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Middle Ear Infections

How Is Middle Ear Infection Treated?

Last modified: 
19/04/2012 - 15:05

Contributing Author: Guy Slowik FRCS

In deciding how to treat your child's middle ear infection, the doctor will take into account:

  • The type of symptoms your child is having
  • How severe they are
  • How long they have lasted

The doctor will look inside your child's ear for signs of redness or bulging of the eardrum, gently using an instrument (called an otoscope) with a cone-shaped tip and a small light attached. A pneumatic otoscope (one with a tiny air pump) may be used to gently blow air into the ear as a way to test the movement of the eardrum.

The first step may be to wait several days to see whether the infection clears up on its own. Other options include the following:

Antibiotics

Antibiotics may be prescribed for treating a single ear infection or for preventing and treating recurrent infections.

  • Antibiotics such as amoxicillin (Amoxil, Larotid, Polymox, Trimox, Wymox) or amoxicillin-clavulanate (Augmentin, Clavulin) are forms of penicillin, the preferred drug for otitis media. To cure the infection, your child must take all of the medication as prescribed (usually for 10 days to two weeks).
  • If your child is allergic to penicillin, the doctor may prescribe trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra) or a combination of erythromycin and sulfisoxazole (Eryzole, Pediazole), unless he or she is also allergic to sulfa drugs. Your doctor may prescribe trimethoprim hydrochloride oral solution (Primsol).
  • If these treatments fail, your doctor may prescribe oral antibiotics called cephalosporins.
  • If you live in an area where bacterial resistance to antibiotics is high, your doctor may prescribe high-dose amoxicillin or newer cephalosporins (cefuroxime, axetil or cefpodoxime proxetil) or antibiotics known as macrolildes (clindamycin, azithromycin, and clarithromycin).
  • A once-daily dose of antibiotics may be given as a preventative measure if a child has recurrent ear infections (three episodes of acute otitis media in six months or four to five episodes in one year).

Need To Know:

Antibiotics: Why They're Controversial

There is some debate over whether antibiotics should be the standard treatment for otitis media. Even though antibiotics may not be necessary or helpful in many cases, doctors often feel pressured by patients and families to prescribe them. Here's what a parent needs to know about antibiotics for acute otitis media:

  • Ear infections account for about 25 percent of all antibiotics prescribed in the U.S.
  • Only about one-third of children with acute otitis media actually need antibiotics, according to recent studies. Most children get better on their own in two weeks without any treatment at all.
  • Doctors are becoming more reluctant to prescribe antibiotics because of concerns about overuse of these medications. If a child takes antibiotics too often or stops taking the medicine once her fever and earache go away, without finishing the entire prescription, dangerous "super bacteria" that can't be killed with antibiotic treatment can develop. This is known as bacterial resistance, and health experts believe it is becoming a serious problem.

Still, many doctors and parents tend to favor the use of antibiotics, not only because children who have an ear infection may be in pain, but also because of the possibility of serious complications.

These include mastoiditis, a condition that results from spread of infection from the ear to the mastoid bone in the skull, sometimes causing deterioration of the bone. Mastoiditis may require long-term antibiotic treatment and sometimes even surgery to remove the infected skull bone. Another serious complication is hearing loss from recurrent or chronic otitis media.

Need To Know:

Q.Will antibiotics clear up my child's ear infection?

A. Approximately 30 to 50 percent of ear infections are caused by viruses. In this case, antibiotics are useless, and the infection must clear on its own. Infections caused by bacteria, on the other hand, respond well to antibiotics.

While doctors commonly prescribe antibiotics for a single attack of acute otitis media, some prefer prescribing a short course of antibiotics only for those children who are at risk for complications.

Antibiotics may be given in liquid, tablet, or capsule form and usually must be taken for 10 days.

Even though ear pain may be completely gone after a few doses of medicine, the infection is still present, and you should be sure your child completes the full course-takes all the medicine-to reduce the likelihood that the infection will come back.

Pain Relievers

Until your child can be seen by a doctor, the most important thing you can do is help relieve the pain. Here are some steps you can take to partially relieve the pain of an acute attack of middle ear infection:

  • Rest your child's ear against a heating pad at a low setting. Avoid allowing your child to go to sleep on the heating pad because of a potential danger of burns.
  • Give antihistamines and decongestants to your child only after checking with your doctor.
  • Give pain relievers, such as acetominophen (Tylenol) or ibuprofen (Advil).
  • Do not to give aspirin to children because of an associated condition called Reye's syndrome, which can be very dangerous.
  • Administer ear drops containing benzocaine, glycerin, or antipyrine (Auralgan), if your doctor approves. Do not give ear drops to your child if fluid has leaked from the ear, since this may be a sign that the eardrum has ruptured.

