Treatment Options

How is it treated?

Because otitis media can be due to a virus, bacteria, or both, it is often difficult to identify the exact cause and thus the most appropriate treatment. Treatment options include the following:

• Pain Management

  Otitis media does not always cause pain. If pain is present, medications such as acetaminophen (Tylenol ?) or ibuprofen are typically effective.

• Antibiotics

  In some patients, the doctor may decide to delay treatment with antibiotics (drugs that kill bacteria), giving the body a chance to fight the infection by itself. It has been reported by the American Academy of Pediatrics that around 61% of children have improved symptoms by 24 hours whether or not they were given antibiotics. Additionally, by 7 days, over 75% of all children were symptom-free, again regardless of treatment with an antibiotic. If there is no improvement in 24 hours in children 6-24 months or no improvement in 72 hours for children older than 24 months, antibiotics should be prescribed. Children younger than 6 months with signs and symptoms of otitis media should receive antibiotics.

  If the doctor decides to treat otitis media then an antibiotic will be prescribed. Some examples of the most common antibiotics used to treat otitis media include amoxicillin, amoxicillin and clavulanate acid, trimethoprim-sulfamethoxazole, cefuroxime, clarithromycin, and azithromycin.

  Because proven effective through clinical trials, some doctors are now choosing to treat uncomplicated cases of otitis media with a shorter course of antibiotic treatment. Antibiotics typically used for 5 days of treatment, but typically in higher doses, include amoxicillin, azithromycin, and cefuroxime.

  Although improvement is typically seen in 48 to 72 hours, the antibiotic should be taken as long as prescribed (typically for 5 to 14 days) to prevent a return of the infection.

  Furthermore, if the antibiotic is stopped early all of the bacteria causing the infection may not be eliminated. In fact, the ?weaker? bacteria die leaving behind the ?stronger? bacteria. These surviving bacteria begin to multiply and the resulting infection or ?return of the infection? is slightly harder to get rid of. Over time, when antibiotics are used improperly like this, bacteria that are no longer killed by the antibiotic develop, i.e., drug resistant bacteria. Many antibiotics are no longer useful due to the development of drug resistance

  Stomach upset and rash are common side effects of these antibiotics. To learn more about antibiotics used to treat otitis media, click on the Drug Class links at the bottom of the page.

• Observation

  If the cause of the otitis media is viral, antibiotics will not help - observation and pain control is the recommended course of action. Viral otitis media should resolve on its own within 7-14 days with no treatment. Observation may also be recommended for many cases of bacterial otitis media. It has been reported that around 80% of otitis media cases (whether viral or bacterial) resolve within 2-14 days without treatment of antibiotics.

• Ear Tubes

  If middle ear fluid has accumulated in the ear for longer than 3 months and the patient is experiencing hearing loss, a doctor may recommend inserting a tympanostomy tube into the patient's ear. This will allow air to move through the middle ear and balance the pressure between the outer and middle ear. Ear tubes may also be recommended for children who have repeated ear infections.

  During myringotomy, the operation performed to insert the tubes, a small incision is made in the opening of the child's eardrum to allow placement of a metal or plastic tube. The tube typically stays in the eardrum for 6 to 12 months, during which time water should be kept out of the ears. Once the tubes are inserted and fluid is drained from the middle ear, any hearing loss should be reversed and any pain should disappear.

• Can otitis media be prevented?

  There is no way to completely eliminate the risk factors associated with otitis media, but certain steps may be taken to lower the chance of developing this condition. Some of these include:

  • Avoid feeding the child while he or she is laying flat
  • Try to reduce the use of a pacifier
  • Avoid utilizing daycare (or moving the child from a large daycare center to a smaller home based place of care)
  • Avoid smoking around children

Drug classes used to treat Otitis Media

Cephalosporins

Macrolides

Penicillins

Sulfonamides and Related Compounds

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