Are Antibiotics Absolutely Necessary To Treat Ear Infections
No, they are not absolutely necessary, but they are helpful for several reasons:
- Antibiotics will help your child feel better faster by eliminating the bacteria, which in turn reduces the fever and ear pain more quickly. Children generally feel better after one or two days of antibiotics.
- Allowing an ear infection to heal on its own usually subjects a child to four to seven days of fever and ear pain.
- Antibiotics help prevent the very rare, but possible, complications of an ear infection spreading into the brain or bone surrounding the ear.
- New research is suggesting that 80 percent of uncomplicated ear infections will resolve within 4 to 7 days without antibiotics. Parents who choose not to use antibiotics can treat the pain and fever with Auralgan anesthetic ear drops and ibuprofen or acetaminophen, or can try using Xlear® nasal spray as mentioned above.
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Causes And Risk Factors
Outer ear infections are usually caused by . They are sometimes caused by a fungus, such as a yeast, but thats less common. Viral illnesses like the flu or a certain type of shingles may also lead to an outer ear infection. And sometimes allergic reactions for instance, to a shampoo are to blame.
Outer ear infections are also often called swimmers ear because germs can easily get into the ear canal while youre swimming. This means that people who swim a lot are more likely to get outer ear infections.
Minor injuries to the ear for instance, through the use of cotton ear buds to clean your ear, or regularly wearing headphones that you stick inside your ear can increase the risk too. People who have already had an outer ear infection or are generally prone to infections are also more likely to get outer ear infections.
When To Contact A Medical Professional
Contact your provider if:
- You have swelling behind the ear.
- Your symptoms get worse, even with treatment.
- You have high fever or severe pain.
- Severe pain suddenly stops, which may indicate a ruptured eardrum.
- New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles.
Let the provider know right away if a child younger than 6 months has a fever, even if the child doesn’t have other symptoms.
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Do: Try Shaking Out Any Water
Sometimes water becomes trapped in your ear, either from a shower or swim, and this can make your ears feel clogged. Tilting your head to the side and gently shaking it can dislodge a drop of water and clear your ear. Sometimes gently putting your finger in your ear and wiggling it will do the same thing.
Complications And Emergency Symptoms
If an outer ear infection goes untreated and doesnt heal on its own, it can result in several complications.
Abscesses can develop around the affected area within the ear. These may heal on their own, or your doctor may need to drain them.
Long-term outer ear infections can cause narrowing of the ear canal. Narrowing can affect the hearing and, in extreme cases, cause deafness. It needs to be treated with antibiotics.
Ruptured or perforated eardrums can also be a complication of outer ear infections caused by items inserted into the ear. This can be extremely painful. Symptoms include temporary hearing loss, ringing or buzzing in the ears, discharge, and bleeding from the ear.
In rare cases, necrotizing otitis externa occurs. This is an extremely serious complication where the infection spreads to the cartilage and bone that surrounds your ear canal.
Adults with weakened immune systems are most at risk. Untreated, it can be fatal. This is considered a medical emergency, with symptoms including:
- severe ear pain and headaches, especially at night
- ongoing ear discharge
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What Are The Signs And Symptoms Of An Inner Ear Infection
Ear infections can happen anywhere in your outer, middle or inner ear. The symptoms can be very different depending on where the problem is located. If the infection is in your inner ear then it can have a particularly dramatic effect on your senses of balance and hearing. Read on to learn more about inner ear infections and how they can affect you.
Response To Antibiotic Treatment
Your childs symptoms, including fever, should improve within 48 to 72 hours after beginning antibiotics. If symptoms do not improve it may be because a virus is present or the bacteria causing the ear infection is resistant to the prescribed antibiotic. A different antibiotic may be needed.
In some children whose treatment is successful, fluid will still remain in the middle ear for weeks or months, even after the infection has resolved. During that period, children may have some hearing problems, but eventually the fluid almost always drains away.
If your child fails to improve and middle ear fluid remains, your doctor may recommend consultation with an ear, nose, and throat specialist . This specialist may perform a tympanocentesis procedure in which fluid is drawn from the ear and examined for specific bacterial organisms. But this is reserved for severe cases.
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Longer Term Effects Of Inner Ear Infections
Generally, the symptoms will clear up as soon as the infection is gone. However, the effects can sometimes last longer.