How-To Information:

Administering Drops for Ear Pain

Your doctor may prescribe ear drops to treat the infection or relieve pain. If the pain continues after 2 days of antibiotics, your doctor should re-evaluate your child. Give the ear drops as follows:

  • Place your child on his or her side with the infected ear up.
  • Straighten the ear canal by very gently pulling the earlobe backward.
  • Drop the medication into the ear as directed on the bottle or by your doctor.
  • Encourage your child to remain in this position for several minutes to allow the medication to be absorbed.

Cold And Allergy Remedies

Over-the-counter medicines with decongestants, antihistamines, or a combination of the two can help relieve cold symptoms, but they are of little benefit in treating ear infections. These remedies should be given only when prescribed by the doctor.

Decongestant nasal spray or pills may help prevent ear-plugging from changes in air pressure during air travel in children with chronic otitis media with effusion. Decongestants do not prevent ear pain in young children during takeoff, but can help by causing drowsiness.

Vaccines

Vaccines may be effective for children susceptible to recurrent ear infections. Vaccines against flu and pneumonia viruses, which are usually given every fall, help protect against the current year's specific flu strain and may offer protection against otitis media during flu season as well.

  • FluMist, a new vaccine in nasal spray form, boosts the immune factors in the mucous membranes of the nose that fight actual flu infections. It has been very successful in protecting against otitis media.
  • Pneumovaxthe pneumococcal vaccine used againstStreptococcuspneumoniae, provides protection for many years and is recommended for children with recurrent infections or chronic otitis media with effusion who are over two years of age. (Immunizing pregnant women may reduce the risk of ear infections in infants, since low levels of antibodies against Streptococcus pneumoniae have been found in the blood of the fetus cord.)
  • PNCRM7, a new pneumococcal vaccine, is considered safe and effective for infants.

Surgery

If your child's middle ear infection fails to respond to medication, your doctor may suggest one of the following procedures:

  • Tympanocentesis is a procedure in which fluid is drawn from the ear with a needle for laboratory testing.
  • Myringotomy is a surgical procedure that involves making a cut, or incision, in the eardrum. It may be necessary as a preventive measure if your child develops repeated ear infections even after taking antibiotics.
  • Tympanostomy tubes are small tubes that may be placed in the ears during myringotomy to help drain fluid that has been present for a long time (three or four months). These ear tubes also are effective in preventing repeated bouts of middle ear infection.
  • OtoLAM, a new laser procedure that involves making tiny holes in the eardrum, reduces the need for antibiotics and myringotomy.
  • Adenoidectomy, removal of the adenoids (located in the back of the throat), may be needed if they are enlarged and interfering with eustachian tube function.

In each case, it is important to prepare your child for surgery, so he or she knows what to expect.

What is tympanocentesis?

Occasionally it may be necessary for a child to have a procedure called tympanocentesis, particularly if he is not responding to antibiotic treatment.

The doctor gently inserting a very thin needle into the middle ear to collect fluid from behind the eardrum. The fluid is then sent to a laboratory to identify the specific bacteria causing the ear infection.

The results of this laboratory test, called a culture, will help your doctor decide which antibiotic will be most successful in clearing the infection. Fluid drainage can also relieve severe ear pain.

What is myringotomy?

If your child's ear infections don't respond to antibiotics, the doctor may suggest a procedure called a myringotomy to drain the fluid.

  • A small incision is made in the eardrum to allow fluid to drain and keep the eardrum from rupturing. This procedure sometimes is performed to drain a severely infected ear or so that a laboratory test, called a culture, can be done to identify the specific bacteria that is causing the infection. The eardrum heals in about a week.
  • Myringotomy may also be performed to insert small ear tubes called tympanostomy tubes, or grommets, in the eardrum. These ear tubes allow the passage of air and aid further drainage of fluid.

What is tympanostomy?

