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Nov 16, 2023

Ear Infection Treatment: Rest, Ear Drops, Antibiotics

Ear infection treatments can vary based on which part of the ear is infected.

Ear infection treatments can vary based on which part of the ear is infected. This includes middle ear infections (otitis media), which cause inflammation in the air-filled space behind the eardrum, and outer ear infections (otitis externa), which cause inflammation in the external ear canal.

Although earache is the primary symptom of both middle and outer ear infections, the underlying cause can differ. The treatment will depend largely on whether the cause is viral, bacterial, or fungal and may involve pain medications, antibiotics, eardrops, or watchful waiting. Some cases can be treated with home remedies, while severe cases may require ear tubes to help drain fluids.

This article describes the various treatments for ear infections, including what to expect and what can be done if the treatments fail to clear the symptoms.

Illustration by Brianna Gilmartin, Verywell

Middle ear infections often heal on their own without treatment. The same may be true for outer ear infections, but they generally take longer and are more likely to require treatment. The differences are due to how each type of infection develops.

Otitis media is more common in children than adults. Most cases are caused by an upper respiratory tract infection (URTI) like a cold or flu that causes the eustachian tube (the passageway connecting the middle ear to the back of the throat) to swell and fill with fluid.

Children are more often affected because their immune systems are less developed. Their eustachian tubes are also smaller and more horizontal, making it harder to drain fluid from the ear. Because of this, they can have recurrent infections, sometimes as many as four or five per year.

URTIs associated with middle ear infections are typically viral. These include rhinoviruses (the most common cause of colds), influenza virus (the flu), and respiratory syncytial virus (RSV). More often than not, the ear infection will clear once the viral URTI runs its course.

As a result, most middle ear infections don't need specific treatment and will usually clear within three to five days.

Otitis externa can affect both children and adults. It is popularly known as swimmer's ear because water remaining in the ear after swimming creates the ideal environment for bacteria or fungi to grow. The infection can also occur when a foreign object such as a cotton swab or ear plug introduces bacteria into the ear canal.

Because the moisture in the ear canal encourages bacterial and fungal growth, it often takes a while for the immune system to control the infection.

Without treatment, it can take several weeks rather than days for an outer ear infection to clear. The problem with this is that, when left untreated, the persistent inflammation can cause permanent narrowing of the ear canal and hearing loss.

Many middle and outer ear infections can be treated quickly and effectively at home. This includes home remedies and over-the-counter (OTC) medications used to relieve inflammation, pain, and swelling.

Many healthcare providers will take a watchful waiting, or watch-and-wait, approach with a middle ear infection, delaying antibiotics for two to three days to see if the infection clears on its own. Since kids often have recurrent infections, this helps lower the risk of antibiotic resistance (when pathogens like bacteria learn to defeat the drugs designed to kill them) caused by antibiotic overuse.

The at-home treatment of otitis media is mainly focused on pain relief. Given that most cases start as a URTI like a cold or flu, the treatment may include:

Never give aspirin to children because it can cause a rare but potentially deadly reaction called Reye's syndrome. Cough and cold medicines are generally avoided in children under 4 years unless recommended by a healthcare provider.

In addition to OTC medications, rest and plenty of fluids can help resolve the underlying URTI.

Additional home remedies that can help include:

The treatment of swimmer's ear primarily involves ear drops. Several OTC options either acidify the ear canal (making it hostile to bacteria or fungi) or dry the ear canal (removing the moisture that promotes bacterial or fungal growth).

Options include:

Ear drops are usually applied three or four times daily for five to seven days. Instructions vary, so speak with your pharmacist or healthcare provider to ensure you are using them correctly.

Some people also swear by homeopathic ear drops containing belladonna (Atropa belladonna) or wolfsbane (Aconitum napellus), both of which are popularly used to treat earaches.

In addition to ear drops, OTC pain relievers like Tylenol, Advil, or Aleve can help ease ear pain.

Oral antibiotics may be prescribed for middle ear infections that do not resolve on their own. Antibiotic or antifungal ear drops may be used to treat outer ear infections, while corticosteroid (steroid) ear drops can help ease inflammation and pain.

According to guidelines from the American Academy of Pediatrics, a watchful-waiting approach is preferred in most children with acute otitis media. This is because four out of five children with otitis media will get better without antibiotics.

