Ear Pain – Earache Treatment, Inner Ear Pain Treatment

Ear Pain - Earache Treatment

Ear Pain (Earache)

People may think that earaches are just a minor nuisance, but they can cause debilitating pain. While waiting for medical care or for antibiotics to work, some home remedies can help.

Ear pain can feel unbearable, making it difficult to sleep, eat, or do anything but think about the pain. Many children find it particularly difficult to deal with an earache. People who are experiencing severe ear pain should always speak to a doctor, especially for the first time. However, there are remedies that people can use at home to relieve less severe earaches, or as a means of reducing pain.

This article explores nine effective home remedies that may help people experiencing ear pain.

What Is Ear Pain?

Ear pain, also known as Earache, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.

Most causes of ear pain are non-life threatening. Primary ear pain is more common than secondary ear pain, and it is often due to infection or injury. The conditions that cause secondary (referred) ear pain are broad and range from temporo mandibular joint syndrome to inflammation of the throat.

Most people assume earaches and ear pain happen only to children, but they can also happen to adults. An earache may affect one or both ears, but the majority of the time it’s in one ear. Ear pain may be dull, sharp, or burning, and it may feel constant or come and go.

Pain in the ear can have multiple causes. It can be an early sign of colds, flu, or infection. If you have an ear infection, fever and temporary hearing loss may occur.

In general, the reason for ear pain can be discovered by taking a thorough history of all symptoms and performing a physical examination, without the need for imaging tools like a CT scan. However, further testing may be needed if red flags are present like hearing loss, dizziness, ringing in the ear or unexpected weight loss.

Management of ear pain depends on the cause. If there is a bacterial infection, antibiotics are sometimes recommended and over the counter pain medications can help control discomfort.  Some causes of ear pain require a procedure or surgery.

83% of children have at least one episode of a middle ear infection by three years of age.

Babies and Children

Earaches and ear pain in children are a fact of life for parents and are one of the most common reasons they call their pediatrician after hours. Experts estimate that 3 out of 4 babies develop ear infections, when fluid in the middle ear builds up and inflammation develops, but diagnosing the exact cause can be challenging.

Young children and babies who have ear infections tend to be fussy and irritable. They may also cry and tug at or rub their ears. Other signs of earaches in babies include trouble sleeping, waking at night, fever, clumsiness, and difficulty hearing. Very rarely, earaches in children can result in hearing loss.

Temporary Ear Pain

Many people experience ear pain and mild hearing loss or muffling due to sudden changes in air pressure, such as traveling on an airplane or riding on an elevator. While disconcerting, this kind of ear pain is temporary and rarely leads to lasting hearing problems. Try chewing gum or swallowing for quick ear pain relief.

Excessive earwax that builds up in the ear canal can also cause pressure and pain in the ear. But that old saying that you should never stick anything smaller than your elbow into your ear still holds true: People who try to clean wax from their ears with cotton swabs or other objects can inadvertently damage the eardrum and push the wax farther back into the ear, making it harder to remove. Excessive earwax should be diagnosed and treated by a healthcare professional.

What is a Ruptured Eardrum?

People who experience intense ear pain accompanied by clear or bloody fluid from the ear may have a ruptured eardrum. Ruptured eardrums can be caused by injuries to the head and neck area, changes in air or water pressure — from going scuba diving, for example — inner ear infections, and less commonly by being around loud noises.

A ruptured eardrum is a hole or perforation in the membrane that separates the inner and outer ear. Ruptured eardrums can be very painful and may result in temporary or permanent hearing loss, but they usually heal on their own.

Ear Pain and Other Conditions

Chronic ear pain in adults can also be associated with related conditions, including tinnitus, a ringing or buzzing in the ear that affects about 1 in 5 people.

Some ear pain comes from a “referred source,” meaning the sensation of pain is felt in the ear but originates elsewhere in the body, such as the brain, jaw area, or throat. Though it’s rare, ear pain can also be caused by structural changes in the jaws or teeth. People with damage to or disorders of the temporomandibular joint (TMJ), which connects the jaws, can feel pressure or fullness, or experience tinnitus.

How to Prevent Ear Pain

To prevent ear pain, avoid smoking and exposure to secondhand smoke, and allergy triggers like dust and pollen, all of which can irritate your sinuses and cause earaches.

