Otitis media: treatment, remedies and duration


Treatment of otitis media

Treatment of otitis media depends on the severity of symptoms and the lesions present.

The American Academy of Pediatrics and the American Academy of Family Physicians recommend a follow-up period of 72 hours (3 days) from the onset of symptoms.
For this period, doctors do not prescribe antibiotics to observe the development of otitis media. However, anti-inflammatories or natural remedies may be recommended.
If the symptoms improve within a few days, it is a viral otitis media and antibiotic treatment is not required.

This rule is especially appropriate for:

  • Children from 6 to 23 months with mild earache that lasts less than 48 hours and who have no other symptoms.
  • Children over 24 months with mild earache and lack of severe symptoms.

The method of observation is not suitable for children:

  • Who have a cochlear implant,
  • Who suffer from repeated middle ear infections,
  • With malformations (for example, cleft palate).

Antibiotics for acute otitis media

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

  • Children over 6 months of age with secretions, moderate to severe pain in one or both ears for at least 48 hours or fever of at least 39°.
  • children from 6 to 23 months with bilateral ear infection, even if the symptoms are mild,
  • Children from 6 to 23 months with unilateral ear infection and with corresponding symptoms,
  • Children over 24 months with severe pain in both ears for at least 48 hours.

Even after improvement of symptoms, the antibiotic must be taken as prescribed by the doctor (usually for 5 or 10 days), otherwise the following may develop:

  • Recurrent infections of the ears,
  • Appearance of resistant bacteria on antibiotic drugs.

Surgery for otitis media

The doctor may order an intervention to drain the fluid from the middle ear if the child:

  • Has a recurrent otitis media, i.e. three episodes in six months or four episodes in a year, with at least one episode within the last six months.
  • Has a chronic serous otitis media with secretion that accumulates in the middle ear.

The drainage is applied on an outpatient basis by means of a surgical procedure and is called paracentesis.

The surgeon:

  • Makes a microscopic incision in the eardrum,
  • Inserts a small drainage tube into the middle ear to prevent fluid retention,
  • The operation takes about 10 minutes and the patient is discharged the same day (day clinic),
  • Some of these tubes are intended to remain for six months and then spontaneously exit the eardrum.

The procedure is performed under general anesthesia.

Surgery for chronic ear infection
For eardrum perforation with significant hearing loss, the surgeon may recommend:

Simple tympanoplasty
This operation is performed to repair an injured eardrum in the absence of:

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

This procedure naturally closes the middle ear and can improve hearing.
The operation is performed under local or general anesthesia.
The surgeon uses a tissue graft taken from the temporal muscle fascia to correct the defect.
The patient:

  1. May have to stay overnight in the hospital,
  2. Can return to work after a week.

As a rule, the recovery time is about eight weeks.

Tympanoplasty with ossiculoplasty
The operation is performed to:

This surgery can improve hearing.
The procedure can be performed:

  1. In a day clinic,
  2. Inpatient overnight in a clinic.

Anesthesia is performed locally or generally.
The surgeon makes an incision behind the ear or operates directly through the ear canal.

The mastoid process is a bony process that is directly connected to the middle ear.
Inside the mastoid or adjacent bone, there are important structures, such as:

  1. Brain
  2. Inner ear
  3. Facial nerve.

Infections on this bone (mastoid) are therefore dangerous, as is surgical intervention.
An infection of the middle ear and a chronic purulent inflammation of the middle ear can spread to the mastoid.
Mastoidectomy is a surgical procedure aimed at “cleaning” the mastoid bone, the surgeon must:

  • Remove pus,
  • Clear out infected bone parts.

Usually this is done together with a tympanoplasty.
To get to the bone, the surgeon makes an incision behind the ear.


  • The patient can be discharged on the day of the operation or the day after,
  • The total recovery time is 3 weeks.

Radical mastoidectomy
The purpose of surgery is to eliminate the infection, without expectation of hearing improvement.
It is indicated in patients who have a highly resistant infection.
In some cases, to improve healing, a transplant may be required from:

  • Adipose tissue
  • Muscle
  • Bone.

Radical mastoidectomy is performed under general anesthesia, the patient remains hospitalized for one night.
Recovery times take about a week or two.
The time to complete recovery can be up to four months.

Therapy of purulent chronic otitis
Often this chronic infection occurs together with a tympanic membrane perforation, which is subsequently very difficult to treat. It is often treated with:

  • Cleaning the ear: The fluid must be thoroughly sucked out of the ear canal and drained.
  • After each cleansing and in the evening before bedtime is treated with antibiotic drops.

Treatment of ear infection in pregnancy

With severe bacterial otitis, doctors may prescribe some antibiotics to relieve symptoms of infection of the middle ear or infection of the inner ear during pregnancy.
The doctor who prescribes these drugs will check whether it is safe for a woman in pregnancy.

Antibiotics for otitis media in pregnancy

Amoxicillin is an antibiotic that the doctor often prescribes to treat ear infections even in pregnant women.
Amoxicillin (Augmentin) is a type of penicillin and is often used together with clavulanic acid.
Doctors may prescribe other antibiotics for:

  • patients with penicillin allergy,
  • In penicillin-resistant bacteria.

Antibiotics indicated for otitis media in adults and children also include:

  • Macrolides: azithromycin (Zithromax).
  • cephalosporins, for example, cefuroxime (Elobact).

Other medications
For earache, the doctor may prescribe anti-inflammatory drops, for example, phenazone (Otalgan).

Natural remedies for otitis media

These remedies are very effective and help with milder ear infections.
Here are some of these home remedies:

Nasal rinsing
This home remedy is indispensable for cleansing the nose in catarrh. In this way, the displacement of mucus from the nose into the ear is prevented.
In children, it is required:

  • A syringe without an injection needle,
  • A cup of lukewarm or heated water,
  • A teaspoon of coarse salt.


  • Dissolve the salt in the water,
  • Fill the syringe with this solution,
  • tilt the child’s head to one side,
  • Drizzle the saline solution into the upper nostril with the syringe,
  • Wait for the water to run out of the lower nostril.

Place a hot water bottle with warm water or a warm salt bag to the ear.

Tea tree oil Tea tree oil
has antibacterial properties, but can eventually irritate the skin.
For this reason, you should mix it with:

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

How is it used?

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

This essential oil helps relieve mild bacterial inflammation of the ear.

The juice of garlic is a remedy that helps in the treatment of microbial infections of the ear.

It is sufficient:

  • boil 2-3 cloves of garlic in water for 5 minutes,
  • Mash garlic and add a pinch of salt,
  • Filter the mixture through a cloth and squeeze the cloth well to obtain the juice,
  • add 2 or 3 drops of garlic juice to the inflamed ear,
  • After that, you should lie down on one side so that the garlic juice flows deep into the ear and can reach the site of infection more easily.

How long does a middle ear infection last? Prognosis

Today, death from a complication of acute otitis media is rare.
With effective antibiotic therapy, the time to improvement is about 48 hours.
In general, patients recover from hearing loss due to acute otitis media.
Secretions from the middle ear and hearing loss may persist throughout the treatment period, depending on the type of treatment:

  • Up to 70% of children may have secretions from the middle ear 14 days after the end of treatment,
  • 50% of children may still have a running ear 1 month after treatment,
  • 20 % over 2 months,
  • 10% after 3 months.

Children are 3 times more likely to recover with a single cycle of antibiotics if:

  • you have had less than 3 episodes of otitis media,
  • You develop an acute otitis media outside the winter months.

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