You might still feel dizzy and off-balance even when the other symptoms caused by the infection have gone. This can be a sign that the balance organs were damaged. Your brain can usually learn to work with these changes, so your sense of balance should usually come back by itself. However, if youre struggling to cope or the problem persists, you should see an ENT specialist. The doctor can check for any underlying causes and may refer you for vestibular rehabilitation therapy to help you to recover your balance.
Inner ear infections can also have a longer term effect on your hearing. This is more likely if you had bacterial infection, so your doctor might recommend a hearing test to check on your ears after the infection.
How Is An Ear Infection Diagnosed
Your healthcare provider will look at your or your childs ear using an instrument called an otoscope. A healthy eardrum will be pinkish gray in color and translucent . If infection is present, the eardrum may be inflamed, swollen or red.
Your healthcare provider may also check the fluid in the middle ear using a pneumatic otoscope, which blows a small amount of air at the eardrum. This should cause the eardrum to move back and forth. The eardrum will not move as easily if there is fluid inside the ear.
Another test, tympanometry, uses air pressure to check for fluid in the middle ear. This test doesnt test hearing. If needed, your healthcare provider will order a hearing test, performed by an audiologist, to determine possible hearing loss if you or your child has had long lasting or frequent ear infections or fluid in the middle ears that is not draining.
Your healthcare provider will also check your throat and nasal passage and listen to your breathing with a stethoscope for signs of upper respiratory infections.
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The goals of therapy are to treat the dental infection and prevent further complications. Amoxicillin is still the first-line drug of choice but with 34% of Prevotella species resistant to amoxicillin, the alternatives of amoxicillin/clavulanate, clindamycin, and metronidazole need to be considered.
When Your Doctor May Prescribe Antibiotics
While every situation is unique, there are several factors that doctors consider when recommending antibiotics:
- What they see If the infection is in the outer ear, it may be clear its caused by bacteria. In this case your doctor may recommend antibiotic eardrops to help clean out the ear infection. If your doctor cant see the ear infection because its on the inside of the ear, they may not prescribe antibiotics right away.
- How long its been Viral infections typically go away on their own in 1-2 weeks. If the ear infection has been around for less than a week, your doctor may recommend waiting to see if the ear infection goes away on its own, a sign that its viral. If its been more than a week, your doctor may recommend starting antibiotics.
- Your childs age The doctor may be more likely to prescribe antibiotics for children under 2 years old, especially if they have infections in both ears, have pain thats moderate to severe, or have a fever.
- Symptoms If you or your child have certain symptoms, such as an extremely high fever or severe dehydration, your doctor may recommend starting antibiotics sooner.
- Medical conditions Your doctor may recommend starting antibiotics right away if there are certain medical conditions, such as cleft palate or repeat infections, that could lead to problems with an ear infection. In most cases, antibiotics will also be recommended when someone with a cochlear implant gets an ear infection.
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Cause Of Ear Infections
- A bacterial infection of the middle ear
- Blocked eustachian tube, usually as part of a common cold. The eustachian tube joins the middle ear to the back of the throat.
- Blockage results in middle ear fluid .
- If the fluid becomes infected , the fluid turns to pus. This causes the eardrum to bulge out and can cause a lot of pain.
- Ear infections peak at age 6 months to 2 years. They are a common problem until age 8.
- The onset of ear infections is often on day 3 of a cold.
- How often do kids get ear infections? 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
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When Else Are Antibiotics Needed
Antibiotics can be the right treatment for kids who get a lot of ear infections. Their doctors might prescribe daily antibiotics to help prevent future infections. And younger children or those with more severe illness may need antibiotics right from the start.
The wait-and-see approach also might not apply to children with other concerns, such as cleft palate, genetic conditions such as Down syndrome, or other illnesses such as immune system disorders.
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Should I Use Antibiotics For An Ear Infection
Antibiotics are a medicine prescribed by your doctor. If youre dealing with an ear infection caused by bacteria, youll likely need antibiotics. They are the best way of quickly getting rid of a bacterial infection and preventing it from spreading to other parts of the body.
The catch is that antibiotics dont work against viruses if you use antibiotics on a viral ear infection, it can actually make the infection worse. Overuse of antibiotics can lead to a condition called antibiotic resistance, which means that the medicine becomes less effective at fighting off bacteria.