People at risk for ear pain should avoid loud music, concerts, and environmental noise, such as banging construction. If you can’t avoid loud noises, it’s worth investing in a good pair of earplugs or noise-canceling headphones.

Keep all foreign objects out of the ear and, if you swim, wear earplugs and a bathing cap. Always take time to carefully dry your ears after swimming, showering, or bathing.

Causes

Ear infections are the most common cause of ear pain. When the ear becomes infected, inflammation and buildup of pressure cause pain that can be intense.

People with ear infections often have other symptoms, such as sinus pressure or a sore throat because infections from nearby areas may affect the ear. An ear infection can also be a standalone condition. Most ear infections are bacterial, not viral.

Only a doctor can diagnose an ear infection. People should not take antibiotics without a prescription, or assume that symptoms are due to an ear infection.

Common causes of earaches and ear pain include:

  • Ear infection
  • Changes in air pressure, such as when flying on a plane
  • Earwax buildup
  • A foreign object in the ear
  • Strep throat
  • Sinus infection
  • Shampoo or water trapped in the ear
  • Use of cotton swabs in the ear

Less common causes of earaches include:

  • Temporomandibular joint (TMJ) syndrome
  • Perforated eardrum
  • Arthritis affecting the jaw
  • Infected tooth
  • Impacted tooth
  • Braces on teeth
  • Eczema in the ear canal
  • Trigeminal neuralgia, or chronic facial nerve pain

However, earaches are not always caused by an ear infection. Other conditions can also cause pain in the ear.

Those include:

  • Referred pain: This may be from infections or inflammation elsewhere in the body. For example, a toothache may cause aching pain in the ear.
  • Chronic conditions: These include temporomandibular joint (TMJ) dysfunction.
  • Skin infections: If they are in or around the ear.
  • Allergic reactions: These could be from a range of things, such as soap, shampoo, or earrings.
  • Water: This may cause pain if trapped in the ear.
  • Pressure: Changes in altitude can affect pressure in the ears. This usually resolves on its own, often with a popping sensation.

If left untreated, ear infections can spread to the jaw and other regions of the body. They may also damage the ear itself and can cause dangerously high fevers.

When symptoms of an ear problem are present and do not resolve on their own within a day or two, people should speak to a doctor. If the pain is intense, is accompanied by a high fever, or includes hearing loss, people should seek medical attention immediately.

Causes of Earaches

The ear has many parts to it, and each may cause ache, pain or other discomfort. Pain may come from one or many parts of the ear, depending on the situation.

Causes of Outer Earaches

The helix and auricle form the outer part of the ear cartilage and may become inflamed and infected. Inflammation may be due to many reasons including:

  • Skin infection or cellulitis
  • Sunburn
  • Chronic skin irritations, like atopic dermatitis
  • Trauma. An injured auricle is a common wrestling injury. If a hematoma (bruise/blood clot) forms, it can be very painful and may cause damage to the underlying cartilage, resulting in a cauliflower ear.
  • The ear canal may be a source of pain due to infection or trauma.

Causes of Swimmer’s Ear (Otitis Externa) Earache

Otitis externa is inflammation of the ear canal, and is often referred to as “swimmer’s ear.”

  • Irritation to the skin that lines the canal may be due to minor trauma, like trying to clean ear wax with a sharp object and causing a scratch that becomes inflamed or infected.
  • swimmer’s ear describes inflammation caused by retained water in the ear canal. The dark, warm, moist area may promote bacterial growth and predispose to infection.
  • Cerumen (ear wax) impaction. Ear wax is part of the body’s protective mechanism to lubricate the ear canal and prevent infection. If the wax hardens and builds excessively, it may cause significant pain. This is especially true if the wax presses against the eardrum.
  • Foreign body. When a foreign body is inserted in the ear and cannot be removed, pain and inflammation may occur. These may include Q-tips, hairpins, and other narrow objects that are often used to scratch an itch or to remove ear wax. This is never safe, and nothing should be inserted into the ear canal. In addition to irritation of the external canal, the eardrum may also be perforated or damaged.

Causes of Middle Ear (Otitis Media) Earache

The middle ear is separated from the external ear canal by the eardrum, and this is the location of nerves involved with hearing. It is a relatively closed space and anything that increases pressure in the middle ear will cause pain.

