Understanding Otitis Media - Treatment

How Do I Know If I Have Otitis Media?

If you or your child has an earache accompanied by a stuffy or runny nose and a sore throat and fever, it is likely that the problem is otitis media. Your doctor will most likely examine the eardrum with an instrument called an otoscope for signs of infection - not an easy task if the patient is a fussy infant. The doctor may also check for blockage of the middle ear using a pneumatic otoscope, which blows a little air at the eardrum. This air should cause the eardrum to move back and forth. If fluid is present or the canal is blocked, the eardrum will not move as readily.

Another test is tympanometry, which uses sound and air pressure to check for fluid in the middle ear. If needed, an audiologist will perform a hearing test to determine if there is hearing loss.

To check for a bacterial infection, a doctor may, on rare occasions, make an opening in the eardrum, draw out a sample of fluid from the middle ear, then culture the sample in a laboratory. This more extreme measure is usually used only for serious or particularly stubborn infections.

What Are the Treatments?

The goal of most doctors and therapists is to rid the middle ear of infection before more serious complications set in. Treatment usually involves eliminating the causes of otitis media, killing any invading bacteria, boosting the immune system and reducing swelling in the eustachian tubes.

Conventional Medicine

Otitis media is often caused by a viral infection, in which case the only relief doctors can offer is treatment of the symptoms. This may involve trying to reduce swelling in the eustachian tubes with a decongestant, such as pseudoephedrine, and an antihistamine, possibly diphenhydramine. (Note: Antihistamines will not cure otitis media, and they may cause minor side effects, including drowsiness and nervousness.)

To ease the pain, your doctor may recommend a pain reliever, typically acetaminophen or ibuprofen, which also helps reduce a fever. Aspirin should be avoided in children because of the threat of Reye's syndrome.

A controversy surrounds the use of antibiotics in treating bacterial middle ear infections. Some physicians initially treat only the symptoms of otitis media, without the help of bacteria-killing drugs. Studies have shown that the majority of otitis media cases will get better when treated this way. Other research, in fact, suggests that many otitis media cases are viral in origin and therefore will not respond to antibiotics.

But many doctors, particularly in the U.S., are concerned that without antibiotics, bacteria lurking inside the middle ear can grow out of control, possibly causing a serious complication such as hearing loss or mastoiditis. After all, they point out, these complications have become rare, largely as a result of antibiotic therapy. To be on the safe side, many American physicians treat all otitis media cases as if bacteria were present.