The American Academy of Pediatrics and the American Academy of Family Physicians recommend a period of observation for 72 hours (3 days) after the onset of the first symptoms. 
During this time, the doctor does not prescribe antibiotics to see the evolution of otitis, but may recommend anti-inflammatoryor natural remedies. 
If symptoms improve within a few days, it is viral otitis and no antibiotic treatment is needed.

This practice is indicated in particular in the following cases:

  • Children 6 to 23 months of age with a mild earache  lasting less than 48 hours and no other symptoms.
  • Children over 24 months of age with mild ear pain and no severe symptoms.

The method of observation is not suitable for children:

  • They have a cochlear acoustic system,
  • Who suffer from recurrent otitis,
  • With malformations (eg palatóschisis).

Antibiotics for acute otitis media

According to the guidelines of the “American Academy of Family Physicians,” your doctor may recommend antibiotic treatment for ear infection in the following situations:

  • Children over 6 months of age with secretions, moderate or severe pain in one or both ears that lasted less than 48 hours or a fever of at least 39 ° C,
  • Children 6 to 23 months of age with bilateral otitis, although the symptoms are mild,
  • Children 6 to 23 months of age with unilateral otitis, with significant symptoms,
  • Children over 24 months of age with a strong in both ears for less than 48 hours.

Even after the symptoms have improved, we should take the antibiotic as prescribed by the doctor (usually for 5 or 10 days), otherwise you may have:

  • Recurrent ear infections,
  • The appearance of bacteria resistant to antibiotics .

Surgical operation for otitis media

The doctor may recommend surgery to drain (remove) fluid from the middle ear if the child has:

  • Recurrent otitis media – three episodes in six months or four episodes in one year, with at least one episode occurring in the last six months,
  • Chronic otitis media with a secretion that accumulates in the middle ear.

Drainage is performed by an outpatient surgical operation called myringotomy.


The surgeon:

  • It makes a microscopic incision in the membrane of the eardrum,
  • It inserts a small tube to drain the middle ear and prevent the accumulation of fluids,
  • The operation takes about 10 minutes and the patient returns home the same day (day-hospital),
  • Some of these small drainage tubes are meant to remain in place for six months, up to a year, then exiting the eardrum spontaneously.

Surgery is performed under general anesthesia.

Surgery for chronic otitis

In case of perforated eardrum with a significant decrease in the ability to listen, the surgeon can advise:

Simple tympanoplasty
This operation is done to repair a tympanic injury if there is no:

  • An infection of the middle ear,
  • The degeneration of the chain of ossicles of the ear.

This surgery closes the middle ear naturally and can improve hearing. 
The surgery is performed under local or general anesthesia. 
The surgeon uses a graft of tissue removed from the temporal muscle band to repair the injury. 
The patient:

  1. You can be hospitalized for one night,
  2. You can go back to work in a week.

Generally, healing times are about eight weeks.

Tympanoplasty with oxytoplasty
The operation is performed to:

  • Eliminate the infection,
  • Repair the eardrum,
  • Rebuild the chain of ossicles (hammer, anvil, and stirrup) using a cartilage graft.

This can improve hearing. 
Surgery can be performed on:

  1. Hospital-day,
  2. Hospital internment.

Anesthesia may be local or general. 
The surgeon makes an incision behind the ear or intervenes directly into the ear canal.



The mastoid process is a bony protuberance directly attached to the middle ear. 
There are important structures within the mastoid or adjacent ones, for example:

  1. The brain,
  2. The inner ear,
  3. The facial nerve.

Therefore, infections of this bone (mastoiditis) and also surgery are dangerous. 
A middle ear infection and cholesteatoma may extend to the mastoid process. 
Mastoidectomy is a surgery used to “clean” the mastoid bone, that is, the surgeon:

  • Remove o pus,
  • Removes infected bone tissue.

It is usually done along with tympanoplasty. 
To access the bone, the surgeon makes an incision behind the ear.


  • The patient may return home the day of surgery or the next day,
  • The total recovery time is 3 weeks.

