Otitis Media - Effective Treatments

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How is acute middle ear infection or inflammation treated?

The treatment for acute otitis media varies depending upon the age and symptoms of the child. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend the following:

AAP and AAFP Recommendations 2013
Age Certain Diagnosis
(Otorrhea with AOM or Unilateral or
Bilateral AOM with Severe Symptoms)
Certain Diagnosis
(Bilateral AOM without Otorrhea)
Uncertain Diagnosis
(Unilateral AOM without Otorrhea)
6 months-23 months   Antibiotics Antibiotics if severe illness;
*Observation without antibiotics if non-severe illness
> 2 years Antibiotics Antibiotics if severe illness;
*Observation if non-severe illness
Antibiotics if severe illness;
*Observation without if non-severe illness

*Observation is an appropriate option only when follow-up can be ensured and antibacterial agents can be started if symptoms persist or worsen within 2-3 days. The guidelines also recommend "shared decision making" with the caregiver. Non-severe illness is represented by mild ear pain and fever <39 C (102.2 F) in the past 24 hours. Severe illness is defined as moderate to severe otalgia (ear pain) or any ear pain for at least 48 hours or fever 39 C. These 2013 guidelines are current.

If antibiotics are initiated, amoxicillin is usually recommended as the first line treatment. This is usually prescribed for 10 days. About 10% of children do not respond within the first 48-72 hours of treatment, and antibiotic therapy may have to be changed. Even after antibiotic treatment, some children are left with some fluid in the middle ear which can cause temporary hearing loss lasting for up to 3 to 6 weeks. In most children, this fluid eventually disappears spontaneously (on its own). Ceftriaxone (50mg/kg/d) injection is recommended for children that cannot take oral antibiotics; three days of this antibiotic is usually more effective than a single injection.

Children who have recurring bouts of otitis media may be referred to an otolaryngologist (ear nose and throat specialist or ENT). Some of these children may benefit from having an ear tube placed (tympanostomy tube) to permit fluid to drain from the middle ear. In addition, if a child has a bulging eardrum and is experiencing severe pain, a procedure to lance the eardrum (myringotomy) may be recommended to release the pus. The eardrum usually heals within a week. Prophylactic antibiotic therapy has not been shown to decrease the frequency of ear infections in those children with recurrent AOM.

Although treatment may cure an ear infection, it is possible for the ear to become re-infected.

Return to Ear Infection (Otitis Media)

See what others are saying

Comment from: Sal, 19-24 Female (Caregiver) Published: March 18

My daughter has severe pain in ear and sometime she hears less too. The doctor has said that it is due to infection and has given her antibiotics.

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Comment from: J5, 25-34 Male (Patient) Published: May 09

I am 32 years old, and suffer from severe recurrent otitis media. At least one episode a year, since I was 3 years old. I have had up to 3 occurrences in a single year, but generally it's one a year, almost like clockwork. Only once, did it reach the point of rupturing my tympanic membrane, and it actually happened at the doctor's office almost immediately after he said he was surprised that it hadn't ruptured yet, based on how severe the infection looked to him. Sometimes I can manage the pain, and just ride them out, but the times it's unbearable I have found that oxycodone or other narcotic pain-relievers help relieve my pain better than anything else, and antibiotic drops work quickest at actually stopping the infection.

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