In many cases, both acute otitis media and otitis media with effusion (in which fluid builds up in the ear) resolve on their own without the need for additional treatments. Ear infections caused by viruses must be allowed to run their course, because drugs such as antibiotics are not effective in treating viruses. Parents can help reduce their child’s discomfort while waiting for an ear infection to clear by giving their child an over-the-counter non-aspirin pain reliever, applying a warm and moist cloth to the child’s ear, or using prescription eardrops that contain an anesthetic that relieves pain. None of these remedies should be used without a physician’s prior approval. Aspirin should never be used in children due to the rare occurrence of Reye syndrome.

Ear infections caused by bacteria can be treated with antibiotics. However, this is generally not recommended, especially if symptoms are not severe (e.g., mild fever) or there is no underlying medical condition, such as immune system disorders. Overuse of antibiotics has created strains of antibiotic-resistant bacteria that are more difficult to treat. Continued antibiotic overuse may create many more strains of antibiotic-resistant bacteria in the future. In addition, antibiotics may cause side effects in some children, including nausea, discoloration of permanent teeth, diarrhea, rashes and in rare cases, life-threatening allergic reactions. Antibiotics also have no effect on the fluid accumulation that triggers the infection in the first place.

Around 50 percent of all antibiotic prescriptions for preschoolers are intended to treat ear infections, according to the American Academy of Pediatrics (AAP). The organization has stated concerns that this high rate of antibiotic use will lead to an increase in resistant bacteria. As a result, the AAP recommends that when appropriate (e.g., symptoms are mild) children should not be given antibiotics for up to 72 hours and watched to determine if the infection will heal on its own. Observing the child during this time is called “watchful waiting.”

If a child’s physician and parents agree that antibiotics should be prescribed, it is important to ensure that the child takes the full dosage of the medication. This will help prevent the infection from recurring and will lessen the chances of developing antibiotic-resistant strains.

After a child is treated, either with medication or with watchful waiting, another consultation with the physician is necessary. This will help determine whether the ear infection has healed or if further treatment is required. A hearing test may be performed in assessment.

Chronic otitis media should not be treated with antibiotics. A new study has found that children who suffer from chronic otitis media have bacterial biofilms on the middle ear tissue. These biofilms are resistant to antibiotic treatment. Chronic otitis media can be effectively treated by inserting drainage (tympanostomy) tubes into incisions in the child’s eardrums. This procedure is known as myringotomy and is usually performed on children between the ages of 6 months and 2 years. Myringotomy is often performed on children with genetic conditions such as cleft palate or Down syndrome earlier than other children. During the procedure, the child is put under a general anesthetic and is not conscious. A small incision is made in each eardrum, and the tubes are inserted. This facilitates drainage of fluid and equalizes pressure between the middle and outer ears.

Myringotomy usually takes about 30 minutes, and a hospital stay is not required. The tubes may remain in place for nine months to a year. As the child grows and the eardrums become larger, the tubes are pushed out and the drainage holes heal. Myringotomy is considered safe for young children, and children who have had a myringotomy often experience a significant improvement in hearing. However, some children may need the surgery a second or third time before it is successful. Children who have this surgery are often advised to refrain from swimming, or to wear earplugs whenever they are going to immerse their heads under water.

Pressure related to otitis media sometimes causes the eardrum to rupture. In most cases, this rupture heals on its own. However, some children may experience repeated rupturing that requires surgery to repair the eardrum.

Surgery may also be necessary to remove a child’s adenoids or tonsils if these organs are too large and are blocking the eustachian tubes. The adenoids are located between the nasal airway and the back of the throat (nasopharynx).

If allergies are causing the ear infections, it becomes important to find the source of the allergies. For instance, an allergy skin test may be performed, in which the skin is pricked with several potential allergens. If a rash or small bump develops, the patient is most likely allergic to that substance.

When an allergen is identified, the most effective treatment is to avoid the allergen, if possible. In addition, prescription medications such as antihistamines, decongestants, and corticosteroids may be prescribed to reduce allergy symptoms. However, the use of allergy medications is not recommended for children who have persistent fluid in the middle ear (otitis media with effusion). According to a recent review of various studies, allergy medications are not effective in alleviating symptoms or avoiding complications of otitis media with effusion and, instead, can increase children’s risk of experiencing drug-related side effects. Successful treatment of allergies may make eustachian tube problems – and thus otitis media – much less likely.