Ear tube surgery, or tympanostomy, is performed in the hospital. Your child probably will be in the hospital for a total of two hours. Infants under three months may stay overnight. Here's what to expect:

  • Ear tube surgery will be performed in the operating room.
  • Your child will receive general anesthesia and will be asleep for about 10 minutes.
  • The surgeon will reach the eardrum through the ear canal opening and will not cut the child's skin.
  • The surgeon will make a small hole in the eardrum to remove any fluid from the middle ear.
  • The surgeon will insert a tiny metal or plastic tube into the hole in the eardrum to allow the remaining fluid and bacteria to drain through the ear canal.
  • After ear tubes are placed, hearing almost always returns to normal, and the likelihood of your child having more ear infections is greatly reduced.
  • Ear tubes stay in the ear for about six months to a year and then fall out on their own, and the eardrum closes.

Need To Know:

Q. Are there risks involved in having tubes inserted?

A. Sometimes, placement of ear tubes is the most effective treatment for chronic otitis media. This must be done in the operating room under general anesthesia, which always involves some risk. However, ear tubes are a last resort, used only after your child has suffered several painful ear infections and fluid in the ears.

In a small number of cases, ear tubes don't fall out on their own and must be surgically removed. Also rare are cases in which the ear tube falls out, but the hole in the eardrum left behind does not close up on its own. Surgery may be necessary to patch the hole.

What is OtoLAM?

OtoLAM, a new procedure, involves making a tiny hole in the eardrum with a laser. The treatment may be performed in the doctor's office. OtoLAM "ventilates," or opens, the middle ear for several weeks, which may be long enough to cure 75 percent of ear infections. The benefits of OtoLAM include the following:

  • No general anesthesia is needed. Instead, topical anesthesia in the form of ear drops is used to numb the area so that your child will feel no pain.
  • There is less need for antibiotics, so repeated courses of antibiotics can be avoided.
  • The procedure is less traumatic. For example, your doctor may permit you to remain with your child during the procedure.
  • The procedure helps children who are prone to repeated infections.
  • Pain relief is immediate, as a result of the reduction in ear pressure from immediate fluid drainage.
  • The procedure is cost-effective and timesaving, since it means fewer prescriptions, doctor visits, and surgical fees, and less absenteeism from school.

What is adenoidectomy?

Adenoidectomy is a surgical procedure to remove the adenoids, which are small organs located in the back of the throat, behind the nose where they can't be seen.

  • Adenoidectomy may be needed if the adenoids are enlarged enough to interfere with eustachian tube function.
  • Removal of the adenoids is an option in children who have had persistent middle ear infections.
  • Often, this procedure is done after myringotomy andtympanostomy, if the surgeon sees that the adenoids are enlarged.
  • There isn't enough evidence yet to know for certain whether adenoidectomy improves middle ear infection in children under age four, but it does appear to be effective in older children.

How-To Information:

Preparing your child for surgery

  • You should explain in advance to your child what is about to happen, in as much detail as possible, while still keeping your explanation simple and reassuring.
  • Children who are scheduled for ear surgery should be warned that they may experience some discomfort from the incision in the eardrum, but that parents and medical personnel will do everything possible to minimize it, and it will go away quickly.
  • Bring a coloring book and a storybook to the hospital. These will help your child cope with the experience.
  • Once your child is admitted to the hospital, he should have unlimited access to parents or other adults who are important to him. Try to be with your child immediately before the trip to the operating room and at the bedside when he or she returns.

Need To Know:

Swimming

Children with middle ear infection should not go swimming. Water pollutants or chemicals may worsen ear infections, and underwater swimming causes pressure changes that can cause pain. If you child swims with implanted ear tubes, be sure he or she uses earplugs or cotton balls coated in petroleum jelly to prevent infection.

Nice To Know:

Heads Up On 'Xylitol'

Would you have ever thought that encouraging your child to chew gum or drink syrup that contains a sugary kind of alcohol would help ward off ear infections?

Studies show that xylitol, a sugar alcohol, contains properties that fight Streptococcus pneumoniaebacteria, a culprit responsible for middle ear infections.

Apparently, the chewing gum is more effective than drinking the syrup. Children in Europe chew xylitol gum to prevent cavities, and although the gum does not reduce bacteria in the nose and throat, it does appear to prevent ear infections.

Some drawbacks: The gum is not widely available in the United States, and studies are needed in children at high risk for otitis media - those between six and 18 months of age.

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Middle Ear Infections

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.