Do All Ear Infections Need Antibiotics

Adenoids And/or Tonsil Removal

Adenoid removal or adenoid and tonsil removal may help some children who have repeat ear infections or fluid behind the eardrum. Children younger than 4 don’t usually have their adenoids taken out unless they have severe nasal blockage.

As a treatment for chronic ear infections, experts recommend removing adenoids and tonsils only after tubes and antibiotics have failed. Removing adenoids may improve air and fluid flow in nasal passages. This may reduce the chance of fluid collecting in the middle ear, which can lead to infection. When used along with other treatments, removing adenoids can help some children who have repeat ear infections. But taking out the tonsils with the adenoids isn’t very helpful.footnote 4 Tonsils are removed if they are frequently infected. Experts don’t recommend tonsil removal alone as a treatment for ear infections.footnote 5

How To Use Ear Drops

Prior to using ear drops, you should always read the instructions provided to you with your prescription. You can also speak to your pharmacist or doctor for advice on using them. The following instructions will help you use ear drops correctly.

For adults:

• Lie down on a flat surface with a folded towel beneath your head and the affected ear facing the ceiling.
• Pull your earlobe up to straighten out the ear canal.
• Administer the appropriate number of drops into the ear.
• Push the ear flap gently to help ease the drops into the ear.
• Remain in this position for up to two minutes to ensure that the ear canal is fully coated with medicine.

For children:

• Have the child lie on the floor or bed with a towel beneath their head and their affected ear facing the ceiling.
• Hold their head still if they are squirming or fidgeting.
• Pull the earlobe out and down to straighten their ear canal..
• Administer the recommended number of drops
• Press on their ear flap or place a cotton ball gently into the ear and let it remain in position for several minutes to ensure that the medication coats the inside of their ear.

The process for infants is similar to children, but you can also cradle your infant while you administer the drops in an appropriate position that allows the medication to go into their ear properly.

Middle Ear Fluid Buildup

Most children who have ear infections still have some fluid behind the eardrum a few weeks after the infection is gone. For some children, the fluid clears in about a month. And a few children still have fluid buildup several months after an ear infection clears. This fluid buildup in the ear is called otitis media with effusion. Hearing problems can result, because the fluid affects how the middle ear works. Usually, infection does not occur.

Otitis media with fluid buildup may occur even if a child has not had an obvious ear infection or upper respiratory infection. In these cases, something else has caused eustachian tube blockage.

In rare cases, complications can arise from middle ear infection or fluid buildup. Examples include hearing loss and ruptured eardrum.

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What Is A Middle Ear Infection

A middle ear infection, also called otitis media, is inflammation or infection of the middle ear. Ear infections often occur along with a cold or other upper respiratory infections. Almost all children have at least one ear infection before age 7.

Most ear infections are caused by bacteria. But viruses also can cause them. The respiratory syncytial virus and the influenza virus are the two main viruses that cause ear infections.

Ear infections are most common in young children, because young children have shorter eustachian tubes, which are more easily blocked than those of older children and adults. When the tube is blocked, fluid builds up. This creates a breeding ground for germs.

Pus forms as the body tries to fight the infection. More fluid collects and pushes against the eardrum, causing pain and sometimes a temporary loss of hearing. Fever lasts about 1 to 2 days. Most children have some pain on and off for up to 4 days. Young children may have pain that comes and goes for up to 9 days.

If your child has an ear infection, he or she may:

• Have an earache. It may be mild, or it may hurt a lot.
• Act fussy or grumpy.
• Pull at his or her ears.
• Have trouble sleeping.
• Not feel like eating.
• Vomit.

A Safer Approach To Treating Ear Infections

Of course, the safest approach is to avoid ear infections altogether. You can help your child reduce the likelihood and severity of ear infection by taking steps to address health issues that may make them susceptible:

• For infants, choose breastfeeding over formula whenever possible. Introducing formula in the first six months of life is associated with more ear infections in early childhood
• Eat a nutrient-dense, whole-foods diet
• Identify food sensitivities and remove problematic foods from the diet. Dairy is the most common culprit in recurrent ear infection
• Ensure adequate vitamin D levels
• Strengthen the immune system

For more strategies to promote overall health and help prevent illness, check out my free eBook 9 Steps to Perfect Health.

However, if your child does get an ear infection, research dictates that a watch-and-wait approach is best in most cases. Keep an eye on illness progression and schedule a follow-up in a day or two. Most ear infections will clear on their own in a few days without much added discomfort.

In the meantime, you might try these low-risk remedies to help ease symptoms and shorten duration:

Despite the risks, antibiotics may be necessary in some cases. If your doctor determines that antibiotics are the safest choice for your child, all hope is not lost. There are steps you can take to limit the negative impact of antibiotics.

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Watchful Waiting: Who Would Do It

Is watchful waiting ready for U.S. prime time? Harvard researcher Jonathan Finkelstein, MD, MPH, and colleagues note that some experts don’t think it’s a good idea, despite the new treatment guidelines.

