Update on Treating Ear Infections

By Roy Benaroch, MD

As printed in Around Town Publishing, January 2006

I’ve heard that ear infections no longer need to be treated. Is this true?

A recent update from the American Academy of Pediatrics suggested that antibiotics are not always necessary for ear infections. Before looking at the treatment recommendations, let’s see what else the report had to say.

An ear infection (or “otitis media”) means there is infected fluid behind the ear drum. Most, but not all, ear infections are triggered by bacteria that are often found innocently waiting in the upper respiratory tract. These bacteria take advantage of conditions that arise when a child has a common cold–that is, when warm mucus is unable to drain properly from the middle ear. When your child has had a cold for a few days, and then gets worsening symptoms such as a new fever, irritability, and wakeful nights, it is very likely that the cold has developed into an ear infection.

The best way to prevent an ear infection is to avoid getting the viral cold in the first place: wash or sanitize hands frequently, avoid sick people, and if possible avoid group child care. Some immunizations can also protect against ear infections, although these only have a modest benefit.

After a careful exam confirms an ear infection, the most important aspect of treatment is pain control. Pain relief can include a warm compress, numbing ear drops, or an oral medicine such as acetaminophen (Tylenol®) or ibuprofen (Motrin®,Advil®). Because pain medicines are better at preventing pain than treating pain, once you know your child has an ear infection it is usually best to continue pain medicines around the clock for a day or so, rather than wait for the child to complain. This is especially true for younger children who can’t tell a parent about worsening pain.

About 2 out of 3 ear infections will resolve on their own, without any antibiotics. The advantages of using antibiotics are that pain will improve sooner, and that you do increase your odds of a successful cure to 80-90%. For older children who can clearly communicate symptoms and have had no history of prolonged or recurrent ear infections, a mild infection without much pain can safely be watched for a few days. Antibiotics should be used for young children (typically less than 2 years), children who are especially ill or uncomfortable, or any child who fails to improve without antibiotics after a few days.