  • Middle ear infections are a common cause of otitis media, especially in children. These are commonly caused by a virus or bacteria that invades and infects stagnant fluid in the middle ear.
  • Serious otitis media describes fluid collection within the middle ear and is usually due to Eustachian tube dysfunction. This is the tube that drains fluid and equalizes pressure between the middle ear and the back of the throat. Increased pressure may cause pain and fullness but usually resolves over time. However, this fluid may also become infected, causing pain and fever.

Causes of Inner Ear Earache

  • The inner ear is adjacent to the middle ear. The inner ear is the site of the labyrinth system that sends messages to the brain to help with balance. Inflammation of the inner ear is associated with vertigo but not necessarily pain.

Eardrum (Tympanic Membrane) and Earache

The eardrum, or tympanic membrane, separates the external ear canal from the middle ear. It vibrates when sound hits it and transmits that vibration to allow the sense of hearing. Myringitis describes inflammation of the eardrum.

  • Bullous myringitis causes inflammation and blistering of the tympanic membrane and can be very painful. Then infection may be due to bacteria, virus, or fungus.
  • Myringitis may be due to extension of an infection from the external canal or from the middle ear
  • Traumatic myringitis may occur from a direct injury like poking a sharp object into the ear canal.
  • Trauma may also cause increased pressure in the area of the eardrum, causing it to rupture. This may include a blow to the ear with the palm of the hand, change in air pressure within an airplane, an explosion or other situations in which air is forced into the ear canal.
  • Electrocution injury is often associated with perforation of the eardrum.

Other Causes of Earache or Ear Pain

Ear discomfort may be due to pain from a nearby structure that that radiates to the ear:

  • TMJ pain. The temporomandibular joint, where the jaw attaches to the skull, is located adjacent to the external ear canal, and inflammation of this joint may be associated with ear pain. TM joint pain may be due to trauma or arthritis. Teeth grinding may cause irritation and ear pain as well.
  • Sinusitis may be associated with increased pressure within the middle ear, causing pain.
  • Dental problems and toothaches may radiate pain to the ear area.
  • Mastoiditis. The mastoids are bony prominences of the skull filled with air cells and are located behind the ear. Infection of these areas may cause ear pain.
  • Pharyngitis (throat inflammation) and tonsillitis may cause pain that radiates to the ear. A peritonsillar abscess will often result in ear pain in addition to difficulty opening the mouth and difficulty swallowing.
  • Thyroid inflammation and carotid artery pain (carotidynia) may also be associated with ear pain
  • Trigeminal neuralgia. Inflammation of the fifth cranial nerve may cause significant facial pain including ear pain.
  • Tinnitus. While not truly pain, ringing in the ear may cause significant discomfort
  • Barotrauma describes an injury to the ear because of an acute change in pressure within the middle and inner ear. This may include changing pressures from flying in an airplane, scuba diving or snorkeling, or trauma due to a blast injury. Damage may occur to any or all of the eardrum, middle and inner ear.

Remedies

Nine home remedies for earache

If an earache is not severe, or if a person is waiting for medical treatment to take effect, they may wish to try home remedies to relieve pain.

Here are a series of nine effective home remedies for people experiencing ear pain:

1. Over-the-counter medication

Non-steroidal anti-inflammatory drugs (NSAIDs) can temporarily reduce the pain of an earache. People experiencing ear pain can try:

  • ibuprofen
  • acetaminophen
  • aspirin

These NSAIDs are available for purchase over the counter or online.

It is important to remember that it is not safe to give aspirin to babies and young children. This is because of the risk of a potentially life-threatening condition called Reye’s syndrome.

The U.S. Food and Drug Administration (FDA) recommends that parents speak to a doctor before giving over-the-counter drugs to a child under 2 years old.

These drugs can cause serious side effects in babies and young children. Note also that the dosage for children is often significantly lower than the proper dosage for adults.

2.Heat

Heat from an electric heating pad or hot pack can reduce inflammation and pain in the ear. A range of heating pads is available for purchase online.

Apply a hot pad to the ear for 20 minutes. For best results, people should touch the neck and throat with the hot pad.

The heating pad should not be unbearably hot. People should never fall asleep with a heating pad, or allow a child to use a hot pack without adult supervision.

3.Cold

A cold pack can help with the pain of an earache.

Try wrapping ice in paper towels or freezing a cold pack and then covering it with a light cloth. Hold this to the ear and the area immediately under the ear for 20 minutes.

The cold should not hurt, and parents should never apply ice directly to their children’s skin.

