How to Treat Ear Infections

An ear infection, also known as otitis media, is a common issue among infants and young children, although it can also occur in adults. Almost 90% of children will experience at least one ear infection before the age of three. The infection causes pain as fluid builds up and puts pressure on the eardrum. Many cases of ear infections resolve on their own with home remedies, but more severe cases or those involving young children may require prescription antibiotics for a full recovery.

Recognize the most vulnerable groups for ear infections. In general, children are more prone to ear infections than adults. This is because their Eustachian tubes (the passage connecting the middle ear to the throat) are smaller and more prone to fluid buildup. Children also have weaker immune systems compared to adults, making them more susceptible to viral infections like the common cold. Anything that blocks the Eustachian tubes can lead to an ear infection. Other risk factors for ear infections include:

• Allergies
• Respiratory infections such as colds and sinusitis
• Enlarged adenoids or issues with the adenoid tissue (located at the top of the throat)
• Exposure to cigarette smoke
• Excessive drool and saliva, such as during teething
• Living in cold climates
• Changes in altitude or weather
• Not being breastfed as an infant
• Recovering from illness
• Attending daycare, especially with a high child-to-caregiver ratio

Recognizing Symptoms of Middle Ear Infections. Middle ear infections (acute otitis media) are one of the most common types of ear infections caused by viruses or bacteria. The middle ear is the space just behind the eardrum, which contains small bones that transmit vibrations to the inner ear. When fluid accumulates in this area, bacteria and viruses can invade and cause inflammation. Ear infections often follow respiratory illnesses like the flu, though severe allergies can also contribute. Symptoms of a middle ear infection include:

• Ear pain
• A feeling of fullness in the ear
• Feeling unwell
• Nausea
• Diarrhea
• Hearing loss in the affected ear
• Tinnitus (ringing in the ear)
• Dizziness
• Ear discharge
• Fever, especially in young children

Distinguishing Between Middle Ear Infection and Swimmer's Ear. Swimmer's ear, also known as otitis externa, is an infection of the outer ear canal caused by bacteria or fungi. Humidity is a common culprit for this type of infection (which is why it's called swimmer's ear), but scratching or inserting foreign objects into the ear can also lead to infection. Initial symptoms may be mild, but they often worsen over time. Symptoms include:

• Itching in the outer ear canal
• Redness in the ear
• Discomfort that worsens when pulling or pressing on the outer ear
• Ear discharge (initially clear and odorless, but may progress to pus)
• More severe symptoms include:
  • A feeling of fullness and blockage in the ear
  • Hearing loss
  • Severe pain radiating to the face and neck
  • Swelling of lymph nodes in the neck
  • Fever

Identifying Ear Infection Signs in Children. Young children may exhibit different symptoms of ear infections compared to older children and adults. Since young children cannot express their pain, look for the following signs:

• Pulling or scratching at their ears
• Fussiness, irritability, or constant crying
• Difficulty sleeping
• Fever (especially in infants and toddlers)
• Ear discharge
• Clumsiness or difficulty with balance
• Hearing problems

When to Seek Immediate Medical Attention. Most ear infections can be treated at home, and many cases will resolve on their own. However, if you or your child experience any of the following symptoms, it's important to contact a doctor immediately:

• Blood or pus draining from the ear (may be white, yellow, green, or pink/red)
• High fever that lasts, especially above 39°C (102.2°F)
• Dizziness
• Stiff neck
• Tinnitus (ringing in the ear)
• Pain or swelling behind or around the ear
• Ear pain lasting longer than 48 hours

Take Your Baby to the Doctor If They Are Under 6 Months Old. If you notice any signs of an ear infection in an infant, it’s crucial to seek medical attention immediately. Babies at this age have an underdeveloped immune system and are much more susceptible to infections, requiring antibiotics right away.

• Avoid home remedies for infants and young children. Always consult a pediatrician for the most appropriate care.

Visit the Doctor for an Ear Examination. If you suspect you or your child has a severe ear infection, prepare for the examination as follows:

• The doctor will inspect the eardrum with an otoscope. It can be tricky to keep a child still during the examination, but it is an essential step to determine whether the child has an ear infection.
• The doctor will check for blockages or fluid in the middle ear using an otoscope and a puff of air to test the eardrum's movement. If there is fluid, the eardrum will not move as freely, indicating an infection.
• A tympanometer may be used to measure sound and air pressure to check for fluid in the middle ear.
• If the infection is chronic or severe, the doctor may test the ear’s hearing capacity to assess possible hearing loss.

Prepare for a Thorough Eardrum Examination in Case of Chronic or Persistent Infection. If you or your child are feeling unwell due to an ear issue, the doctor may decide to create a small incision in the eardrum to drain fluid from the middle ear for testing.

