Ear infections are one of the most common illnesses of childhood. Treatment of ear infections will depend upon the severity of symptoms, history of infections and a comparison of the risks and benefits of various treatment options.

The most common ear infection among children is infection of the middle ear (otitis media). This type of ear infection can be caused by viruses (such as those that cause a cold or the flu) or bacteria, or a mixture of both viral and bacterial causes. Viral ear infections usually resolve without treatment – except for therapies designed to make a child as comfortable as possible, or to reduce symptoms. Bacterial ear infections, however, require antibiotic treatment to stop the infection and prevent its spread.

Because of an increase in its prevalence due to drug-resistant bacteria over the last decade, the American Academy of Pediatrics (AAP) in conjunction with the American Academy of family Physicians (AAFP) issued the first clinical guideline on the appropriate diagnosis and treatment for acute ear infections in 2004. The guidelines call for a dramatic overhaul in the treatment of ear infections. Rather than automatically prescribing antibiotics for suspected cases of otitis media, the guidelines call for more accurate diagnosis, including encouraging pain relief efforts (usually with acetaminophen or ibuprofen), reducing antibiotic-related adverse effects, and targeting antibiotics for children likely to receive the most benefit. It was estimated that about 30 percent of all antibiotic prescriptions among children were written by middle ear infections.  

In order to determine whether the cause of a middle ear infection is viral or bacterial, a fluid sample from the middle ear can be analyzed. This test is often not practical (since it involves piercing the eardrum) and is rarely performed. Thus, for many middle ear infections, a physician may suggest an observation approach – a period of time in which parents carefully watch their child to see if the ear infection appears to be resolving on its own. Many infections may resolve in this manner in just a few days. If a child appears to be getting better, no further treatment may be necessary. Several large studies have shown that there is often no difference in patient or parent satisfaction between patients who were prescribed antibiotics and those who weren't, even as there was a corresponding rise in the number of antibiotic-resistant bacteria.

The “watch and wait” approach avoids the unnecessary use of antibiotics. To do so is important because an increase in antibiotic use has led to the development of antibiotic-resistant bacteria, which are difficult to treat. However, antibiotics may be prescribed immediately for patients at risk of complications from ear infections or younger patients (less than 6 months of age).

Bacterial ear infections (including most cases of swimmer’s ear) are easily treated with antibiotics and thorough cleaning of the ear canal and usually result in no lasting damage to the child. Antibiotics for ear infections are available in tablet or eardrop form. Follow-up appointments are usually scheduled to ensure the absence of infection following treatment. In addition, a hearing test (e.g., an audiogram) may be required to confirm that a child’s hearing has not been impaired by the infection. 

Steroids may sometimes be prescribed to reduce swelling in the ear. In addition, a physician may place a “wick” in the ear canal that can help carry medicated eardrops into a swollen ear canal. In some cases of ear infection, the ear may need to be drained or cleaned. Any debris in the ear canal may be removed by a physician with a suction device or cotton-tipped probe.

Fluid may remain in the ear even after an infection has cleared. The fluid usually disappears on its own within one to three months. This generally causes no lasting problems, as long as hearing is not impaired and the fluid is not infected. Fluid buildup that occurs without an infection usually clears up on its own within a couple of weeks.

In severe or recurrent cases, a physician may recommend the surgical placement of an ear drainage tube (tympanostomy tube) in one or both ears. A small incision is made in the eardrum while the child is under general anesthesia and the tympanostomy tube is placed inside. The tube helps to drain fluid from the ear and ventilate the middle ear to avoid the buildup of pressure. This procedure takes less than an hour to perform and generally does not require hospitalization. The tube is designed to remain in the child’s ear for up to a year, after which time it often falls out on its own, or may be surgically removed.

Ear tubes may be recommended in the following situations:

• Fluid remains in the ear for more than four months
  
  
• Chronic ear infections occur
  
  
• Hearing loss occurs as the result of ear infections
  
  
• Ear infections do not respond to antibiotics
  
  
• Eardrum rupture or structural damage occurs in the middle ear caused by infection
  
  
• Delayed speech development occurs as the result of chronic ear infections

There are several things parents can do to make their children more comfortable during the course of an ear infection. These include:

• Pain relief medications. Drugs to reduce pain or fever that may accompany ear infections. Since oral antibiotics generally do not provide pain relief for the first 24 hours, these over-the-counter pain relievers may help. Parents should not use any medications without first consulting their child’s pediatrician.
  
  
• Decongestants. Although rarely necessary, these may be used under the supervision of a physician to reduce fluid production and therefore reduce pressure in the ear.
  
  
• Topical anesthetic eardrops. A physician may prescribe these to numb the pain of middle ear infections in children. These eardrops should not be used if a child has ear drainage tubes or a hole in the eardrum.
  
  
• Warm the ear. Warmth may help soothe an infected ear. Parents can hold a hot water bottle filled with warm (not hot) water and wrapped in a dry towel against the infected ear. A child may also lay with the infected ear against the towel.
  
  
• Keep the ear dry. Make every attempt to keep water, shampoo, hair spray or bubble bath from entering the ear canal. For external ear infections, cotton may be placed in a child’s ear and covered with petroleum jelly to make a watertight seal during baths or showers. Swimming or submerging the head in water should be avoided during recovery for several weeks after the infection has cleared.
  
  
• Avoid flying. Postpone or reschedule any airplane flights with a child who has an ear infection since it can worsen symptoms by increasing the pressure in the middle ear.

Some alternative therapies have been used to help alleviate the symptoms of ear infections. These therapies include acupuncture (a technique that uses needles to relieve pain), chiropractic care and herbal medications. Parents should check with their child’s pediatrician before administering any type of treatment to their child.

Anyone with an infection associated with ear piercings should visit their physician for proper treatment. Most mild infections clear within one to two weeks and can be cleaned by swabbing the area with rubbing alcohol. Jewelry should not be worn in the infected ear while it is healing.

Parents who suspect that their child has an object lodged in the ear should contact their child’s pediatrician. Any attempt to dig items out of the ear may result in injury to the ear canal, possibly causing an ear infection. A physician may use a lighted magnifying device that can make removal safe and easy.