How to treat pediatric ear infections

I get asked medical questions periodically (I like being able to put my knowledge to use and to help friends and family when I can. I got all this schooling under my belt . . . it’s nice to be able to put it to tangible use every once in a while). Anyway, one of the questions that comes up from time to time is what should be done for an infant with an ear infection.

The American Academy of Pediatrics just updated the clinical practice guidelines (April 2013 update, last published in 2004). Admittedly, this is a somewhat esoteric post. When I was in medicine, I was an ENT (head and neck surgeon), and I still tend to find ENT topics interesting. If you are a parent of an infant or toddler (or if you ever will be a parent), at some point, this may be relevant.

The appropriate treatment of infant/toddler ear infections (also referred to as otitis media, OM, or otitis) very briefly is as follows:

  1. For mild unilateral otitis (pain/discomfort, where the infant pulls at his or her ears, fever less than 102 degrees, mild-to-moderate ear drum inflammation as seen by a physician) – treat with acetaminophen (aka Tylenol) or ibuprofen (aka Advil or Motrin) for pain. Trials have shown that antibiotics have little benefit in speeding recovery or producing benefits in these cases.
  2. For severe otitis, (bilateral infection, fever > 102 [39degrees Celsius], severe bulging of the ear drum seen by a physician, or symptoms lasting longer than 48 hours), antibiotics are appropriate. Amoxicillin is the recommended first choice.
  3. “Ear tubes” (surgery to make an incision in the ear drum with small plastic tubes to keep the incision open): Surgery is recommended for recurrent OM, defined as three bouts of otitis in a six-month time frame or four bouts in one year. Of note, the ear tubes generally come out spontaneously after several months, by which time the process of getting a little older makes toddlers more resilient and resistant to these infections.

There is no single rule that fits all cases. Medicine is an art as well as a science. In mild cases,especially when observation is appropriate, it’s important that parents have good access to follow-up care.

sources: The Diagnosis and Management of Acute Otitis Media (American Academy of Pediatrics); A Placebo-Controlled Trial of Antimicrobial Treatment for Acute Otitis Media (NEJM); Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years (British Medical Journal);  A randomized, double-blind, placebo-controlled noninferiority trial of amoxicillin for clinically diagnosed acute otitis media in children 6 months to 5 years of age (British Medical Journal)

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