Diagnosis
A healthcare professional can often diagnose an ear infection based on symptoms and an exam. The exam likely includes looking inside the ears with a lighted instrument known as an otoscope. If the eardrum is red and bulging, there’s likely an infection.
Other tests might be needed if there’s doubt about a diagnosis, if the condition hasn’t gotten better with treatment or if there are other issues.
What a diagnosis means
- Acute otitis media. The diagnosis of ear infection often means acute otitis media. This involves having fluid in the middle ear or symptoms of an infection, such as fluid suddenly coming from the ear.
- Otitis media with effusion. This means there’s fluid in the middle ear, but no symptoms of infection.
- Chronic suppurative otitis media. This is caused by a long-term ear infection that caused a tear in the eardrum. This condition often involves pus coming from the ear.
Treatment
Many ear infections clear up without antibiotics. Treatment depends on the person’s age and how bad the symptoms are.
Watchful waiting
Symptoms of ear infections usually get better in a couple of days. Most ear infections clear up in a week or two without treatment. We recommend a wait and see approach as one choice for:
- Children 6 to 23 months with mild pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C).
- Children 24 months and older with mild pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C).
Antibiotic medicines
Antibiotics might be helpful for some adults and for children with ear infections. But using antibiotics too often can cause the medicine to not work as well against the bacteria. Talk to your healthcare professional about the pros and cons of using antibiotics.
Children younger than 6 months who have acute otitis media are more likely to be treated with antibiotics without the watch and wait time.
It’s important to take the antibiotic as directed even after symptoms improve. Not taking all the medicine can cause the infection to return. Talk to a healthcare professional or pharmacist about what to do after missing a dose.
Tympanostomy tubes/Ear tubes
Ear tubes drain fluid from the middle ear. Ear tubes might help children who have repeated, long-lasting ear infections, also known as chronic otitis media. Ear tubes also might help children who have fluid buildup in the ear after an infection cleared up, known as otitis media with effusion.
The tubes are placed during an outpatient surgery called a myringotomy. A surgeon makes a tiny hole in the eardrum to suction fluids out of the middle ear. The surgeon then puts the ear tube in the opening to help air get to the middle ear and to prevent the buildup of more fluids.
The patient will likely be given medicine to put them to sleep for the surgery, also known as general anesthesia.
Some tubes stay in place for 6 months to 2 years. They fall out on their own. Other tubes are meant to stay in longer. They might need to be removed with another surgery.
The hole in the eardrum usually closes again after the tube falls out.
Treatment for chronic suppurative otitis media
Chronic infection that causes a tear in the eardrum, called chronic suppurative otitis media, is hard to treat. Antibiotics drops put into the ear might treat the condition. You might get directions on how to suction fluids out through the ear canal before putting in the drops.
Monitoring
Children who have infections often or who always have fluid in the middle ear will need to be watched. Talk to your healthcare professional about how often to schedule follow-up.
Dr. Mwangi Grace