Some people find that heat offers greater relief than cold. For others, alternating hot and cold packs (20 minutes hot, followed by 20 minutes cold) provides the best pain relief.

4.Ear drops

Ear drops can reduce pressure in the ear caused by fluid and earwax. These are available for purchase over the counter or online.

People should read the directions carefully, and talk to a doctor before using ear drops on a child.

Ear drops are no substitute for prescription ear drops or antibiotics, so people should only use them for a few days. If symptoms return, people should see a doctor.

It is important to remember that people should not use ear drops in a child with tubes in their ears or whose eardrum has ruptured.

5.Massage

Gentle massage can help with ear pain that radiates from the jaw or teeth, or that causes a tension headache.

People can message the tender area, as well as any surrounding muscles. For example, if the area behind the ear hurts, try massaging the muscles of the jaw and neck.

Massage may also help with the pain of an ear infection.

  • Using a downward motion, apply pressure beginning just behind the ears and down the neck.
  • Continuing to apply pressure downward, work forward to the front of the ears.

This type of massage may help drain excess fluid from the ears and prevent the pain from getting worse.

6.Garlic

Eating a clove of garlic a day may help prevent ear infections.

Garlic has long been used in folk medicine to relieve pain. Some research suggests it has antimicrobial properties that can fight infection.

People should not use it as a substitute for antibiotics a doctor has recommended. Instead, consider adding garlic to an antibiotic regimen to speed up relief.

To prevent ear infections, try eating a clove of garlic each day.

Garlic ear drops may also reduce pain and prevent an infection from getting worse. Cook two or three cloves in two tablespoons of mustard or sesame seed oil until brown, then strain the mix. Then, apply a drop or two to each ear.

7.Onions

Like garlic, onions can help fight infection and reduce pain. Also like garlic, onions are not a substitute for medical attention.

Heat an onion in the microwave for a minute or two. Then, strain the liquid and apply several drops to the ear. A person may want to lie down for 10 minutes and then allow the liquid to flow out of the ear. Repeat this as needed.

8.Sucking

Sucking can help reduce pressure in the Eustachian tubes, offering some relief.

Babies who are nursing may feel better when allowed and encouraged to nurse as frequently as possible. Adults and children can suck on hard candy or cough drops.

9.Breast milk

Breast milk has antimicrobial properties. Some research suggests that a mother’s breast milk changes based on the microbes to which a baby is exposed.

This means that breast milk is most effective in babies. However, some sources suggest that breast milk may even help adults. Infants and children should continue nursing to get the most benefits from breast milk.

In nursing babies, as well as in children and adults, topical application of breast milk may also help. Even if it doesn’t, breast milk is unlikely to cause any serious side effects.

People can try dropping a few drops of breast milk in each ear, and repeat the application every few hours as needed.

Symptoms

Symptoms associated with ear pain depend on the underlying cause. Symptoms that may occur with otitis externa include ear redness, ear swelling, ear tenderness, and discharge from the ear canal. Additional symptoms that may occur with otitis media include fever, sinus congestion, hearing loss, dizziness, and vertigo — a feeling that the room is spinning.

An earache from an ear infection can be especially troublesome for children and babies.

Symptoms of ear pain include:

  • Babies appearing hot and irritable
  • Children pulling, tugging, or rubbing an ear
  • A high temperature, over 100.4 degrees Fahrenheit (38 degrees Celsius)
  • Poor feeding in babies, or loss of appetite in children
  • Sleep problems and restlessness at night
  • Coughing and runny nose
  • Not hearing as well as normal
  • Balance problems

The structures of the ear

  • Earache or ear pain may be due to infections and inflammation of the external, middle or inner ear as well as from structures that are located adjacent to the ear itself.
  • Earaches are a common symptom and may be due to a variety of illnesses.
  • Causes of earaches include Swimmer’s ear, middle ear infections, TMJ, infections, bullous myringitis, sunburn, dermatitis, and trauma.
  • Signs and symptoms associated an earache depend upon the cause, but may include:
    • Redness and swelling around the outer ear
    • Fever
    • Ear pain
    • Jaw pain
    • Sore throat
    • Itching
    • Draining
    • Ringing in the ears
    • Vertigo
  • Earaches often need urgent medical care, and maybe treated with natural home remedies, for example, warm compresses; OTC pain relievers like ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol and others); olive oil in the affected ear, and essential oils.
  • Medical care should be sought when there is fever, ear drainage, vertigo, loss of hearing or decreased hearing associated with ear pain.
  • Evaluation, diagnosis, and treatment of earache is usually done in the health-care professional’s office and little testing is needed.