Remember That Many Ear Infections Can Be Treated at Home. Most ear infections resolve on their own. Some infections may clear up in a few days, and most will resolve within 1-2 weeks without treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a ‘wait and see’ approach with the following guidelines:

• For children aged 6 to 23 months: Wait and monitor if the pain is mild in one ear for less than 48 hours and the fever is below 39°C.
• For children over 24 months: Wait and monitor if the pain is mild in one or both ears for less than 48 hours and the fever is below 39°C.
• If the symptoms persist beyond 48 hours, you should consult a doctor. Antibiotics may be prescribed to prevent the infection from spreading and to reduce the risk of rare, life-threatening infections.
• Severe and rare complications can include mastoiditis (infection of the bones around the skull), meningitis, brain infections, or hearing loss.

Be Cautious When Flying with a Child Who Has an Ear Infection. Children with ear infections are at higher risk of experiencing barotrauma, the pain caused by the middle ear trying to adjust to pressure changes. Chewing gum during takeoff and landing can help alleviate this discomfort.

• If flying with an infant who has an ear infection, it is recommended to feed the baby a bottle during takeoff and landing to help balance the pressure in their middle ear.

Over-the-Counter Pain Relievers. You can take ibuprofen or acetaminophen if the pain doesn’t subside on its own or if no other symptoms appear. These medications can also help reduce fever in your child, providing them with some comfort.

• Never give aspirin to children under 18, as it is associated with Reye's syndrome, which can cause brain and liver damage.
• When giving pain relievers to children, use age-appropriate children's health supplements as directed, or consult your pediatrician.
• Do not give ibuprofen to babies under 6 months old.

Warm Compresses. Applying a warm compress can help alleviate pain from an inflamed ear. You can use a warm, damp washcloth for this purpose.

• Fill a clean sock with rice or beans, tie or sew it shut, and microwave it for 30 seconds to reach the desired temperature. Then, apply the warm compress to the affected ear.
• You can also use salt as a natural remedy. Heat a cup of salt, wrap it in a cloth, and secure it with a rubber band. Lie down and place the warm salt pouch on the affected ear for 5-10 minutes, as long as it’s bearable.
• Apply the warm compress for 15-20 minutes at a time.

Get Plenty of Rest. Your body needs rest to recover when dealing with an ear infection. Make sure not to overexert yourself, especially when dealing with a fever.

• Pediatricians do not generally recommend keeping a child home from school due to an ear infection unless they have a fever. However, it’s important to monitor your child and ensure they get enough rest when needed.

Stay Hydrated. It's especially important to drink plenty of fluids when you have a fever.

• The Institute of Medicine recommends that men drink at least 13 cups (3 liters) of water, and women drink at least 9 cups (2.2 liters) of water daily.

Try the Valsalva Maneuver if There is No Pain. The Valsalva maneuver can be used to open the Eustachian tube and relieve the feeling of 'blockage' that can occur with a middle ear infection. Only use this technique if your ear is not in pain.

• Take a deep breath and close your mouth.
• Pinch your nose shut. While keeping your nose pinched, gently exhale through your nose.
• Do not blow too hard, as this can damage the eardrum. You should hear a ‘pop’ sound in the ear.

Use Warm Mullein or Garlic Oil Drops in Your Ear. Mullein and garlic are natural antibiotics that can help soothe ear pain. If you don't have garlic oil, you can make it at home by heating two garlic cloves with 2 tablespoons of mustard or sesame oil until the mixture darkens. Let the oil cool, and then use an eye dropper to place 2-3 drops of the warm oil (never too hot) into each ear.

• You should always consult a doctor before using this treatment on children.

Consider Natural Remedies. Research shows that a natural herbal remedy called Oticon Otic might help reduce pain associated with ear infections.

• Always consult your doctor before trying this remedy. Never use alternative treatments on young children without first consulting a pediatrician.

Carefully Monitor Your Ear Condition. Take regular temperature readings and watch for any other symptoms.

• If the fever increases or if you observe flu-like symptoms such as nausea or vomiting, this could indicate that the infection is worsening and home treatments may not be effective.
• Symptoms that warrant a visit to the doctor include confusion, neck stiffness, swelling, pain, or redness around the ear. These symptoms may indicate that the infection is spreading and requires immediate treatment.

Watch for a sudden severe ear pain followed by relief. This may be a sign of a ruptured eardrum. A ruptured eardrum can lead to temporary hearing loss and make the ear more susceptible to infections, worsening the condition.

• In addition to the pain disappearing, there may be drainage from the ear.
• Although a ruptured eardrum often heals within a few weeks without treatment, lingering issues may require medical attention or treatment.

