Middle ear infection (otitis media) - Treatment 

Treating middle ear infection 

Most cases of middle ear infection (otitis media) will clear up within 72 hours without the need for treatment.

You can relieve your child’s symptoms of earache and high temperature using over-the-counter painkillers such as ibuprofen and paracetamol.

Aspirin should not be given to children under 16 years of age.

Placing a warm flannel or washcloth over the affected ear may also help relieve pain.

Antibiotics

The routine use of antibiotics to treat ear infection is not recommended because:

  • there is no evidence they speed up the healing process
  • many middle ear infections are caused by viral infections so antibiotics are often ineffective
  • every time you use antibiotics to treat a non-serious infection it increases the likelihood of bacteria becoming resistant to it, meaning more serious infections could become untreatable (read more about antibiotic resistance)

Antibiotics are usually only recommended if:

  • your child has a serious health condition that makes them more vulnerable to infection such as cystic fibrosis or congenital heart disease
  • your child is under the age of three months
  • your child’s symptoms show no signs of improvement after four days

If antibiotics are needed, then a five day course of an antibiotic called amoxicillin is usually prescribed. This is usually given as a liquid suspension which your child has to drink.

Common side effects of amoxicillin include:

If your child is allergic to amoxicillin, alternative antibiotics such as erythromycin can be used.

Adults who develop a long-term middle ear infection (chronic suppurative otitis media) may benefit from antibiotic ear drops.

Additional treatment

Additional treatment is usually only needed if your child has frequent, reoccurring middle ear infections. These treatments are outlined below.

Grommets

For children with recurrent, severe middle ear infections, tiny tubes may be inserted through the eardrum to help drain fluid. These tubes are called grommets or tympanostomy tubes.

A grommet insertion is performed under general anaesthetic (where the patient is unconscious). It usually only takes about 15 minutes, so your child should be able to go home the same day.

As the ear recovers from the effects of the infection it will slowly push the grommet tube outwards and it will eventually fall out of the ear.

This process happens naturally and should not be painful.

Most grommets will fall out from 9 to 15 months after being inserted. Around one child in three will need further grommets.

Myringotomy

A myringotomy is a surgical procedure where the surgeon makes a tiny cut into the eardrum.

This can help relieve pressure on the middle ear and allows the surgeon to drain away excess fluid inside the middle ear.

In some cases a myringotomy may then be followed with a grommet insertion.


Page last reviewed: 23/04/2012

Next review due: 23/04/2014

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Xylitol

Some research has shown that consuming syrup or chewing gym containing xylitol reduces the incidence of acute middle ear infections in children.

Xylitol is a substance found in some trees, fruits and vegetables, and is used as a sweetener instead of sugar. It seems to stop bacteria growing in the mouth.

A recent study found children who took xylitol five times a day, on a daily basis, had less ear infections than their peers.

But a practical consideration is that it is probably unrealistic for younger children to remember or want to take so much xylitol on a daily basis.

Also gum may not be suitable for younger children because of the potential risk of choking.

Clinical trials looking at whether a more concentrated type of xylitol syrup could be effective when taken on a less frequent basis, are ongoing.

Medicines for children

Not all medicines are suitable for children. Find out what to use to treat your sick child