Ear Infection (Middle Ear)

Diagnosis

A healthcare professional can often diagnose an ear infection based on symptoms and a physical examination. The exam typically involves using an otoscope, a lighted instrument that helps visualize the eardrum. If the eardrum appears red and bulging, it is a sign of infection.

Additional tests may be needed if the diagnosis is uncertain, if the condition does not improve with treatment, or if other complications are suspected.

What a diagnosis means

• Acute otitis media: This diagnosis indicates fluid buildup in the middle ear and symptoms of infection, such as ear pain or fluid drainage.

• Otitis media with effusion: This means there is fluid in the middle ear but no active infection symptoms.

• Chronic suppurative otitis media: This long-term infection causes a hole or tear in the eardrum and often leads to pus discharge from the ear.

Treatment

Treatment for ear infections depends on the individual’s age, the severity of symptoms, and the specific type of infection. Many infections resolve without antibiotics.

Watchful waiting

Symptoms of ear infections often improve within a few days, and most clear up in one to two weeks without treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for:

• Children aged 6 to 23 months with mild pain in one ear lasting less than 48 hours and a temperature below 102.2°F (39°C).

• Children aged 24 months or older with mild pain in one or both ears lasting less than 48 hours and a temperature below 102.2°F (39°C).

Managing pain

Pain relief may include:

• Over-the-counter pain relievers such as acetaminophen or ibuprofen. Follow the dosage instructions carefully.

• Numbing ear drops may be used for short-term relief if there is no hole or tear in the eardrum.

Caution: Avoid giving aspirin to children or teenagers recovering from flu-like symptoms or chickenpox, as it may cause Reye’s syndrome, a rare but serious condition.

Antibiotic medicines

Antibiotics may be prescribed for certain children and adults, but overuse can reduce their effectiveness. A healthcare provider may recommend antibiotics for:

• Children 6 months or older with moderate to severe pain in one or both ears lasting at least 48 hours or with a temperature of 102.2°F (39°C) or higher.

• Children 6 to 23 months with mild pain and a temperature below 102.2°F (39°C).

• Children 24 months or older with mild symptoms and a temperature below 102.2°F (39°C).

• Children under 6 months with acute otitis media, who typically need antibiotics without waiting.

Always complete the full course of antibiotics even if symptoms improve early.

Ear tubes

Ear tubes, or tympanostomy tubes, help drain fluid from the middle ear and prevent future infections. They are often used for children with recurrent or long-lasting infections.

The tubes are placed during a minor surgery called a myringotomy. The surgeon makes a small opening in the eardrum, removes fluid, and inserts the tube to allow airflow into the middle ear.

• The procedure is done under general anesthesia in young children.

• Tubes usually stay in place for 6 months to 2 years and often fall out on their own.

• The eardrum typically heals naturally after the tube falls out.

Treatment for chronic suppurative otitis media

This persistent infection, which causes a tear in the eardrum, can be difficult to treat. Antibiotic ear drops are usually recommended. Before using the drops, you may need to remove fluid from the ear canal as directed by your healthcare professional.

Monitoring

Children who experience frequent ear infections or persistent fluid buildup should be closely monitored. Regular follow-up appointments may include hearing and speech assessments to ensure proper development and early detection of any complications.