Call your doctor if the pain worsens within 48 hours. While most doctors recommend a 'wait and see' approach for 48 hours, if the pain intensifies during that time, you should contact your doctor. They may decide to initiate stronger treatments or prescribe antibiotics.

Have your hearing tested if fluid buildup in the ear persists for 3 months. This condition could indicate more serious hearing problems.

• Occasionally, hearing loss may occur temporarily, which is particularly concerning for children under the age of 2.
• If your child is under 2 and experiences fluid buildup in the ear along with hearing issues, the doctor may begin treatment immediately without waiting for 3 months. Hearing problems at this age can affect speech development and lead to other complications.

Take antibiotics as prescribed by your doctor. Antibiotics are ineffective against ear infections caused by viruses, which is why doctors do not always prescribe them. However, all children under 6 months of age are treated with antibiotics.

• Inform your doctor about the last time you used antibiotics and the type you took. This will help the doctor select the most effective treatment for you.
• Be sure to complete the full course of antibiotics as prescribed to prevent the infection from returning.
• Do not stop taking antibiotics just because you feel better until you have finished the full prescribed course. Stopping antibiotics prematurely can lead to antibiotic resistance in the remaining bacteria, making the infection harder to treat.

Ask your doctor for a prescription for ear drops. Ear drops like antipyrine-benzocaine-glycerin (Aurodex) can help relieve ear pain caused by an ear infection. However, doctors will not prescribe ear drops for someone with a ruptured or perforated eardrum.

• To administer ear drops to a child, first warm the solution by placing the bottle in warm water or holding it in your hand for a few minutes. Lay the child down on a flat surface with the affected ear facing up. Use the recommended dosage. Keep the child’s head tilted for about 2 minutes with the painful ear facing upward.
• Since benzocaine is a numbing agent, it's best to have someone else administer the drops for you. Avoid letting the dropper touch the ear.
• Benzocaine may cause mild itching or redness. It can also be associated with a rare but serious condition affecting blood oxygen levels. Never exceed the recommended dosage, and always consult a pediatrician to ensure the correct dose for your child.

Consult your doctor about ear tubes if you have recurring ear infections. Recurrent middle ear infections may require a procedure called ear tube placement. Recurrent infections are defined as occurring three times in the past six months or four times in the past year, with at least one episode occurring in the past six months. If the ear infection persists after treatment, ear tube placement may be necessary.

• Ear tube surgery, or tube placement, is an outpatient procedure. The surgeon will insert small tubes into the eardrum to allow fluid behind the eardrum to drain more easily. The eardrum usually heals after the tubes fall out or are removed.

Consult your doctor about the possibility of an adenoidectomy to remove swollen lymph tissue. If you frequently experience swollen adenoids – tissue located behind the nasal cavity – you may require surgery to remove them.

Keep up to date with vaccinations. Many serious infections can be prevented through vaccination. Seasonal flu and pneumococcal vaccines can help reduce the risk of ear infections.

• You and your family members should get the annual flu vaccine. This will help prevent infections in your household.
• Experts recommend the pneumococcal conjugate vaccine PCV 13 for young children. Consult your pediatrician for advice.

Keep your child's hands, toys, and play areas clean. Regularly wash your child's hands, toys, and play surfaces to reduce the risk of infection.

Avoid giving your child a pacifier. Pacifiers can serve as a breeding ground for bacteria, including those that can lead to ear infections.

Breastfeed instead of using a bottle. Babies tend to leak more when bottle-fed than when breastfed, which increases the chances of bacteria spreading.

• Breast milk also boosts your child's immune system, helping them fight off infections more effectively.
• If you must use a bottle, make sure to hold your baby in a sitting position so that milk flows downward, not into their ears.
• Never offer a bottle when your baby is drowsy or as a way to soothe them to sleep at night.

Reduce exposure to secondhand smoke. This helps prevent ear infections and is also crucial for your overall health and safety.

Avoid overusing antibiotics. Long-term use of antibiotics can lead to some bacteria becoming resistant to certain medications. Only use antibiotics when prescribed by a doctor, or when no other options are available.

Avoid sending your child to daycare, or take extra precautions. In places like daycare centers, the risk of ear infections increases by 50% due to the higher likelihood of bacterial and viral infections spreading.

• If you must send your child to daycare, teach them skills to avoid spreading illnesses like colds that can lead to ear infections.
• Teach your child not to put toys or fingers in their mouth, avoid touching their face, especially areas with mucous membranes such as the mouth, eyes, and nose. They should also wash their hands before eating and after using the bathroom.

Follow a healthy diet, including probiotics. Eating a variety of fresh fruits, whole grains, and lean proteins will help keep your body strong and healthy. Studies have shown that beneficial bacteria like probiotics can protect the body from infections.

• Acidophilus is a well-researched probiotic that can be found in many types of yogurt.