Parents can tell if an ear infection is getting better

The Pediatric Insider

© 2016 Roy Benaroch, MD

Good things come in small packages. A short, sweet letter to the editor in the November, 2016 edition of JAMA Pediatrics confirms that parents can tell whether their children are getting over an ear infection, with no doctor exam required.

The letter, from four Finnish physicians, is about a page long. It summarizes a small part of their data from a much larger study on the treatment of ear infections. In the letter, they’re only looking at 160 children, age 6 months to 3 years, who were initially treated for an ear infection without any antibiotics. Current guidelines from the US and many other countries do support treating less-severe ear infections with pain relievers only, waiting on antibiotics. But these guidelines suggest that if children with ear infections aren’t given antibiotics, they need to be followed closely and re-examined to make sure they’re really getting better. These authors asked, is that really necessary?

The 160 children were all reexamined for this study, and parents were also asked questions about whether they thought their children were improving, getting worse, or staying about the same. It turns out that among the children whose parents thought were getting better, only a very small number had worsening ear exams (less than 3%). Compare that with children thought to be getting worse – about 30% had worsening findings on their ear exams. Keep in mind that these were all children who did not receive any antibiotics. Presumably, if they had, even fewer of them would have gotten worse.

Parents, not surprisingly, were pretty good at judging whether their children were getting better. So good that based on these numbers, a repeat exam to make sure ear infections were clearing was probably unnecessary!

Caveats: I’d be a little more cautious with children at risk for prolonged ear infections or  persistent fluid behind the ears. Children with a history of difficult-to-treat ear infections should get a repeat exam, as should kids with hearing problems or developmental language delays—it’s crucial that those children get over their infections completely. But for the majority of children with ordinary ear infections that seem to be getting better, it may be reasonable to wait until their next check up to look at those ears again. Most of the time, parents’ judgment is just as good as a repeat ear exam.



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7 Comments on “Parents can tell if an ear infection is getting better”

  1. Roxane Auer Says:

    This is very helpful to read, but the more noteworthy part of this is the fact that most pediatricians do not immediately prescribe antibiotics, because mine always did. I questioned this practice and even told them that I preferred to wait if that was at all an option, but they never failed to give me antibiotics. In talking to a few other parents, I did not find any whose doctors told them to wait out an ear infection. I loved our pediatrician, they were very pragmatic and attentive. We moved so they are no longer my doctor, but if this is the recommended practice, why hasn’t everyone gotten the word?

    On Mon, Dec 5, 2016 at 6:56 AM, The Pediatric Insider wrote:

    > Dr. Roy posted: “The Pediatric Insider © 2016 Roy Benaroch, MD Good things > come in small packages. A short, sweet letter to the editor in the > November, 2016 edition of JAMA Pediatrics confirms that parents can tell > whether their children are getting over an ear infe” >


  2. Hi Dr. Roy, greetings from Sri Lanka 🙂 My baby recovered from an ear infection recently but there is a persistent odor from one. Her pead says there is no infection but it’s probably the wax. One doctor said wax doesn’t smell and this doctor says it does :/ Any idea about this? Thank you and love the blog!


  3. Dr. Roy Says:

    Hello Dinu! How’s the Weather in Sri Lanka this time of year? A long time ago, in 4th grade I think, Mr. Monday made us memorize all of the major islands on Earth, including what was still incorrectly labeled “Ceylon” on the old maps we had (this was around 1975, something like that.) I remember thinking at the time how cool it was that an island nation just changed its name, and decided I wanted to visit some day.

    Anyway: earwax can indeed pick up what are technically called “volatile organic molecules” — essentially, stink particles. There’s a genetic basis for this, as people from different backgrounds have different kinds of wax. As long as the ear exam is normal otherwise (the eardrum is fine, there’s no infection), the odor itself isn’t anything medically important. From my personal experience, parents sometimes get a whiff because they hold their babies so close, but I don’t think anyone else would ever notice.


  4. Carrie Says:

    Is there any research on oral antibiotics vs ear drops for ear infections?

    I can tell you anecdotally that oral antibiotics never seemed to do a lot of good for my ear infections, but also that I rarely or never had an ear infection that would have gone away by itself. I would be taken to the doctor, prescribed oral antibiotics, and return to the doctor, usually with a burst eardrum (which I long thought was just what happened when one had an ear infection. In fact I was glad when it happened as it relieved the unbearable pain) to be prescribed drops.

    Eventually I think they started to give me drops right away, though I’m not sure if that was my doctor’s idea or if my mum demanded it.


  5. Dr. Roy Says:

    Carrie, ear infections occur in the middle ear, on the other side of the eardrum. Drops put into the ear canal cannot get into the middle ear, so they cannot treat an ear infection.

    The exception is when the eardrum has a hole in it, either spontaneously (a “burst” eardrum) or when a surgeon has placed a tube in the eardrum. In these circumstances drops can go through the hole or tube, and will treat the ear infection.


  6. Hi Doctor, yes it was indeed called Ceylon. Have you had our tea? 😀 Please do visit, its very exotic with elephants and stuff… 🙂

    Thanks for the feedback on the smell from the ear. I guess it’s normal and nothing to be worried about!


  7. Carrie Says:

    That makes sense, thanks. I guess drops worked for me because I always got burst eardrums.


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