Ear Infection and Middle Ear Fluid (Otitis Media) Patient Education Handout associated with UMHS Clinical Care Guideline

This information is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your physician or make an appointment to be seen if you have questions or concerns about this information or your medical condition.

Otitis Media Diagram

What is otitis media?
Otitis media means that your child has fluid behind his or her ear drum.  There are two kinds of otitis media:

• Acute Otitis Media (AOM), which means that the fluid is causing pain or fever
• Otitis Media with Effusion (OME), which means that the fluid is not causing pain

The treatment your doctor recommends will depend on which type of otitis media your child has.

For AOM, treatment is aimed at reducing symptoms.  This means treating pain with ibuprofen (Motrin or Advil) or ear drops such as Auralgan. Antibiotics can sometimes be helpful, but most of the time, AOM goes away without antibiotic treatment.

What causes otitis media? 
Otitis media is caused by a blockage of the tube (called the Eustachian tube) that connects the middle ear to the nose. When this tube is blocked, fluid collects behind the ear drum.  Sometimes bacteria will grow in this fluid, and sometimes that will cause pain.  However, about a third of the time, there is no bacteria.  These cases are probably caused by viruses.  Otitis media is more common in the winter and in children in day care. Sometimes children get otitis media after catching a cold.  Getting water in the ear does not cause otitis media.

How do antibiotics help otitis media?
Antibiotics are only helpful in some cases of AOM.  Most cases of AOM go away without antibiotics. The main outcome of antibiotics is to reduce pain and fever 2-3 days after starting them.  Depending on age and symptoms, most children with AOM will improve 3 days after starting antibiotics.  In some cases children treated with antibiotics for ear infections end up getting severe infections with antibiotic resistant bacteria.  For these reasons, doctors try to save antibiotics for those children most likely to benefit—young children and children with fever or severe ear pain.  In most cases, treating with a pain medicine is more helpful than treating with an antibiotic.  If there is no pain or fever (OME) there is no advantage of treating otitis media with antibiotics.

What happens if my child is not treated with antibiotics?
If your child’s symptoms are mild, your doctor might offer you “the Observation Option.”  Your doctor will recommend giving your child pain medicine and ask you to wait a few days for the symptoms to go away.  If the symptoms continue for 3 more days, your doctor would want you to call to get a prescription for an oral antibiotic.  There is no long term negative impact of putting off antibiotics in children with mild symptoms.

What antibiotic is the best for treating my child?
When antibiotics are needed, amoxicillin is almost always the best choice.  It is more effective, safer, and less expensive than any other oral antibiotic.  However, like all antibiotics, it would be expected to “fail” 10-20% of the time.  It is unclear why this is, but probably many of the ear infections that do not respond to amoxicillin were caused by viruses.  If your child still has symptoms 72 hours after starting amoxicillin, your doctor will want to check your child again to make sure that the symptoms are actually caused by the ear infection.  Your doctor might then change your child to a different  antibiotic.  Even in these cases amoxicillin should still be the first antibiotic chosen for future episodes of AOM.  If your child gets a diaper rash after taking antibiotics, you can treat it with an antifungal cream such as clotrimazole or miconazole (ask your pharmacist).  It is probably a good idea to feed your child yogurt with active cultures during and after treatment with antibiotics.

What happens after the symptoms go away?
Once the acute symptoms are gone, the name we use for the ear fluid changes from AOM to OME.  Sometimes middle ear fluid can occur without any known AOM.  In most cases, this fluid goes away within 3 months.  Your doctor might want to recheck your child to make sure the fluid is gone. Usually this fluid does not cause problems, but it can cause a mild hearing loss. If your child seems to not be hearing well or seems to be ignoring you, you can help by doing some of the following things:

1. Reduce distracting background noise (the TV or radio) when you are talking to him or her.
2. Speak directly to your child using a louder voice than usual. Use good eye contact and make sure your child understands what you are saying.  Use gestures to help explain what you mean.
3. Spend at least 15 minutes each night sitting with your child reading a book.

If you have any questions about your child’s hearing or speech development, ask your doctor or call 1-800-EARLY ON to get a free developmental evaluation.

What else can be done?
The pneumococcal conjugate vaccine (Prevnar) and the flu vaccine can both reduce the risk of recurrent ear infections.  Avoid pacifiers and bottle propping. Older children can chew gum containing the sugar “xylitol”.  Giving antibiotics to children with colds does not prevent ear infections.  It only makes them harder to treat.

If your child is having problems with many ear infections or prolonged OME with behavior or language problems, your doctor can refer you to an otolaryngologist, who is a specialist in the care of ear problems.  The otolaryngologist might suggest putting tubes in the ear drum to let ear fluid come out.

March 2007