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When deciding on a course of treatment your doctor will consider a number of factors, including age, the type, severity, and duration of the infection, the frequency of ear infections in the medical history, and whether the infection has resulted in hearing impairment. Most of the time, the human immune system can fight off and heal ear infections with a bit of time (usually two to three days). The fact that most ear infections can actually clear up on their own has led a number of physician associations to support the "wait-and-see" approach, which essentially means administering pain relief but not treating the infection with antibiotics. The American Academy of Pediatrics and the American Academy of Family Physicians recommends the "wait-and-see" approach for children from six months old to two years old who experience ear pain in one ear and for children over two years who have pain in one or both ears for less than two days and have a temperature of less than 102.2F (39C). Many doctors support this approach because of the limitations of antibiotics, including the fact that they are often overused and have lead to the proliferation of antibiotic-resistant bacteria. In addition, antibiotics can't treat an infection caused by a virus. If the infection does not go away on its own, your doctor will likely prescribe a 10-day course of antibiotics, which can treat the infection and potentially shorten some symptoms. Commonly prescribed antibiotics include Amoxicillin as well as Zithromax (the latter case if you are allergic to penicillin). Antibiotics are often prescribed for individuals who suffer from frequent infections or for those with severe and extremely painful infections. In most cases, the antibiotics clear any fluid in the ear. For children ages six and up who have a mild to moderate infection as determined by the doctor's assessment, a shorter course of antibiotic treatment (five to seven days instead of 10) may be prescribed. Even if symptoms improve partway through the course of antibiotic treatment, make sure to finish the full prescription. If you are prescribed enough for 10 days, take the antibiotics for 10 days. However, you should notice improvement within 48 hours. A persistent high fever (of over 100F or 37.8C) suggests resistance to that particular antibiotic and you may need to acquire a different prescription. Ear surgery may be an option in cases of prolonged ear fluid (when fluid exists for more than three months after an infection has cleared up or in the absence of any infection), recurrent OME (three episodes in six months or four episodes in a year with at least one occurring in the past six months), or frequent ear infections that don't clear up through antibiotics. The surgery, called a myringotomy, involves draining the fluid from the middle ear and inserting a ventilation tube. Usually, you will need to be referred to an ENT to determine whether this surgery is appropriate. In this outpatient surgery, an ENT specialist will surgically place the tympanostomy tube into the eardrum through a small incision. The process should help ventilate the ear, prevent the buildup of more fluid, and allow existing fluid to drain completely from the middle ear. Some tubes are intended to stay in place for six months to two years 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. In this surgery, the small glands in the throat at the back of the nose (the adenoids). This is sometimes an option in cases of recurrent or persistent problems with the ears. The Eustachian tube runs from the ear to the back of the throat and is met by the adenoids. When inflamed or swollen (due to a cold or sore throat) the adenoids can press on the entrance of the Eustachian tubes. Moreover, bacteria on the adenoids can sometimes spread up into the tubes, causing infection. In these cases, problems and blockages in the Eustachian tubes lead to ear infections and fluid buildup. In this surgery, more common in children whose adenoids are larger and thus more likely to cause problems, an ENT specialist removes the adenoids through the mouth while the patient is under anesthetic. In some hospitals, the adenoidectomy is done as a day surgery, meaning that you can go home the say day. In other cases, surgeons like to keep the patient in hospital overnight for supervision.
Be aware that there is no single best approach for treatment. Follow the "wait-and-see" approach. Take antibiotics if your doctor prescribes them. Undergo a myringotomy if your doctor recommends it. Discuss having an adenoidectomy with your doctor.