Ear Infection Health Article

Medications

Antibiotics are the treatment of choice for acute otitis media (AOM). Different antibiotics are used depending on the type of bacteria most likely to be causing the infection. This decision involves knowledge of the types of antibiotics that have worked on other ear infections occurring within a particular community at a particular time. Options include sulfa-based antibiotics, as well as a variety of penicillins, cephalosporins, and others. The patient's sensitivity to certain medications, as well as previously demonstrated resistant strains, also contributes to the choice of antibiotic. As of 2003, an 0.3% topical solution of ofloxacin has been recommended as a more effective medication than other oral or topical antibiotics.

Following a course of antibiotic treatment, approximately 40% of children will continue to have fluid behind the eardrum, resulting in otitis media with effusion (OME). The eardrum is no longer red or infected. The fluid may take weeks to months to resolve. Generally, it is safe to allow this condition to continue with observation for up to 12 weeks. At that time, hearing should be tested. If hearing loss is insignificant or only in one ear, observation can continue for up to a total of 4–6 months, at which time placement of ventilation tubes in the eardrum is often recommended. The tube functions as an accessory eustachian tube until it falls out. If hearing loss is significantly affecting both ears at any time after six weeks from diagnosis of OME, antibiotic treatment or tube placement should be considered.

The overuse of antibiotics is contributing to some strains of bacteria—particularly S. pneumoniae—developing resistance and becoming more difficult to treat. Research is being done to try to help determine whether there may be some ear infections that would resolve without antibiotic treatment. One pediatrician has suggested some changes in usage of antibiotics for otitis media. He describes five factors to use to determine whether antibiotic treatment can be limited to five days or perhaps avoided altogether. The factors to consider are the age of the child; time of year; severity of the infection; frequency of infection; and rapidity of response to antibiotics. Generally, otitis media clears more readily when it occurs in an older child, in the summer, and causes relatively mild symptoms in a child who has not experienced frequent infections in the past. Given these factors, it may be possible to avoid antibiotic use. The patient must be monitored to be sure the infection clears without complication. If antibiotic treatment is initiated and the infection clears quickly, a five-day course of medication may be all that's needed.

Whether or not antibiotics are used, such pain relievers as Tylenol or Motrin can be very helpful in reducing the pain and inflammation associated with otitis media.

The use of decongestants and antihistamines does not appear to shorten the course of infection.

Surgery

In a few rare cases, a surgical perforation to drain the middle ear of pus may be performed. This procedure is called a myringotomy. The hole created by the myringotomy generally heals itself in about a week. In 2002 a new minimally invasive procedure was introduced that uses a laser to perform the myringotomy. It can be performed in the doctor's office and heals more rapidly than the standard myringotomy.

Although some doctors have recommended removing the adenoids to prevent recurrent otitis media in young children, recent studies indicate that surgical removal of the adenoids does not appear to offer any advantages over a myringotomy as a preventive measure.

Expected results

With treatment, the prognosis for acute otitis media is very good. Long-lasting accumulations of fluid within the middle ear, however, place the patient at risk both for difficulties with hearing and speech, and for the repeated development of ear infections. Furthermore, without treatment, otitis media occasionally leads to serious complications, including an infection within the nearby mastoid bone, called mastoiditis.