What treatment is recommended, and is it necessary?
Acute Otitis Media
Antibiotic treatment is recommended for acute otitis media. This has a modest effect in the reduction of pain and fever and may reduce the risk of complications of acute otitis media.
However, there remains some dispute about the benefits of antibiotics - some doctors believe there is not enough evidence to provide antibiotic treatment for acute otitis media in some older and otherwise healthy children. Although this issue is yet to be clarified, most doctors prefer to err on the side of caution and to treat children (and adults) with antibiotics for Acute Otitis Media.
Paracetamol is usually effective too, for reduction of pain and fever.
Grommets may be recommended for recurrent episodes of Acute Otitis Media. There is no absolute definition of the number of episodes required before grommet insertion is recommended, but a rule of thumb is 6 episodes in a year. This would also depend upon the time of year (more likely to be recommended if Acute Otitis Media is recurrent through the summer months, when the incidence should usually be at its lowest) and individual factors, such as predisposing risk factors and occurrence of complications of Acute Otitis Media.
Because most episodes of Glue Ear resolve without treatment, regular observation alone is often for three months if the eardrums are otherwise of normal appearance. Once fluid has been present behind the eardrum for three months, it is considered unlikely to resolve for a considerable time (sometime years).
Continued observation alone may be an option after this time if hearing is completely normal and there has been no eardrum damage.
Treatment options include:
- More concerns are being raised also about the over use of antibiotics, including the development of antibiotic resistance, allergic reactions, diarrhoea and thrush.
- Grommet (ventilation tube) insertion. This results in resolution of the middle ear fluid, and in addition reduces occurrence of Acute Otitis Media. Grommets are discussed further below.
- Other treatments, which have been used, include decongestants, (e.g. pseudoephridine), antihistamines (e.g. phenergan) and steroids (e.g. prednisone). There is no evidence for their effectiveness or benefit.