Recent guidelines covering the diagnosis and treatment of ear infections — the most common secondary bacterial infection occurring with or following a viral upper respiratory infection, or cold — have been reviewed previously on The PediaBlog and summarized this way:


If your child has an acutely infected ear causing significant pain and/or fever, an antibiotic should be offered.  All others may be given the option of antibiotics vs. observation.  Ears that simply have fluid (middle ear effusions) are not acutely infected and should not be treated with antibiotics.  It will be up to us to explain what we are seeing and why we think an antibiotic should or shouldn’t be used.  It will be up to parents to help us determine what is best for their child.  As it should be.


Using “watchful waiting” as a treatment choice with “SNAP” (safety-net antibiotic protocol: prescribing antibiotics if the child does not improve within a certain amount of time) results in the prescribing of fewer antibiotics.  This lessens the chances of children having severe side effects from these powerful drugs as well as lowering the risk of antibiotic resistance in the community.

Sometimes watchful waiting or antibiotics are not enough — often because the frequency of ear infections can be high in young children (particularly those in day-care, those who have older siblings, those with anatomic or immunologic predispositions, and those affected by air pollution like tobacco smoke) — and the insertion of tympanostomy, or ventilation, tubes are indicated. (Read The PediaBlog “The Time For Ear Tubes.”)

Even when children get tubes, they can still get infections that drain out from the middle ear space to the outside through patent tubes — what we call tube otorrhea.  Ear, Nose, and Throat specialists and pediatricians typically treat these infections with antibiotic ear drops rather than oral antibiotics.  A new study published in this week’s New England Journal of Medicine compares the use of drops and oral antibiotics with watchful waiting, and the results validate current practices for treating what Catherine Saint Louis calls “drippy ears”:

Smaller trials with different designs have found that ear drops are more effective than systemic antibiotics for this common problem. But the new study is the first to include a no-treatment, wait-and-see group, and provides the best evidence to date for the superiority of ear drops for children with tubes.

“This is a big study, very high quality and very rigorous. It’s more of a definitive study,” said Dr. Richard M. Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, who was not involved in the research. Putting drops into the ear canal, he said, is akin to “dropping a Scud missile on the bacteria.”

There are two benefits, he said. “It resolves the otorrhea more effectively and faster than oral medicine,” he said. “More importantly, you avoid the problem of resistant germs, which is a major, major problem.”


(Google Images/ Centre for Ears Nose Throat Allergy and Snoring)