Kids Ear Infections: Antibiotics Vs Waiting
Less Aggressive Treatment for Otitis Media Gains Ground With Parents and Doctors
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 theyd be satisfied with their kidsotitis 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.
Steroid Treatments Equally Effective Against Sudden Deafness
Injecting steroids into the middle ear works just as well as taking them orally when it comes to restoring hearing for sudden deafness patients. This finding, the result of a large clinical trial comparing the therapies, will help doctors choose the best treatment for patients with this condition.
Sudden deafness, also called sudden sensorineural hearing loss, is an emergency medical condition that affects several thousand people annually, usually between the ages of 40 and 60. It often arises without an obvious cause and occurs in one ear all at once or over a period of up to 3 days. Oral steroids, such as prednisone, are usually prescribed over the course of 2 weeks to restore hearing. There is only a 2- to 4-week window of time for treatment before hearing loss becomes permanent.
Recently, doctors have started injecting steroids directly into the middle ear a procedure called intratympanic treatment. This technique is thought to deliver more of the drug to the ear and to avoid some of the side effects that can come along with oral steroids. The side effects of oral therapy can be mild, like weight gain, mood changes and sleep disruption, or more serious, like high blood pressure and elevated blood sugar. Side effects of injected steroids are usually local, such as ear infection and vertigo. However, up until now, no study had compared the 2 treatments to see whether direct injection worked as well as oral steroids.
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Why Dont Doctors Give Antibiotics For Middle Ear Infections Just In Case
Often, the infection will go away by itself after about 4 days. On average, children who take antibiotics have ear pain for only about 12 hours less than children who dont take antibiotics.
On the other hand, if antibiotics are prescribed, some children will have side effects. Using antibiotics can also cause bacteria to become resistant to them, meaning that the antibiotics might not work in future.
For these reasons, antibiotics are not generally recommended for middle ear infections unless your child is at risk of developing complications. For more information, speak to your doctor or visit the Australian Commission on Safety and Quality in Health Care website.
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.
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Cost Of Treating An Ear Infection Without Insurance
SwimmerÃ¢s ear and middle ear infections are two common types of ear infections. Since these infections occur in different parts of the ear, they require different treatments and times for recovery. Treatment for an ear infection depends on a few factors, including the type of infection, the severity of the infection, and the number of times you have experienced an ear infection. Symptoms of ear infections usually improve within the first couple of days and can sometimes be resolved without treatment.
If your condition worsens, you should consider taking over-the-counter medication or seeing a health care provider. Some of the best-recommended medications for treating an ear infection or the pain associated with it include:
- Tylenol and Motrin for pain-relievers
- Amoxicillin for oral antibiotics
- Ofloxacin .3 percent ear drop for middle ear infections
- Antipyrine and benzocaine otic drops for anesthetic ear drops
Note that your health care provider will be able to advise which medication is best for you.
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What Does An Ear Infection Feel Like
Symptoms depend on which part of your ear is infected and can include:
- ear pain or itch
- discharge from your ear
- redness or swelling of your ear
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
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Talk With Your Doctor If You Develop Any Side Effects Or Allergic Reactions While Taking An Antibiotic
In children, reactions from antibiotics are the most common cause of medication-related emergency department visits.
Common side effects range from minor to very severe health problems and can include:
More serious side effects can include:
- C. diff infection, which causes diarrhea that can lead to severe colon damage and death
- Severe and life-threatening allergic reactions
- Antibiotic-resistant infections
If you need antibiotics, the benefits usually outweigh the risks of side effects and antibiotic resistance.
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 dont think its a good idea, despite the new treatment guidelines.
To see whether watching and waiting might really work for U.S. kids with otitis media, Finkelsteins team asked more than 2,000 parents and 160 doctors what they thought about holding off antibiotic treatment. Their findings:
- 38% of parents say theyd be satisfied or extremely satisfied with watchful waiting.
- 40% of parents say theyd 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 sometimestry 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, its not so clear. While there are community-wide benefits such as a reduction in antibiotic resistance, watchful waiting isnt a very great benefit to an individual patient. Some experts dont think its a good idea at all. And U.S. doctors tend to prefer active treatment over passive waiting.
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What Causes An Ear Infection
Ear infections are caused by bacteria and viruses. Many times, an ear infection begins after a cold or other respiratory infection. The bacteria or virus travel into the middle ear through the eustachian tube . This tube connects the middle ear to the back of the throat. The bacteria or virus can also cause the eustachian tube to swell. This swelling can cause the tube to become blocked, which keeps normally produced fluids to build up in the middle ear instead of being able to be drained away.
Adding to the problem is that the eustachian tube is shorter and has less of a slope in children than in adults. This physical difference makes these tubes easier to become clogged and more difficult to drain. The trapped fluid can become infected by a virus or bacteria, causing pain.
Medical terminology and related conditions
Because your healthcare provider may use these terms, its important to have a basic understanding of them:
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What Should I Expect If I Or My Child Has An Ear Infection
Ear infections are common in children. Adults can get them too. Most ear infections are not serious. Your healthcare provider will recommend over-the-counter medications to relieve pain and fever. Pain relief may begin as soon as a few hours after taking the drug.
Your healthcare provider may wait a few days before prescribing an antibiotic. Many infections go away on their own without the need for antibiotics. If you or your child receives an antibiotic, you should start to see improvement within two to three days.
If you or your child has ongoing or frequent infections, or if fluid remains in the middle ear and puts hearing at risk, ear tubes may be surgically implanted in the eardrum to keep fluid draining from the eustachian tube as it normally should.
