Ear Infections and Antibiotics -- When is Enough Enough?

by Steven D. Shotts, MD, FACS 


Beautiful as it is, fall unfortunately signals the beginning of cold and flu season. As people spend more time indoors, viruses are transmitted more easily (especially true for those with children). Along with the rise in viral illnesses, Acute Otitis Media (AOM, middle ear infections) rates rise as well. In fact, most AOM begins with a viral illness. Unlike viral AOM, bacterial infections should be treated with antibiotics. Truthfully, most AOM, viral or bacterial, will resolve in time even without treatment, but studies show bacterial infections resolve much quicker with antibiotic treatment. The real reason that antibiotics are used though is to prevent the estimated 1 in 400 chance of developing serious complications such as brain infection or abscess in untreated patients. Although very rare, these complications are serious enough that roughly 399 out of 400 patients are given treatment to prevent the one complication.

Ear infections are so common in infants; frequent antibiotic usage has led to a tremendous rise in bacterial antibiotic resistance. This is because the bacteria that cause ear infections are routinely carried near a child’s adenoids in the back of the nose. Children typically catch a cold, which causes a temporary suppression of their immune system, allowing the bacteria to flourish and make their way from the adenoids out the underdeveloped Eustachian tube to the ear, where they cause an infection. Taking antibiotics not only kills the bacteria behind the eardrum, but also the bacteria in the adenoids. Some of the bacteria least sensitive to that antibiotic survive and repopulate the adenoids with bacteria resistant to that antibiotic. For the next infection, a higher dose or different antibiotic must be used. After three infections in a six-month period or four infections in a twelve-month period, it is difficult to select an antibiotic to treat the infection. At this point, one can treat with antibiotics, but they may be no more effective than no treatment. As most infections improve without treatment, this often passes as effective treatment. Now there are two options: 1) Continuing treatment with antibiotics knowing they may be no more effective than no treatment or 2) Considering ear tubes.

Ear tubes are small, wheel-hub shaped implants, which are surgically positioned into the eardrum by an ENT specialist. They prevent the build-up of fluid behind the eardrum, significantly reducing ear infections while they are in place. They usually last approximately a year before the growth of the eardrum pushes them out into the ear canal. For children, placing them requires a brief mask anesthetic. Complications are very rare. After the ear tube placement, ear infections are no longer painful, rarely have fever, and are normally treated by placing eardrops in the ear canal. This prevents many of the gastro-intestinal complications of oral antibiotics while also allowing the body’s immune system to eradicate naturally the carried resistant bacteria in time. For the children with frequent ear infections, ear tubes regularly ensure both the child and parents return to a healthier and happier lifestyle.