Thats why doctors are careful about using antibiotics wisely and may not immediately prescribe them for ear infections.
Ear Infection Signs And Symptoms
The telltale sign of an ear infection is pain in and around the ear. Young children can develop ear infections before they are old enough to talk. That means parents are often left guessing why their child appears to be suffering. When your child cant say my ear hurts, the following signs suggest an ear infection could be the culprit:
- Tugging or pulling the ear
- Crying and irritability
- Fever, especially in younger children
- Fluid draining from the ear
- Loss of balance
- Difficulty hearing or responding to auditory cues
Signs that require immediate attention include high fever, severe pain, or bloody or pus-like discharge from the ears.
Johns Hopkins Pediatric Otolaryngology
Our pediatric otolaryngologists are committed to providing compassionate and comprehensive care for children with ear, nose, and throat conditions. As part of the Johns Hopkins Childrens Center, you have access to all the specialized resources of a childrens hospital. Your child will also benefit from experts who use advanced techniques to treat both common and rare conditions.
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Uncommon But Serious Ear Infection Complications
Ear infection complications can happen when the infections become severe or recurrent. I already discussed common myths about ear infections and shared ear infection facts that I believe parents should know.
Ear infection complications can be divided into the common and the uncommon types.
Common ear infection complications include temporary hearing loss, speech delay, dizziness, balance problems and sensory processing and learning disorders.
Uncommon ear infection complications happen because of long term problems that have not been successfully treated or where symptoms seemed to go away. Without significant symptoms, it can be hard to know if a more serious problem is developing.
When kids suffer from ear infections for many years, they get used to ear symptoms and stop complaining about them. Kids are tough! They often say: Its not bad, and I can handle it.
You do not want your child to handle ear problems. If your childs ear infections do not happen as often as they used to, you need to understand that the ear problems should completely go away.
If ear infections keep happening, annual ear exams and hearing tests with an Ear Nose and Throat doctor allows for better evaluations.
Although these problems are not common, children with chronic ear infections may develop one or more of these severe ear infection complications.
Home Remedies For Ear Infections
While ear infections are more common in children, people of any age can get them.
Because ear infections often clear up on their own, healthcare professionals are hesitant to jump to prescribing antibiotics as a first course of treatment unless the infection is severe, the child is very young, or there are other mitigating circumstances.
This has many people turning to home remedies for ear infections. Many home remedy recommendationsoften passed from one person to another through word of mouthare not backed by scientific evidence and may even be harmful. It’s important to evaluate home remedy recommendations for ear infections for accuracy and safety before trying them out. And as always, when in doubt, ask your healthcare provider.
IAN HOOTON/SCIENCE PHOTO LIBRARY / Getty Images
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Infections Inside The Ear
Antibiotics are not usually offered because infections inside the ear often clear up on their own and antibiotics make little difference to symptoms, including pain.
Antibiotics might be prescribed if:
- an ear infection does not start to get better after 3 days
- you or your child has any fluid coming out of the ear
- you or your child has an illness that means there’s a risk of complications, such as cystic fibrosis
They may also be prescribed if your child is less than 2 years old and has an infection in both ears.
If antibiotics are not prescribed, eardrops containing a painkiller and an anaesthetic might be prescribed.
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What Is An Ear Infection
An ear infection, officially known as otitis media is the inflammation of the middle ear. It is usually caused by bacteria that materializes when fluid builds up behind the eardrum.
The three main types of ear infections are acute otitis media, otitis media with effusion, and chronic otitis media with effusion.
Acute otitis media is the most common and this is what typically causes an earache. Sometimes this can be a dull pain and sometimes it can feel like stabbing ear pain.
In AOM, the middle ear becomes swollen and infected due to fluid behind the eardrum. AOM can also cause a fever. Sometimes this can be a dull pain and sometimes it can feel like stabbing ear pain.
Otitis media with Effusion can happen if an ear infection doesnt totally clear up and fluid stays behind the eardrum. Kids who have these infections might not have any symptoms, but a doctor can see the fluid.
Chronic otitis media with effusion occurs when fluid stays in the middle ear for an extended period of time or continues to return, even if there isnt an infection. This type of ear infection makes it difficult for kids to fight off new infections and can negatively impact their hearing.