Duration Health — Field Guide: Ear

Ear

Introduction

Ear pain can be due to injury/trauma to the ear or due to infection. There are 2 main types of ear infections. The first is otitis media, which is an infection of the middle ear, or the area behind the eardrum. This can cause throbbing, sharp, or stabbing pain to the ear, which may radiate down into the throat, feeling of ear fullness, muffled hearing, fever and sometimes, if severe, a yellow discharge can drain from the ear. Another infection of the ear, is called otitis externa. Otitis externa is often called “swimmer’s ear” as it is commonly caused by water that remains in the ear after swimming with allows a moist environment for bacterial growth. Symptoms of otitis externa include: itching and discomfort of the outer ear and canal, redness of the skin of the ear, pain when you tug on the earlobe, and draining yellow fluid.

Ear infections can spread past the ear and into the bones behind the ear within the skull. The bony bump behind the ear, called the mastoid process, can become infected (mastoiditis). This is a serious infection requiring emergent medical attention. Ear infections can spread to the brain, causing meningitis. Ear infections can also spread to the skin of the ear and the skin surrounding the ear, in a serious infection called malignant otitis externa.

Treatment

Most otitis media is caused by viruses and will get better on its own within 3 days. Otitis media that does not improve on its own is treated with oral antibiotics, most commonly amoxicillin or amoxicillin-clavulanate. Otitis externa is treated with ear drops, called ofloxacin.

Pediatrics

When To Worry

Seek immediate medical care if you have any of the following:

  • worsening of pain and drainage from the ear that does not improve with medication
  • loss of hearing
  • spreading redness around the ear
  • if severe ear pain migrates to include your face and jaw or the bony bump behind the ear
  • any blood draining from the ear

Quick Guide

If you have

  • inner ear pain
  • drainage from ear
  • fever

You may have

otitis media

Consider using

amoxicillin-clavulanate 875 mg-125 mg twice daily for 7 days

Note: if amoxicillin alone is available, amoxicillin alone should be used instead of amoxicillin-clavulanate combination

OR

azithromycin 500 mg by mouth the first day, then 250 mg per day for the next 4 days

Note: if amoxicillin is unavailable or if an allergy to penicillins is present, azithromycin may be considered as an alternative. However, it is ineffective against some organisms responsible for otitis media.

OR

doxycycline 100 mg by mouth twice daily for 5 days

OR

Pediatrics

For children age 17 and under

amoxicillin pediatric 45 mg/kg/dose twice daily for 10 days (maximum dose 2000 mg per day)

For example, a child weighing 15 kg (33 lbs) would receive 675 mg (equal to 15 times 45) in the morning and another 675 mg at night, for a total of 1350 mg in a 24 hour period.

See also: Pediatrics

If you have

  • ear pain or itching
  • redness of skin of ear
  • pain when you tug on earlobe
  • no fever
  • recent swimming

You may have

otitis externa

Consider using

ofloxacin 10 drops in the affected ear 2 times per day for 10-14 days

OR

polymyxin B-neomycin-hydrocortisone otic 4 drops in the affected ear every 6 hours for 7 days

OR

Pediatrics

For children age 17 and under

ofloxacin ear drops may be used in children

polymyxin B-neomycin-hydrocortisone otic may be used in children for swimmer’s ear, but should never be used in children with ear tubes or with any concern for a ruptured eardrum

See also: Pediatrics

If you have

  • ear pain that spreads to the face or area behind the ear
  • redness of the skin around ear
  • hearing loss
  • facial paralysis
  • dizziness
  • confusion or behavior change
  • persistent fever

You may have

meningitis or cellulitis or mastoiditis

You should

seek emergency medical care

Reference

ofloxacin

Ofloxacin is an antibiotic eye drop. It is used to treat bacterial conjunctivitis (pink eye). It also used to prevent infection in cases of corneal abrasion (a scratch on the eyeball). While ofloxacin is formulated to be used in the eye, it can also be used in the outer ear to treat an outer ear infection (otitis externa) if no other alternative is available. Ofloxacin can be used to treat eye infections in people who normally wear contact lenses, but should never be used at the same time as wearing contact lenses.

Prescription only

InfectionMedication

amoxicillin-clavulanate

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin-clavulanate pediatric

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin-clavulanate suspension

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin capsule

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

InfectionMedication

amoxicillin pediatric

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

PediatricsMedication

amoxicillin

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

PediatricsMedication

polymyxin B-neomycin-hydrocortisone otic

Polymyxin B-neomycin-hydrocortisone otic is an antibiotic ear drop. It is used to treat otitis externa, an infection of the ear canal. Otitis externa, also called swimmer's ear, presents with ear pain, swelling of the ear canal, pain with movement of the outer ear, and occasionally decreased hearing. Do not use this medication if a ruptured ear drum (ruptured tympanic membrane) is suspected. This medication should not be relied upon to treat ear pain and a fever. Presence of a fever suggests an infection of the middle ear (otitis media) or a more serious infection, which may require oral antibiotics or other treatment.

Prescription only

InfectionMedication

cefdinir

Cefdinir is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefdinir suspension

Cefdinir is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefpodoxime

Cefpodoxime is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefuroxime

Cefuroxime is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is also sometimes used to treat the STD gonorrhea. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

ciprofloxacin ophthalmic

Ciprofloxacin ophthalmic is an antibiotic eye drop. It is used to treat bacterial conjunctivitis (pink eye). It also used to prevent infection in cases of corneal abrasion (a scratch on the eyeball). While ciprofloxacin is formulated to be used in the eye, it can also be used in the outer ear to treat an outer ear infection (otitis externa) if no other alternative is available. Ciprofloxacin drops can be used to treat eye infections in people who normally wear contact lenses, but should never be used at the same time as wearing contact lenses.

Prescription only

InfectionMedication

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