Treatment for middle ear infections (acute otitis media) involves home treatment for symptom relief. Antibiotics are prescribed in some cases.

If a child with an ear infection appears very ill, is younger than age 2, or is at risk for complications from infection, the doctor may prescribe antibiotics.

In children age 2 and older with simple ear infections, more options are available. Some doctors prescribe antibiotics for all ear infections because it's hard to tell which ear infections will clear up on their own. Other doctors ask parents to watch their child's symptoms for a couple of days, since more than 80% of ear infections get better without treatment. Antibiotic treatment has only minimal benefits in reducing pain and fever. The cost of medication and possible side effects are factors doctors consider before giving antibiotics. Also, many doctors are concerned about the growing number of bacteria that are developing resistance to antibiotics because of frequent use of antibiotics.

Follow-up exams with a health professional are important to check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections.

• If your child has ongoing ear pain, a fever [101 F or higher], or is grumpy or vomiting after 48 hours of treatment, see your health professional.
• Children younger than 3 should have a follow-up visit in about 4 weeks, even if they seem well. If fluid behind the eardrum persists for 3 months, the child should have his or her hearing tested.²

Initial treatment

The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess the child for risk of complications. If your child has an ear infection, does not seem very sick, and is not at risk for complications, your doctor may ask you to watch your child's symptoms for a couple days before deciding whether to give antibiotics.

If your child has an ear infection and appears very ill, is younger than 2, or is at risk for complications from the infection, your doctor may give antibiotics right away.

If your child's condition improves in the first couple of days, treating the symptoms at home may be all that is needed. Up to 80% of all ear infections get better without treatment. Some steps you can take at home to treat ear infection include:

• Using pain relievers. Pain relievers such as nonsteroidal anti-inflammatory medicines (such as Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol and Tempra) can help make your child more comfortable. Giving your child something for pain before bedtime is especially important. Do not give aspirin to anyone younger than 20 because its use has been linked to Reye's syndrome, a serious illness that needs emergency treatment.
• Applying heat to the ear, which may help relieve the earache. Use a warm washcloth or a heating pad. Do not allow your child to go to bed with a heating pad, because he or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
• Encouraging rest. Encourage your child to rest to let his or her body fight the infection. Arrange for quiet play activities.
• Using eardrops. Doctors often prescribe pain-relieving eardrops for earache. Don't use eardrops without a health professional's advice, especially if your child has ear tubes. For more information, see the safest way to insert eardrops.