Never hesitate to contact your healthcare provider if you have any concerns or questions.
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Symptoms Of Ear Infections
- The main symptom is an earache.
- Younger children will cry, act fussy or have trouble sleeping because of pain.
- About 50% of children with an ear infection will have a fever.
- Complication: In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
Are There Alternatives To Antibiotics For Dog Ear Infections
If your dog is showing signs of an ear infection, it is important to seek veterinary advice. Do not be tempted to try and treat the ear infection at home as the infection could progress, leading to more serious problems such as a ruptured ear drum, middle ear infections, abscesses around the ear, or inner ear infections. Not all ear infections require antibiotics.
Your vet can advise on the most appropriate treatment. Ear cleansers that contain antibacterial ingredients or change the acidity of the ear canal can be used to control mild ear infections. For some infections, controlling the inflammation and removing the underlying cause is enough to allow the infection to resolve without antibiotics.
Ear infections can be painful and uncomfortable for our canine friends, so naturally, we want to resolve them as fast as possible. Seek veterinary advice promptly if you notice signs of infection with your dogs ear and follow the advice carefully to avoid problems or recurring infections. Antibiotics can be a safe and effective treatment for ear infections in dogs. However, they are not always needed. We all have a role to play in ensuring the safe and responsible use of antibiotics and in limiting serious problems such as antibiotic resistance.
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1) Johns Hopkins Antibiotic Guide
3) Ear Infection, Centers for Disease Control and Prevention, 5 May 2021,
4) Swimming and Ear Infections,Centers for Disease Control and Prevention, 5 May 2021,
Can Middle Ear Infections Be Prevented
It’s not possible to prevent middle ear infections, but there are some things you can do that may reduce your child’s risk of developing the condition. These include:
- make sure your child is up-to-date with their routine vaccinations particularly the pneumococcal vaccine and the DTaP/IPV/Hib vaccine
- avoid exposing your child to smoky environments
- don’t give your child a dummy once they’re older than six to 12 months old
- don’t feed your child while they’re lying flat on their back
- if possible, feed your baby with breast milk rather than formula milk
Avoiding contact with other children who are unwell may also help reduce your child’s chances of catching an infection that could lead to a middle ear infection.
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Who Is At Higher Risk For Ear Infections
- Children less than 5 years old, because they have shorter eustachian tubes.
- Children who attend daycare, because they tend to have more colds.
- Children with allergies.
- Children who are exposed to cigarette smoke. Smoke causes inflammation of the eustachian tube, making ear infections more likely.
- Children who were not breastfed. Breast milk has antibodies that help fight infections.
- Babies who are being bottle-fed, especially if they swallow milk while lying too flat. Milk can enter the eustachian tube and cause inflammation, which increases the risk of an ear infection. Children should be held upright while drinking a bottle. When they are old enough to hold their own bottle well, they should be taught to drink from a regular cup and no longer given a bottle.
- Children with cleft palates, as their eustachian tubes are often inflamed.
- Children of First Nations and Inuit descent, though its not clear why.
- Children with Down syndrome.
What Is My Doctor Looking For
Your doctor will ask you about any symptoms youâve had. Be sure to come to the office with any notes you might need and questions on your mind.
She will look at the eardrum with an instrument called an otoscope for signs of infection. This is a tough task with a fussy infant, so be ready to help calm the little one if itâs your child with the earache.
Signs of infection include a red eardrum or a bulging eardrum with fluid behind it. The fluid may be thin like during a cold, or thick like pus. It is located in the middle ear, just behind the ear drum. Otitis media means inflammation of the middle ear. A puffer attached to the otoscope blows air to see if your thin eardrum moves. With fluid in the middle ear, the eardrum is more rigid and doesn’t move back and forth.
She might also look for signs of infection with another instrument. Itâs called a tympanometer, and it uses sound and air pressure to check for fluid in the middle ear.
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How Do Ear Infections Happen
A middle ear infection usually happens because of swelling in one or both of the eustachian tubes . The tubes let mucus drain from the middle ear into the throat.
A cold, throat infection, acid reflux, or allergies can make the eustachian tubes swell. This blocks the mucus from draining. Then, or grow in the mucus and make pus, which builds up in the middle ear.
When doctors refer to an ear infection, they usually mean otitis media rather than swimmer’s ear . Otitis media with effusion is when noninfected fluid builds up in the ear. It might not cause symptoms, but in some kids, the fluid creates a sensation of ear fullness or “popping.”
Synthetic Antibiotics Derived From Dyes
Synthetic antibiotic chemotherapy as a science and development of antibacterials began in Germany with Paul Ehrlich in the late 1880s. Ehrlich noted certain dyes would color human, animal, or bacterial cells, whereas others did not. He then proposed the idea that it might be possible to create chemicals that would act as a selective drug that would bind to and kill bacteria without harming the human host. After screening hundreds of dyes against various organisms, in 1907, he discovered a medicinally useful drug, the first synthetic antibacterial organoarsenic compoundsalvarsan, now called arsphenamine.
The first sulfonamide and the first systemically active antibacterial drug, Prontosil, was developed by a research team led by Gerhard Domagk in 1932 or 1933 at the Bayer Laboratories of the IG Farben conglomerate in Germany, for which Domagk received the 1939 Nobel Prize in Physiology or Medicine. Sulfanilamide, the active drug of Prontosil, was not patentable as it had already been in use in the dye industry for some years. Prontosil had a relatively broad effect against Gram-positivecocci, but not against enterobacteria. Research was stimulated apace by its success. The discovery and development of this sulfonamide drug opened the era of antibacterials.
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