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Not All Ear Infections Require Antibiotics | The Survival Doctor

Ear Infection Decision Making

Key Question: Is It an External Ear Or Middle Ear Infection?

External ear infections are likely caused by bacteria. Middle ear infections are probably caused by a virus, but sometimes they’re from bacteria. Those are the ones the guidelines are about.

Why is it important to know the cause? Ideally, you don’t want to take antibiotics if you don’t have to because of antibiotic resistance. But if you do need them and don’t take them, an untreated bacterial ear infection can cause hearing loss or, rarely, a potentially deadly mastoiditis (skull-bone infection) or meningitis (brain-membrane infection).

External Ear Infections

External infections develop in the ear canal somewhere between the eardrum and the outer ear. They occur at any age but more in adults. Swimmer’s ear is one example, but you don’t have to be a swimmer to get an external infection. You can get one any time the ear is irritated or its wax mixes with water (causing a great medium for bacteria).

Signs? Suspect an external ear infection if you can reproduce the pain or make it worse by moving the ear. If you grab your ear and pull on it, or you push on the front of the ear, it doesn’t take much to cause a good deal of pain.

Is it serious? It can become very serious if the infection ever spreads to adjacent bone, so you need to always treat it.

Treatment? Antibiotic eardrops are the best. If you don’t have them, oral antibiotics work but take longer. If you have a mild infection or don’t have the antibiotics, you can try using a few drops of white vinegar mixed with a couple of drops of rubbing alcohol. Use the drops every four hours while awake for a week. (Learn more about oral antibiotics and how to get them here.)

Prevention? Avoid irritating the ear, causing wax buildup, and letting water sit in the canal. So: Don’t stick anything in your ear except a clean, wet cloth. In most people, the little hairs along the ear canal move the wax gradually out. Cotton swabs irritate the canal and can pack the wax in so far that it the hairs can’t help it get out. Earplugs can do the same. If you go swimming, you can help dry your ears out with a couple of drops of rubbing alcohol.

If the wax does get clogged up, I have a post on how to remove it.

Middle Ear Infections

People of any age can get middle ear infections as well, but they’re more common in children. These are the type you usually get after a cold or the flu. The infection is behind the eardrum. They’re the ones that are usually viral and have the guidelines.

Below is a summary of those guidelines, from the American Academy of Pediatrics, for health-care providers on treating middle-ear infections. Remember, if you start antibiotics, it’s important to keep them up for ten days (three to five with azithromycin) so you can kill off all the bad bacteria. If you don’t, the next ear infection may be resistant to the very antibiotic that has worked in the past. Also be sure to always read the package insert for dosage, directions, side effects, precautions, interactions with other meds, etc.

  • If you suspect an ear infection in a baby under six months old—the baby suddenly starts crying for no apparent reason, pulling at the ears, etc.—give antibiotics. The guidelines suggest amoxicillin at 90 mg per kg every twenty-four hours. Give in divided doses of 45 mg per kg every twelve hours or 30 mg per kg every eight hours. If there’s a penicillin allergy, you can give an alternative, such as erythromycin, azithromycin, or sulfa.
  • If the child is six months to two years old and there’s a certain diagnosis, give antibiotics. (Unless you’re a health-care provider and have the proper equipment, a certain diagnosis is going to be difficult to make.)
  • If you don’t have a definitive diagnosis and the person is over six months old, you have some options:
    1. If the symptoms are severe (moderate to severe pain, or a fever over 102): give antibiotics.
    2. If the fever is 102 or less, and the ear pain is mild: Wait and see if the person gets better. This is best done in cooperation with your doctor. Start antibiotics only if the symptoms get worse or are not gone in forty-eight to seventy-two hours.

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What Else Can You Do?

There are some things you can do to help the bacteria drain out of the middle ear.

If you go back to the anatomy of the ear photo, you’ll see that the Eustachian tub runs from the middle ear to an opening high up in the throat. It drains fluid that accumulates in the middle ear. It’s also the source of most middle ear infections. The virus or bacteria travels into the ear from the throat.

Many times with infections, the Eustachian tube gets irritated and swollen, and the fluid from the middle ear can’t drain out. Ways to make it drain and hence to help clear the ear infection are to take a decongestant for a few days, use a humidifier, and gargle with warm water every few hours.

What About the Pain?

With any ear infection, the pain’s a big factor. Many times, it’s the major factor.

Take your favorite over-the-counter analgesic, such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). If you have prescription numbing drops, now’s the time to use them.

Placing something warm over the ear may help, as can putting a few drops of warm oil in the ear. Garlic or mullein oil is supposed to be a good choice. Just make sure the drops are not too hot.

Oh, there’s one other thing to look for because it’ll need antibiotics right away.

>> Next: Warning signs of one dangerous infection


Ear diagram by jacquichris on Flickr.