Diagnosis

Your doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and an exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope.

Pneumatic horoscope

An instrument called a pneumatic horoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic horoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.

Additional tests

Your doctor may perform other tests if there is any doubt about a diagnosis, if the condition hasn’t responded to previous treatments, or if there are other long-term or serious problems.

  • Tympanometry. This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, which causes the eardrum to move. The device measures how well the eardrum moves and provides an indirect measure of pressure within the middle ear.
  • Acoustic reflectometry. This test measures how much sound is reflected back from the eardrum — an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect.
  • Tympanocentesis. Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis. The fluid is tested for viruses and bacteria. This can be helpful if an infection hasn’t responded well to previous treatments.
  • Other tests. If your child has had multiple ear infections or fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities.

What a diagnosis means

  • Acute otitis media. The diagnosis of “ear infection” is generally shorthand for acute otitis media. Your doctor likely makes this diagnosis if he or she sees signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if symptoms started relatively suddenly.
  • Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection.
  • Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, he or she has found that a long-term ear infection resulted in tearing of the eardrum. This is usually associated with pus draining from the ear.

Treatments

Treatment for ear pain depends on the underlying cause. It may include over-the-counter, age-appropriate painkillers, such as aspirin or ibuprofen (Advil, Motrin) for pain and fever. Treatment may also include warm compresses, acetaminophen (Tylenol), other nonsteroidal anti-inflammatory medication (NSAIDs), or a short course of narcotic pain medication.

Treatment for otitis media may include oral antibiotics, while treatment for otitis externa requires antibiotic eardrops. Your doctor may prescribe antibiotics for ear infections, although some research suggests antibiotics may not always be an effective treatment.

A pharmacist may be able to recommend over-the-counter eardrops for quick at-home ear pain relief. Olive oil, as well as some eardrops, may also help loosen earwax. Never use eardrops or olive oil if you suspect your eardrum — the membrane that separates the outer and middle parts of the ear — may have burst.

Holding a warm flannel or cloth-covered hot water bottle to the painful ear for around 20 minutes is one DIY form of treatment. But if an ear infection is suspected, avoid getting the inside of the ear wet.

In most cases, ear pain subsides without any treatment at all, but if it doesn’t go away, or is accompanied by other, more serious symptoms, you should see a healthcare provider — either your primary care physician or an otolaryngologist, a doctor who specializes in ear, nose, and throat disorders.

Which Home Treatments Help With Ear Pain?

Chances are you think of ear infections as something only kids get. It’s true that ear infections are less common ingrown children and adults, but they can still happen.

Thankfully, ear infections often go away on their own and don’t require medication. Still, it’s helpful to know how you can treat ear pain at home.

Treating earaches at home

You can take several steps at home to reduce earache pain. Try these options to ease the ear pain:

  • Apply a cold washcloth to the ear.
  • Avoid getting the ear wet.
  • Sit upright to help relieve ear pressure.
  • Use over-the-counter (OTC) ear drops.
  • Take OTC pain relievers.
  • Chew gum to help relieve pressure.
  • Feed an infant to help them relieve their pressure.

Medical treatment for earaches

If you have an ear infection, your doctor will prescribe oral antibiotics or eardrops. In some cases, they’ll prescribe both.

Don’t stop taking the medication once your symptoms improve. It’s important that you finish your entire prescription to ensure that the infection will clear up completely.

If a buildup of wax is causing your ear pain, you may be given wax-softening eardrops. They may cause the wax to fall out on its own. Your doctor may also flush out the wax using a process called ear lavage, or they may use a suction device to remove the wax.

Your doctor will treat TMJ, sinus infections, and other causes of earaches directly to improve your ear pain.

When to Call a Doctor

It’s important to know when your discomfort might be a sign of something more serious.

If you or your child has a persistent fever of 104ºF (40 ºC) or higher, seek medical attention. For an infant, seek medical help immediately for a fever higher than 101ºF (38ºC).

You should also seek immediate medical attention if you have severe pain that stops suddenly. This could be a sign of the eardrum rupturing.

