Revised | May 9, 2011 |
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