Ear infections account for almost 30 million visits to a doctor every year. We all have either experienced ear pain ourselves, or been woken up in the middle of the night with a crying child in pain from an ear infection. As time goes on, we are understanding more about these infections and how they should best be treated.
An external ear infection, or otitis externa, is a problem of the ear canal. Usually these are infections caused by bacteria, but sometimes they can be a fungal infection as well. It presents with pain, swelling, and sometimes drainage from the ear. Studies have shown time and again that the best treatment, above all, is cleaning out the ear to get rid of all the debris and using antibiotic ear drops. The ear is cleaned out best under the microscope in our office. Oral antibiotics not routinely necessary in this case, since you get a much higher concentration of the medicine if you use the drops, and avoid the side effects.
A middle ear infection, or otitis media, is a problem of the middle ear, which is the area behind the ear drum. In this case, fluid builds up behind the ear drum and can cause pressure and pain. This infection is most common in children, since their ears don’t “pop” as well as adult’s and they are more prone to getting colds. Although severe infections can lead to complications and should be treated with antibiotics, we are now learning that mild cases can be watched.
There have been several well done studies where children were treated with either an antibiotic or a placebo for a mild ear infection. It seems that antibiotics are not necessary in every case, as most children recovered from their infection just fine either way. The most important things the studies found though were close observation was essential, meaning a physician should be able to follow up if they child isn’t improving, and above all, pain medication was the most important thing a child needed.
In certain cases, such as a very young child, high fevers, ear infections in both ears, or no improvement over a certain amount of time, antibiotics are still the way to go. As we learn more and more about the side effects of antibiotics and the dangers of using them too much, we are all making an effort to be more careful. In the end, the decision on how to best treat these conditions is a shared one between the physician and the patient/their family.