To see whether watching and waiting might really work for U.S. kids with otitis media, Finkelstein’s team asked more than 2,000 parents and 160 doctors what they thought about holding off antibiotic treatment. Their findings:

• 38% of parents say they’d be satisfied or extremely satisfied with watchful waiting.
• 40% of parents say they’d be unsatisfied or extremely unsatisfied with watchful waiting.
• 38% of doctors say they never or almost never try watchful waiting.
• 39% of doctors say they “occasionally” try watchful waiting.
• 17% of doctors say they “sometimes” try watchful waiting.
• 6% of doctors say they recommend watchful waiting most of the time.

For parents, the results are clear.

“Parental opinions in a community are likely to change as experience with successful treatment of acute otitis media without antibiotics becomes more common,” Finkelstein and colleagues write.

For doctors, it’s not so clear. While there are community-wide benefits such as a reduction in antibiotic resistance, watchful waiting isn’t a very great benefit to an individual patient. Some experts don’t think it’s a good idea at all. And U.S. doctors tend to prefer active treatment over passive waiting.

Antibiotics For An Ear Infection

Years ago, the standard procedure for treating ear infections was to prescribe an antibiotic every time someone had an earache.

Because of this, antibiotics were used too frequently. The general population built up a resistance making them not as effective as they used to be. For this reason, your doctor may not give you an antibiotic right away, even if you do have an ear infection.

Some ear infections are viral and an antibiotic wouldnt help anyway. If an earache doesnt go away on its own, then your doctor will give you the appropriate antibiotic to help your ear heal quicker. Often times it will be drops that go in the ear rather than an oral medication.

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Symptoms Of Ear Infection

Babies and small children might:

• pull or rub their ear
• have a high temperature
• have redness around the ear
• be restless or irritable
• not respond to noises that would normally attract their attention

See your doctor if:

• your child is in pain
• there is discharge from the child’s ear
• your child is unwell or vomiting
• your child can’t hear properly
• there is swelling behind the ear and the ear is being pushed forward
• your child keeps getting ear infections

Why Do Kids Get So Many Ear Infections

The NIH points to several reasons why kids are more likely to get ear infections:

• Childrens eustachian tubes are smaller and more level than those of adults. This means its harder for fluid to drain from the ear, so if a childs tubes get blocked by mucus from another respiratory infection, fluid may not drain properly.
• Childrens immune systems are still developing so it can be harder for them to fight infections.
• In children, if bacteria gets trapped in the adenoids , it can cause a chronic infection that gets passed to the eustachian tubes and middle ear.

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What Are The Symptoms Of Otitis Media

Symptoms of ear infection include:

• Ear pain: This symptom is obvious in older children and adults. In infants too young to speak, look for signs of pain like rubbing or tugging ears, crying more than usual, trouble sleeping, acting fussy/irritable.
• Loss of appetite: This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
• Irritability: Any kind of continuing pain may cause irritability.
• Poor sleep: Pain may be worse when the child is lying down because the pressure in the ear may worsen.
• Fever: Ear infections can cause temperatures from 100° F up to 104° F. Some 50% of children will have a fever with their ear infection.
• Drainage from the ear: Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured .
• Trouble hearing: Bones of the middle ear connect to the nerves that send electrical signals to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.

What Are The Types Of Ototopical Antibiotics

Ototopical antibiotics are available in three forms:

Powders

Powders are not approved by FDA, but regionally compounded powders have been in use for years. Powders have the advantage of adhering to and remaining for a long time in moist surfaces. Powders are prepared with several components.

Two preparations of powders used are:

• Gold dust: comprised of chloramphenicol, sulfanilamide and hydrocortisone
• Mastoid powder: comprised of ciprofloxacin, clotrimazole, dexamethasone and boric acid

Creams and ointments

Creams and antibiotics are applied only for bacterial and fungal infections in the external ear and auditory canal, usually with a single dose. Following are some of the antibiotic ointments and creams used for external ear infections:

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% Don’t Need Antibiotics

The idea of delaying antibiotic treatment for ear infections is not new. The strategy is catching on in Europe, and the American Academy of Pediatrics says 80% of children whose ear infections are not treated immediately with antibiotics get better on their own.

The AAP gave its stamp of approval to the watch-and-wait strategy in 2004, telling physicians it was OK to delay antibiotics in children over age 2 for 48 to 72 hours as long as pain is managed with pain relievers like ibuprofen or acetaminophen.

But the strategy will not work, Rosenfeld says, unless parents are given enough information to make them comfortable with the idea.

Specifically, they need to understand that for many children the benefits of taking antibiotics for ear infections are outweighed by the side effects, which can include diarrhea, upset stomach, rash, allergiesallergies, and the possibility of drug resistance.

“We need to replace antibiotic therapy with information therapy. You can’t just replace antibiotics with nothing,” he says. “Parents won’t stand for it.”

Paul Little, MD, conducted one of the first studies examining the delayed antibiotic approach to treatment of ear infections in the United Kingdom. He agrees informed parents will accept the idea of delaying antibiotics for ear infections.

