After completing a course of amoxicillin‑clavulanate (Augmentin), I have a sensation of full ears, severe hearing loss, and difficulty swallowing—what should I do next?

Post-Augmentin Ear Fullness and Hearing Loss

You need urgent ENT evaluation today for possible serous labyrinthitis or inner ear involvement—this is not typical post-antibiotic middle ear effusion and requires immediate specialist assessment. 1

Immediate Differential Diagnosis

Your constellation of symptoms—severe bilateral ear fullness ("train tunnel" sensation), profound hearing loss, and difficulty swallowing—suggests one of three urgent conditions:

• Serous labyrinthitis or inner ear involvement from extension of middle ear infection, which can cause sudden sensorineural hearing loss requiring urgent corticosteroid therapy within 72 hours of onset 2
• Eustachian tube dysfunction with severe bilateral effusion causing conductive hearing loss and referred pharyngeal symptoms 3
• Treatment failure with persistent middle ear infection that has worsened despite Augmentin therapy 1

Why This Is Not Routine Post-Treatment Effusion

While 60–70% of patients have middle ear effusion 2 weeks after successful AOM treatment, this effusion is typically asymptomatic and does not cause profound hearing loss or swallowing difficulty 3. Your severe symptoms indicate either:

• True treatment failure (infection persisting or worsening beyond 48–72 hours of therapy) requiring antibiotic escalation 1
• Inner ear involvement requiring urgent corticosteroid intervention 2
• Bilateral severe effusion with secondary complications 3

Required Actions Today

1. Urgent ENT Referral

• Immediate specialist evaluation is mandatory when severe refractory symptoms suggest complications beyond simple middle ear infection 1
• ENT can perform pneumatic otoscopy to confirm middle ear effusion, tympanometry to quantify conductive hearing loss, and audiometry to rule out sensorineural hearing loss 3, 2
• If sudden sensorineural hearing loss is confirmed, oral corticosteroids must be initiated within 72 hours for optimal outcomes 2

2. Antibiotic Escalation (If Middle Ear Infection Confirmed)

• Intramuscular ceftriaxone 50 mg/kg once daily for 3 consecutive days is the evidence-based next step after Augmentin failure 1
• This 3-day regimen is superior to single-dose ceftriaxone and covers resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 1
• Do not simply continue Augmentin or switch to another oral antibiotic—worsening symptoms at day 4+ indicate clear treatment failure requiring parenteral escalation 4

3. Verify Treatment Adherence

• Confirm you completed the full Augmentin course at the correct dose (90 mg/kg/day of amoxicillin component divided twice daily) 1
• Patients commonly under-administer antibiotics as symptoms improve, leading to apparent treatment failure 1

Critical Pitfalls to Avoid

• Do not assume this is benign post-treatment effusion—profound hearing loss and swallowing difficulty are red flags for complications 1, 2
• Do not use trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, or azithromycin for treatment failures, as pneumococcal resistance to these agents exceeds 40% 3, 1
• Do not delay ENT referral beyond 24 hours—sudden sensorineural hearing loss has a narrow therapeutic window for corticosteroid intervention 2
• Do not accept "watchful waiting" for severe symptoms—this approach is only appropriate for mild, non-severe AOM in children ≥2 years with reliable follow-up 3

Alternative Diagnoses to Consider

• Referred pain from temporomandibular joint dysfunction or dental pathology can mimic ear disease, but your bilateral presentation and hearing loss make this less likely 5
• Malignant otitis externa (especially if immunocompromised) can cause severe refractory symptoms, but typically presents with visible external ear canal inflammation 4
• Contact sensitivity to Augmentin components occurs in 13–30% of patients with chronic ear disease, but would not explain profound hearing loss 4

What to Tell the ENT

Provide this timeline:

1. Completed full course of Augmentin (specify dose and duration)
2. Developed bilateral ear fullness and profound hearing loss after completing antibiotics
3. Cannot hear conversations and have difficulty swallowing due to ear pressure sensation
4. No improvement or worsening since finishing antibiotics

This history will help the ENT distinguish between treatment failure requiring ceftriaxone versus inner ear involvement requiring corticosteroids 1, 2.