Antibiotics are typically reserved for:

In such cases, the recommended first-line treatment is high-dose Amoxil (amoxicillin) prescribed as follows:

Middle ear infections in adults are less common but often more serious due in part to underlying risk factors (like smoking or compromised immunity) that give rise to complications like mastoiditis (a type of skull bone infection) and permanent hearing loss.

Because of this, otitis media in adults is more often treated with antibiotics than not. The recommended treatment is Augmentin (amoxicillin and clavulanate) taken every 12 hours for 10 days.

Although otitis externa can often be treated with OTC ear drops, prescription ear drops may be needed for the infection. These are often prescribed for people who have swelling and obstruction of the ear canal.

Antibiotic ear drops used for otitis externa are sometimes combined with a corticosteroid like hydrocortisone that helps ease inflammation. Options include:

If the infection is confirmed to be caused by a fungus, it can be treated with a 1% clotrimazole solution available over the counter. Prescription antifungal options include:

In most cases, you will need to use the ear drops for 10 to 14 days.

If there is ear swelling that blocks the ear canal, your healthcare provider may need to insert a tiny sponge into your ear canal called a wick. Applying the drops to the wick allows the medicine to be drawn into the ear canal beyond any areas of inflammation. Ear wicks can be left in place for two to three days and replaced with fresh ones if needed.

You should avoid using ear drops—particularly over-the-counter ear drops—if you think you have a ruptured eardrum. Symptoms include sudden hearing loss, ear pain, ringing in the ears, ear drainage, and vertigo (spinning sensations).

There are ear drops like Floxin Otic that can be prescribed if your eardrum is punctured, but these should only be used under the direction of a healthcare provider. Other ear drops can be toxic to the middle ear, injuring the hearing bones (ossicles) as well as the eustachian tube.

In an ideal situation, an ear infection will clear on its own or with a short course of medications. But this is not always the case, and some acute infections can resist treatment and become chronic.

An ear infection is considered acute if it lasts for up to six weeks and chronic if it recurs three times or more in a six-month period or four times a year.

Depending on the symptoms, there are several ways a healthcare provider can deal with a chronic ear infection.

If a middle ear infection does not respond to treatment, a tympanostomy tube (ear tube) may be needed to drain fluids and promote healing. These are typically used for people with recurrent middle ear infections or a long-lasting complication called serous otitis media in which fluid remains in the middle ear even after the infection has cleared.

Tympanostomy tubes improve hearing and also prevent recurrent infections and the overuse of antibiotics.

Tympanostomy tubes are placed under local anesthesia using a thin scope (called a transcanal endoscope) that directs the placement of the 2-millimeter tube in the eardrum. Once inserted, the tube is left in place until it falls out on its own, usually within four to 18 months. The hole will usually close on its own.

Mastoiditis is a rare bone infection usually caused by severe untreated otitis media or otitis externa. It affects part of the skull called the mastoid bone located just behind the ear. Symptoms include ear pain, fluid discharge, hearing loss, and a visible swelling behind the ear.

Mastoiditis is a serious condition that often requires repeated or long-term treatment, This typically starts with intravenous (IV) antibiotics (delivered into a vein) followed by a course of oral antibiotics.

If the antibiotics do not work, a surgery called a mastoidectomy may be used to drain fluids by removing part of the mastoid bone. Ear tubes are also frequently part of the treatment plan.

Rarely, an outer ear infection can spread into the floor of the ear canal and the bones of the base of the skull. This happens most often in people with a weakened immune system, including those with diabetes or who are undergoing chemotherapy.

Symptoms include ongoing drainage from the ear, ear pain, trouble swallowing, and weakness of the facial muscles. The infection can damage bones, tissues, and nerves and is life-threatening. It requires hospital admission and intravenous antibiotics, followed by long-term antibiotics and monitoring.

Ways to reduce the risk of ear infections in you or your child include:

The treatment of an ear infection will vary by the location and underlying cause of the infection. Middle ear infections (otitis media), most common in children, often clear on their own. Infections that are severe or don't clear may require antibiotics. Children under 6 months are commonly treated whether symptoms are severe or not. While middle ear infections in adults are less common, they can be more severe and, more often than not, require antibiotic treatment.

Outer ear infections (otitis externa), common in adults and children, are mainly treated with ear drops. These include over-the-counter ear drops that are mildly acidic or reduce moisture in the ear canal. Outer ear infections may require prescription ear drops containing an antibiotic, antifungal, or corticosteroid drug.

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By James Myhre & Dennis Sifris, MDDennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.