Treating Middle Ear Infections

You may be prescribed antibiotics. Some antibiotics may be taken orally. Others can be applied directly to the site of the infection with ear drops. Medications for pain, such as over-the-counter pain relievers and anti-inflammatory drugs may also be used to manage your symptoms.

If youre still experiencing cold or allergy symptoms, you may be advised to take a , nasal steroids, or an antihistamine.

Another helpful technique is called autoinsufflation. Its meant to help clear your eustachian tubes. You do this by squeezing your nose, closing your mouth, and very gently exhaling. This can send air through the eustachian tubes to help drain them.

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Diagnosis Of Ear Infections

Your physician will look into your ear with an otoscope, a medical instrument with a light on one end designed to get a better view inside the ear. Your doctor will look for the visual signs of ear infection, such as redness and inflammation.

To check for fluid buildup, a pneumatic otoscope, which blows air at the eardrum, will be used. If there is excessive fluid behind the eardrum, it will not move as it should when the air hits it.

In some cases, hearing tests may also be performed to assess any damage to the ear from the infection.

Different types of ear infections present with different symptoms, which can include:

• Inner ear infections: Hearing loss, ringing in the ears , dizziness, loss of balance, nausea and vomiting, and ear pain
• Middle ear infections: Fluid in the ear, ear pain, fever, a feeling of general illness, pressure in the ears, and hearing loss
• Outer ear infections: Inflammation of the ear canal, itching in the ear, ear pain, swelling of the ear canal, redness, and fluid draining from the ear

Ear Infection Doctor Discussion Guide

Children with ear infections, especially toddlers or infants, may not be able to describe their symptoms, but an ear infection will often present with the following signs:

• Tugging or pulling at their ears
• Fussing or crying
• Being clumsy and having balance issues
• Trouble hearing or responding to quiet noises

How I Treat Ear Infections Naturally In My Home

The first thing I do when I suspect an ear infection is grab the hydrogen peroxide.

For the first and second days, I administer peroxide up to four times daily.

I also rub lavender oil behind the ear and down the neck to provide pain relief since we dont have over-the-counter pain killers in our house.

If my child isnt back to her old self by the end of the second day, I call the chiropractor and schedule an adjustment for the third day.

I still continue the peroxide 3 or 4 times a day.

If Im on the third or fourth day of the infection and it shows no sign of improvement at all, Ill pull out the garlic oil and colloidal silver and alternate them, while still using essential oils for pain relief.

Ear infections are VERY rare in our family, but this is the protocol Ive used each time and neither of my kids have taken an antibiotic in over 10 years.

These 5 natural home remedies for ear infection work quickly for adults and children! I hope youll feel empowered to reduce antibiotic use in your home and give some of these remedies a try next time youre faced with an ear infection!

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Who Is Most Likely To Get An Ear Infection

Middle ear infection is the most common childhood illness . Ear infections occur most often in children who are between age 3 months and 3 years, and are common until age 8. Some 25% of all children will have repeated ear infections.

Adults can get ear infections too, but they dont happen nearly as often as they do in children.

Risk factors for ear infections include:

• Age: Infants and young children are at greater risk for ear infections.
• Family history: The tendency to get ear infections can run in the family.
• Colds: Having colds often increases the chances of getting an ear infection.
• Allergies: Allergies cause inflammation of the nasal passages and upper respiratory tract, which can enlarge the adenoids. Enlarged adenoids can block the eustachian tube, preventing ear fluids from draining. This leads to fluid buildup in the middle ear, causing pressure, pain and possible infection.
• Chronic illnesses: People with chronic illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as cystic fibrosis and asthma.
• Ethnicity: Native Americans and Hispanic children have more ear infections than other ethnic groups.

Where To Get Help

• Your doctor
• NURSE-ON-CALL Tel. for expert health information and advice
• Royal Children’s Hospital Tel. 9345 5522
• Your maternal and child health nurse
• Your local hospital emergency or casualty department.
• 24 hour Maternal and Child Health Telephone Service: Tel. 13 22 29 for the cost of a local call throughout Victoria.

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Kids’ Ear Infections: Antibiotics Vs Waiting

Less Aggressive Treatment for Otitis Media Gains Ground With Parents and Doctors

June 6, 2005 — U.S. doctors usually treat kids’ middle ear infections — otitis media — with antibiotics. That may be changing, new studies show

The first study, a clinical trial, shows that immediate antibiotic treatment results in fewer symptoms in the first 10 days. But simply watching and waiting to see if the infection gets worse worked too — and it cut antibiotic use by two-thirds. Thirty days after the first doctor visit, the cure rate was the same in the immediate treatment and watchful-waiting groups.

The second study surveyed parents and doctors in six Massachusetts communities. About a third of parents said they’d be satisfied with their kids’ otitis media treatment if their doctors advised watching and waiting. But 40% said this would not be satisfactory. Meanwhile, 38% of doctors said they never used watching and waiting for otitis media. Only 6% said they did it most of the time, while 39% reported occasional use.

Both studies appear in the June issue of Pediatrics.