This is the season not only for colds, flus, and COVID infections, but we also have that nagging visitor that often comes after these meddlesome infections. Acute otitis media, aka the notorious ear infection, is an infection of the middle ear and is so common that it tops the list of emergency visits as the second most common pediatric diagnosis in the emergency room.
Who should be concerned about this? Both adults and children can have ear infections, but this is most commonly seen between the ages of 6 and 24 months. Most kids will have had an ear infection in their lifetime before age 5, but adults are also susceptible to ear infections. Ear infections can be caused by a viral infection, a bacterial infection, or both.
What Symptoms Are Common in Ear Infections?
- Ear pain
- Fever
- Fussiness and irritability (children)
- Rubbing or tugging at an ear (children)
- Difficulty sleeping
When Should You Go to the Doctor?
- Presence of a fever of 102.2 or higher
- Pus, discharge, or fluid coming from the ear
- Worsening symptoms
- Symptoms of a middle ear infection lasting more than 2-3 days
- Hearing loss
What Could Happen If an Ear Infection Goes Untreated?
- Perforation of the tympanic membrane (think fluid leaking out of the ear)
- Inflammation of the bone behind the ear (mastoiditis)
- Other structural inflammation that can cause vertigo symptoms (dizziness, nausea, etc.)
- Meningitis
- Brain abscess
- Hearing loss (important for infants and young children to be treated to avoid speech and hearing problems)
- The list goes on…
How Does a Caldwell Family Medicine Clinic Diagnose an Ear Infection?
Whether you are new to a doctor’s office or not, providers evaluate the ear using a device called an otoscope to look at the outer and middle ear structures. An exam is typically all that is needed to make the diagnosis of having a middle ear infection. There may be times when other tests or tools are needed- we would need to refer you to a specialized provider called an otolaryngologist to have them use their special tools to evaluate further in these types of scenarios.
Treating an Ear Infection
So how do we treat it? Great question! Because of the risk of complications, if your provider has determined that this is likely related to bacteria versus a virus (cold, flu, RSV etc.) - you will be treated with high-dose amoxicillin. If you have an allergy to amoxicillin or penicillins, an alternative will be given based on evidence-based practice guidelines. We may also implement something called “watchful waiting”, meaning we wait for the infection to resolve on its own without using antibiotics—usually 2-3 days.
However, if the symptoms worsen or do not show improvement in those 2-3 days, then the provider will prescribe an antibiotic to treat the infection due to the risk of prolonged middle ear fluid and its effect on both hearing and speech development. Fortunately, the American Academy of Pediatrics provides guidelines on when a child should receive antibiotics and when observation is better depending on the child’s age, severity of the infection, and their temperature.
In addition to antibiotics, we will also recommend over-the-counter medications to relieve pain and inflammation, such as ibuprofen and acetaminophen (Tylenol). Steroids and antihistamines have not been shown to show significant benefits when treating ear infections. If there is no improvement, we ask the patient to follow up to have the ear evaluated further. Otherwise, the treatment results are typically excellent when the antibiotics are taken in their entirety for the full length of time recommended.