ear, nose, and throat disorders
Otitis Media (Acute)
Treatment of Acute Otitis Media
Pain relievers Antibiotics if needed Most people with acute otitis media get better without treatment. However, because it is hard to predict whose symptoms will not lessen, some doctors in the United States treat all people with antibiotics, such asamoxicillin. Other doctors may give antibiotics only in the following circumstances: Children are young (for example, younger than 6 months). Symptoms are severe. Symptoms do not lessen after 72 hours. Otitis media recurs frequently. Some experts say that children age 6 to 23 months with acute otitis media that is in only one ear and is not severe and older children can start treatment with or without antibiotics. If antibiotics are not used initially, they are given if the child is worse or does not feel better after 48 to 72 hours have passed since symptoms began. Pain relief is important.Acetaminophenor nonsteroidal anti-inflammatory drugs (NSAIDs), such asibuprofen, can relieve pain. Adults may be given decongestant nasal sprays containing medications such asoxymetazolineor decongestants taken by mouth such aspseudoephedrine. Antihistamines are useful for people who have allergies but not for those with colds. Decongestants and antihistamines are not helpful for children and may cause bothersome and possibly dangerous side effects, particularly in children younger than 2 years. If a person has severe or persistent pain and fever and the eardrum is bulging, myringotomy may be done. For this procedure, an opening is made through the eardrum to allow fluid to drain from the middle ear. The opening, which does not affect hearing, usually heals without treatment. People who have repeated bouts of otitis media may need to have drainage tubes (tympanostomy tubes) placed in their eardrums (see figure). During a myringotomy, doctors make a small opening in the eardrum to allow fluid to drain from the middle ear. Then they place a tiny, hollow plastic or metal tube (tympanostomy tube, or ventilating tube) in the eardrum through the opening. These tubes balance the pressure in the environment with that in the middle ear. Doctors recommend ventilating tubes for some children who have had recurring ear infections (acute otitis media) or recurring or persistent collections of fluid in their middle ears (chronic serous otitis media). Placement of ventilating tubes is a common surgical procedure that is done in a hospital or doctor’s office. General anesthesia or sedation is usually required. After the procedure, children usually go home within a few hours. Antibiotic ear drops are sometimes given after the procedure for about a week. The tubes usually come out on their own after about 6 to 12 months, but some types stay in longer. Tubes that do not come out on their own are removed by the doctor, sometimes under general anesthesia or sedation. If the opening does not close on its own, it may need to be closed surgically. Children with ventilating tubes may wash their hair and go swimming, but some doctors recommend children do not submerge their head in deep water without using earplugs. Drainage of fluid from the ears indicates an infection, and the doctor should be notified. 