Will otitis media resolve on its own?

From the Guidelines

Most ear infections, particularly those of viral origin, can resolve on their own without the need for antibiotics, and a "wait-and-see" approach is often recommended for mild cases in adults and children over 2 years old. This approach involves managing pain and fever with over-the-counter pain relievers like acetaminophen or ibuprofen for 48-72 hours 1. However, it's crucial to seek medical attention if symptoms are severe, such as high fever over 102.2°F, severe pain, or discharge from the ear, or if symptoms last more than 2-3 days, as these could indicate a bacterial infection that may require prescription antibiotics like amoxicillin 1.

Key Considerations

• For children under 2 years or those with recurrent infections, medical evaluation is necessary to determine the best course of action, as their immune systems are still developing and they are more susceptible to complications 1.
• Bacterial ear infections, which can be more serious, may necessitate antibiotic treatment to prevent potential complications such as hearing loss or the spread of infection 1.
• While waiting for an infection to resolve, it's beneficial to keep the ear dry, apply warm compresses to relieve pain, and rest with the affected ear facing up to help with drainage, as these measures can aid in the body's natural healing process 1.

Evidence Summary

Studies have shown that the majority of ear infections, especially those caused by viruses, will resolve without antibiotic treatment 1. The use of antibiotics is generally reserved for cases where a bacterial infection is suspected or confirmed, highlighting the importance of proper diagnosis 1. Given the potential for antibiotic resistance and side effects, a judicious approach to their use is essential, supporting the "wait-and-see" strategy for mild and uncomplicated cases 1.

Management and Prevention

• Monitoring and Supportive Care: For many cases, especially viral infections, monitoring and supportive care (e.g., pain management, keeping the ear dry) are sufficient 1.
• Antibiotic Use: Reserved for bacterial infections or severe cases, with the choice of antibiotic (e.g., amoxicillin) and duration of treatment (typically 7-10 days) guided by clinical guidelines and the severity of the infection 1.
• Prevention: Measures to prevent ear infections include avoiding exposure to known risk factors (e.g., reducing pacifier use in infants, avoiding tobacco smoke exposure) and ensuring up-to-date vaccinations, which can help reduce the incidence of infections that may lead to ear infections 1.

From the Research

Ear Infection Resolution

• Most cases of acute otitis media (AOM) spontaneously remit without complications in high-income countries 2
• The benefits of antibiotics must be weighed against the possible harms, as for every 14 children treated with antibiotics, one child experienced an adverse event that would not have occurred if antibiotics were withheld 2
• An expectant observational approach seems justified for most children with mild disease in high-income countries, with clinical management emphasizing advice about adequate analgesia and the limited role for antibiotics 2

Antibiotic Treatment

• Antibiotics do not reduce pain at 24 hours, but result in almost a third fewer children having pain at two to three days, and likely result in two-thirds fewer having pain at 10 to 12 days 2
• Antibiotics increase the risk of adverse events such as vomiting, diarrhea, or rash, with a number needed to treat for an additional harmful outcome of 14 2
• Immediate antibiotics may result in a reduction of pain at two to three days, but probably do not reduce the risk of pain at three to seven days, and may not reduce the risk of pain at 11 to 14 days 2

Observation and Safety-Net Antibiotic Prescription

• A safety-net antibiotic prescription can be an acceptable treatment option for parents in the United States, with 63% of parents reporting that they would be willing to treat future AOM episodes without antibiotics and with pain medication alone 3
• The use of a safety-net antibiotic prescription can lower antibiotic usage, with only 31% of parents filling their antibiotic prescription 3

Pain Relief

• Both paracetamol and ibuprofen as monotherapies are more effective than placebo in relieving short-term ear pain in children with AOM, with low-quality evidence indicating a number needed to treat to benefit of 7 for paracetamol and 6 for ibuprofen 4
• There is insufficient evidence of a difference between ibuprofen and paracetamol in relieving short-term ear pain in children with AOM 4