Mastoidectomia radical

The purpose of this operation is to eliminate the infection without considering the auditory improvement. 
It is indicated for patients with very resistant infections. 
In some cases, to facilitate healing, a graft of:

  • Fat tissue,
  • Muscle,
  • Bone.

Radical mastoidectomy is performed under general anesthesia and the patient can be hospitalized for one night. 
The recovery time is about one to two weeks. 
For a complete cure, it can take up to four months.


Treatment for suppurative chronic otitis media

Often, this chronic infection occurs along with the perforated eardrum, therefore it is very difficult to treat. 
It is often treated with:

  • Ear cleansing: It is necessary to suck and drain the fluid properly into the ear canal.
  • Antibiotic in drops: apply after each wash and at night before bed.

Treatment for otitis in pregnancy

In the case of severe bacterial otitis, doctors may prescribe some antibiotics to relieve the symptoms of a middle ear infection or an infection of the inner ear during pregnancy. 
The doctor who prescribes these medicines should check whether it is safe for a pregnant woman.

Antibiotics for otitis media in pregnancy

Amoxicillin is an antibiotic that the doctor prescribes often for the treatment of ear infections also in pregnant women.

Amoxicillin (Amoxifar) is a type of penicillin and is often associated with clavulanic acid.

Doctors may prescribe other antibiotics in case of:

  • Patients allergic to penicillin,
  • Bacteria resistant to penicillin.

Among the antibiotics for otitis media in adults and children are also:

  • Macrolides: azithromycin (Zitromax),
  • Cephalosporins, for example cefuroxime (Zinnat).


Other medicines
For ear pain, your doctor may prescribe drops of anti-inflammatories, such as phenazone.

Natural Remedies for Otitis Media

These remedies are quite effective and help treat milder otitis. 
Here are some of these homemade treatments:

Nasal wash

This home remedy is crucial to rid your nose of the catarrh . 
This prevents mucus from moving from the nose to the ear. 
For children it is necessary:

  • A needleless syringe,
  • A cup of warm or warm water,
  • One teaspoon of coarse salt.

How to do the washing?

  • Dissolve the salt in the water.
  • Fill the syringe with this solution.
  • Tilt the child’s head to one side.
  • Pour salty water into the upper nostril with the syringe.
  • Wait for the water to come out of the lower nostril.



Press a hot water bottle or a hot salt bag against the ear.


Tea tree oil

The tea tree oil  has antibacterial properties, it can irritate the skin.

For this reason, it is advisable to mix:

  • 3 teaspoons of tea tree oil,
  • 2 teaspoons of olive oil,
  • 1 teaspoon of apple cider vinegar.

How to apply?

  • Put your head in a towel with the sick ear up,
  • Add a few drops of the mixture to the ear,
  • Leave on for 5 minutes,
  • Turn your head to let the mixture out,
  • Repeat 2-3 times a day for 2 days.

This essential oil is used to treat mild bacterial ear infections.



Garlic juice is a remedy that helps treat microbial ear infections.

  • Boil 2-3 cloves of garlic in water for 5 minutes,
  • Crush the garlic and add a pinch of salt,
  • Filter the compost into a cloth, squeeze the cloth well to get the juice,
  • Put 2 or 3 drops of garlic juice on the inflamed ear,
  • Lie on your side for a while to allow the garlic juice to drain from your ear and to reach the point of infection more easily.

How long does otitis media last? The prognosis

Today, death from complications of acute otitis media is rare. 
With effective antibiotic treatment, the improvement time is about 48 hours. 
Usually, patients recover the hearing loss caused by acute otitis media. 
Middle ear secretions and hearing loss may persist well beyond the duration of treatment, regardless of the type of treatment:

  • Up to 70% of children may have some middle ear secretions 14 days after the end of treatment,
  • 50% of children may have otorrhea for 1 month after the end of treatment,
  • 20% after 2 months,
  • 10% after 3 months.

Children are 3 times more likely to resolve otitis media with a single course of antibiotics if:

  • They had less than 3 episodes of otitis media,
  •  They develop an acute otitis media in non-winter months.

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