Community Q & A
1. When should antibiotics be administered?
- Acute ear infection (Acute otitis media – AOM)
Antibiotics [LINK] should always be given to children less than 6 months of age with an acute ear infection. For children 6 months or older antibiotics should be given for an acute ear infection with severe symptoms (severe ear pain and/or fever 102.2F or higher) and to children with an ear infection that develops acute drainage from the ear. This indicates that the eardrum has perforated. Antibiotics should also be given to children 6 months to 2 years for an ear infection with non-severe symptoms in both ears (mild ear pain and/or fever less than 102.2F). For children 2 years or older with non-severe symptoms, treatment with antibiotics or observation without antibiotics and close follow-up can be offered. Children that are observed without antibiotics should be re-evaluated and placed on antibiotics if their symptoms get worse or do not improve. It is important for the physician to emphasize that the child should take all medication as prescribed. The child should have a follow-up in 4 weeks for a re-examination of the ears.
- Pain management is very important in the treatment of acute ear infections
Over the counter medications like acetaminophen and ibuprofen are effective at managing the fever and/or pain often associated with ear infections.
- Persistent fluid in the ear (otitis media with effusion – OME)
Antibiotics are not recommended for persistent fluid in the ear. The fluid is not infected. The fluid may stay in the ear after an acute ear infection or may develop during a cold. Most children do not have complaints about ear problems and the fluid usually goes away spontaneously within 3 months. However, some children may have complaints about mild discomfort, pressure, feeling of fullness in the ear, hearing loss, and/or imbalance or clumsiness. If the fluid stays in the ear for 3 months or longer a hearing test should be done. If the hearing is normal and the child has no complaints, a follow-up in 3 to 6 months is recommended. However, if the child has hearing loss, speech-language delay, and balance concerns, or is a child “at-risk” the child should be seen for a re-evaluation sooner.
2. Who is “at-risk” for acute ear infections and persistent fluid in the ear?
- At-risk groups include children with hearing loss; speech or language delays; poor school performance; balance problems; behavior problems; cleft palate; unusual face shape or skull bones; blindness; autism spectrum disorder; developmental disorders and/or other special needs such as Down syndrome. These groups may be more likely to develop acute ear infections and/or persistent fluid in the ear. These children should be monitored with hearing testing regularly to assess the need for medical or surgical treatment
3. When is surgery necessary?
- Acute otitis media
Children with frequent ear infections (3 or more in 6 months, or 4 or more in 12 months) and fluid in the ear should be examined for possible surgery. It should be noted that for children with frequent ear infections without fluid in the ear, tubes are not recommended
- Persistent ear fluid
A child with persistent ear fluid for 3 months or longer and documented hearing loss, speech and language delay, balance concerns, or a child “at-risk” should be evaluated for surgery.
The most common procedure is called myringotomy and tube placement [LINK] which involves making a small cut in the eardrum and placing a very small tube in the opening of the eardrum to keep it open. The tube drains the fluid and lets air into the ear, which improves hearing. The child is under anesthesia during this procedure, which only takes less than 10 minutes. Tubes are usually placed in both ears. The child is seen back in clinic 4-6 weeks after surgery, at which time a hearing test is done. The child is then re-evaluated every 6-12 months. Any child with a tube or perforation in the eardrum can develop an ear infection, which consists of pus draining from the ear through the tube, sometimes with mild discomfort. The drainage is usually treated with drops.
4. Are water precautions needed for children with tubes?
- Most children are back to normal activity within a day of surgery. In regards to water activities, earplugs are not needed for most children with tubes as water usually does not go through the tubes. Exceptions are for pain/discomfort from water in the ears; frequent or prolonged drainage from the ears; swimming more than 6 feet under water; swimming in lakes or non-chlorinated pools; or dunking the head in the bathtub (soapy water has lower surface tension and can enter ear tubes more easily).