Melissa Arca: Ear pain doesn't always require an antibiotic

03/07/2013 12:00 AM

03/06/2013 1:54 PM

Aside from the usual cough, runny noses and congestion, an ear infection (or worry that their child might have one) is one of the most common reasons parents take children in to see the doctor. Pain from a congested or infected ear can be quite intolerable for children and can keep them (and their parents) up at night.

Most ear infections (approximately 70 percent of them) will resolve on their own without the use of antibiotics. Both viruses and bacteria can cause middle ear infections (acute otitis media).

The typical scenario goes like this: Runny nose, low-grade fever, cough and congestion last for a few days; child seems to get better, then out of nowhere the fever spikes again and the child is holding his ear in pain.

Most ear infections pop up after a few days of battling an upper respiratory infection (the common cold). Of course, there are those children who are simply prone to them during childhood, and for those children prevention and prompt diagnosis, treatment and potentially referral to a specialist are in order.

So if we know that in most healthy children, ear infections will spontaneously resolve without antibiotic intervention, what are parents and health care providers to do when faced with a child having ear pain and a diagnosis of a middle ear infection?

First and foremost, treating the pain will be the best treatment your child receives. So, say "yes" to acetaminophen and/or ibuprofen to ease that throbbing ear as you and your child's doctor come up with an action plan.

Fortunately, the American Academy of Pediatrics recently released new and updated guidelines (based on years of research) to assist health care providers and parents in diagnosing, treating and preventing acute ear infections in children. Most of us know by now that judicious and conservative use of antibiotics is a plus. There's less risk of allergic reactions, less hassle in trying to get a 3-year-old to take her daily medicine, less stomach upset and less potential for resistance and growth of "superbugs."

Here's what parents need to know:

Not all ear-tugging or pain is an ear infection. Ears can hurt for a variety of reasons. If your child is battling a cold, the presence of fluid behind the ear can put pressure on the tympanic membrane (eardrum) and cause intermittent pain without it truly being infected.

Your child's doctor will need to use an otoscope (that "flashlight" we use to look in your child's ear) to see the eardrum clearly. Bulging of that membrane more than anything is the most reliable predictor of an ear infection. Add severe pain and presence of fluid behind that eardrum, and your child's doctor will be fairly certain that your child has an ear infection requiring antibiotic intervention.

So when your child's doctor insists you come in for an ear check, he is not trying to waste your time. He is trying to do what is best for your child by being certain of the diagnosis before prescribing unnecessary antibiotics.

Waiting may be an option. For some children diagnosed with an ear infection, you may be able to skip the antibiotics altogether. Children older than age 2, with mild ear pain and soft signs of an ear infection may benefit from the wait-and-see approach.

Offer pain control and see what happens over the next 48-72 hours. Stay in close contact with your child's health care provider. Some will ask your child to come back in for a quick recheck or give you a prescription in case your child's symptoms don't improve. Whatever plan you and your child's doctor come up with, feel good about giving your child's body a chance to fight off that infection without having to commit to a 10-day course of antibiotics.

You'll be getting antibiotics if your child 6 months to 2 years of age has a double ear infection. Expect a prescription and follow-up in two weeks. Also, don't forget about the pain control. If your child has severe ear pain, fever over 102 degrees and/or a ruptured eardrum (in which case there is fluid draining from your child's ear), expect a 10-day course of antibiotics.

If ears and eyes are both affected, one scenario is worth mentioning: If your child ends up with pink eye (the bacterial kind) and an ear infection; treatment with Augmentin (instead of the usual, Amoxicillin) is in order to successfully treat the ear. Eye drops will be needed too.

Prevention is a huge part of the picture. Avoid exposing your child to secondhand smoke, make sure they are vaccinated, breastfeed your babies for the first year of life if possible, and do your best to treat any underlying medical condition such as seasonal allergies.

Working as a team, you and your child's pediatrician should be able to handle those ear infections with ease and confidence whether antibiotics are part of the package or not.

Dr. Melissa Arca is a mother of two. Her blog,, is featured on The Bee's blog and community news network,


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