Q&A: Can ear infections clear up on their own?
Can ear infections clear themselves? I am reluctant to give my 18-month-old antibiotics.
Your question is a well-timed one. This has been a subject of debate in the pediatrics field over the past few years. Can we be more precise about our diagnosis of an ear infection? Which infections self resolve? Which are the nastier ones that will require antibiotics? In this day and age where germs are becoming more resistant to our usual antibiotics, the questions become even more relevant.
Otitis Media is an infection located in a small, enclosed space behind the eardrum. On the other end of the middle ear space is a tube called the Eustachian tube that drains middle ear fluid into the throat and nose. In a situation where the nose and throat become congested, as with a cold or allergies, the tube cannot drain well. Fluid “backs up” and can then become infected by germs. (This is a simplified explanation, and I hope it gets the big picture across).
When pediatric providers look in ears, we look directly at the eardrum, and we infer by its angry red color, or a bulge, or pain what is going on behind it. After looking at many, many eardrums we can become pretty good at it, but diagnosing ear infections remains an inexact science because our information is indirect. Some eardrums turn very red, some only pink. Some children run high fevers, some never do.
Studies that involve puncturing the eardrum and analyzing the fluid behind it estimate that between 30 and 50 percent of ear infections involve only viruses, usually the same viruses that caused the cold in the first place. These infections may not need antibiotics. The other 50 percent probably do, but even this can be debated.
So pediatricians need to make judgment calls sometimes about which ears to treat and which not to treat. In general, the sicker the child and the angrier the eardrum, the more likely antibiotics are needed. Children under 2 are much more likely to receive treatment as well.
The bottom line is, yes, some ear infections will clear up without antibiotics. There are many variables that go into a decision to treat, but it is appropriate to ask your doctor how bad the infection seems, and the reasoning behind his or her decision.