You should also watch for other symptoms. If any of the following symptoms appear, make an appointment with your doctor:

  • severe ear pain
  • dizziness
  • bad headache
  • swelling around the ear
  • drooping of the facial muscles
  • blood or pus draining from the ear

You should also make an appointment with your doctor if an earache gets worse or doesn’t improve in 24 to 48 hours.

Preventing earaches

Some earaches may be preventable. Try these preventive measures:

  • Avoid smoking and exposure to secondhand smoke.
  • Keep foreign objects out of the ear.
  • Dry the ears after swimming or bathing.

Avoid allergy triggers, such as dust and pollen.

Call your doctor if:

  • You notice fluid (such as pus or blood) oozing out of your ear
  • You have a high fever, headache, or are dizzy
  • You believe an object is stuck in your ear
  • You see swelling behind your ear, especially if that side of your face feels weak or you can’t move the muscles there
  • You’ve had severe ear pain and it suddenly stops (which could mean a ruptured eardrum)
  • Your symptoms don’t get better (or get worse) in 24 to 48 hours

Things You Can Try

While research that says home remedies work for ear pain is scarce, most doctors agree these treatments are safe to try at home. Still, before you do, it’s a good idea to talk with your doctor.

Some options include:

A cool or warm compress. Soak a washcloth in either cool or warm water, wring it out, and then put it over the ear that’s bothering you. Try both temperatures to see if one helps you more than the other.

Olive oil drops. While there’s no scientific evidence that proves this treatment works, the American Academy of Pediatrics says it could be moderately effective on ear pain. Put a few drops of warm olive oil in the ear that’s giving you trouble, like you would use ear drops. Olive oil or ear drops should not be used in people who have ear tubes or a ruptured eardrum.

Try a pain reliever. Acetaminophen, ibuprofen, or naproxen can often relieve the pain of an earache. Ask your doctor which is right for you.

Chew gum. If you’re on an airplane or driving at high altitudes and your ear pain is from the change in air pressure, chew some gum. It can help lower that pressure and ease your symptoms.

Sleep upright. While it may sound strange, resting or sleeping sitting up rather than lying down can encourage fluid in your ear to drain. This could ease pressure and pain in your middle ear. Prop yourself up in bed with a stack of pillows, or sleep in an armchair that’s a bit reclined.

Some ear infections resolve without antibiotic treatment. What’s best for your child depends on many factors, including your child’s age and the severity of symptoms.

A wait-and-see approach

Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:

  • Children 6 to 23 months with mild middle ear 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 middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Some evidence suggests that treatment with antibiotics might be helpful for certain children with ear infections. On the other hand, using antibiotics too often can cause bacteria to become resistant to the medicine. Talk with your doctor about the potential benefits and risks of using antibiotics.

Managing pain

Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:

  • Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve pain. Use the drugs as directed on the label. Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin because aspirin has been linked with Reye’s syndrome. Talk to your doctor if you have concerns.
  • Anesthetic drops. These may be used to relieve pain as long as the eardrum doesn’t have a hole or tear in it.

Antibiotic therapy

After an initial observation period, your doctor may recommend antibiotic treatment for an ear infection in the following situations:

  • Children 6 months and older with moderate to severe ear pain in one or both ears for at least 48 hours or a temperature of 102.2 F (39 C) or higher
  • Children 6 to 23 months with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
  • Children 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Children younger than 6 months of age with confirmed acute otitis media are more likely to be treated with antibiotics without the initial observational waiting time.

Even after symptoms have improved, be sure to use the antibiotic as directed. Failing to take all the medicine can lead to recurring infection and resistance of bacteria to antibiotic medications. Talk with your doctor or pharmacist about what to do if you accidentally miss a dose.

Ear tubes

If your child has certain conditions, your child’s doctor may recommend a procedure to drain fluid from the middle ear. If your child has repeated, long-term ear infections (chronic otitis media) or continuous fluid buildup in the ear after an infection cleared up (otitis media with effusion), your child’s doctor may suggest this procedure.

During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear.

A tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the buildup of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.

The eardrum usually closes up again after the tube falls out or is removed.

Treatment for chronic suppurative otitis media

Chronic infection that results in a hole or tear in the eardrum — called chronic suppurative otitis media — is difficult to treat. It’s often treated with antibiotics administered as drops. You may receive instructions on how to suction fluids out through the ear canal before administering drops.

Monitoring

Children who have frequent infections or who have persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.

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