Treating Ear Infections
By James Donovan, MD
An infection in the space behind the eardrum is called otitis media - otherwise known as an ear infection. It can cause significant pain and fever or be completely asymptomatic. Otitis media accounts for the vast majority of office visits.
Ear infections occur most commonly in the middle ear. It is important that the middle ear contain air that is of the same pressure as the outside ear so that the eardrum can vibrate. To equalize the pressure there is a valve called the eustacean tube that runs from the middle ear to the back of the throat near the adenoids. When the pressure is not equal air travels through the eustacean tube and "pops" the ears.
Because the tissue of the eustacean tube is like that of the nose, anything that can cause swelling of the nose can cause swelling of the eustacean tube and close it off so that no air can travel to relieve the pressure. Children get more infections because their eustacean tubes are smaller and it takes very little swelling to close them off. Colds, allergies, tobacco smoke and other irritants increase the swelling and set children up for infection. Heredity is also a factor, as we tend to have the same anatomy as our parents.
Most earaches can be treated at home with warm packs, plenty of fluids, rest and lots of love. For pain, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) work well if one follows the recommended dosing on the bottle. If your child or you are not showing improvement over 3-5 days or symptoms are worsening including increased pain, fever (temperature greater than 100.3 by any measurement) or drainage from the ear, a physician should be consulted.
Your physician may elect to treat the infection with antibiotics. There are a wide variety of antibiotics available, and your physician will chose one based on the likely bacteria present, previous experience with you and within the community, and other factors such as convenience and your insurance formulary. A decongestant may be prescribed to try to shrink the swelling of the eustacean tube and decrease the fluid in the middle ear. Ear drops may be given for pain relief or antibiotic drops if the eardrum has ruptured. Your physician may elect just to observe the infection or not use antibiotics if it is viral.