What’s the Best Treatment for an Ear Infection?

If you or your child have ever had an ear infection, you know they can be quite uncomfortable — and even painful. While anybody can develop an ear infection, they’re more common in children. 

Ear infections are painful, but they’re highly treatable. In fact, many ear infections may resolve on their own. But pain relievers and antibiotics are sometimes needed.

What is an ear infection?

There are three types of ear infections.

Outer ear infections (otitis externa) 

Outer ear infections, or otitis externa, affects the ear canal. It’s also called swimmer’s ear. It causes pain, redness and discharge of the ear canal and sometimes of the outside of the ear. 

Middle ear infections (otitis media) 

Middle ear infections, or otitis media, is what most people think of when they picture an ear infection. It’s an infection that develops behind the eardrum and causes fever, pain, and hearing changes. 

Children are more likely to develop otitis media. Their eustachian tubes — or tubes that connect the ears to the throat — are smaller and flatter than in adults. This can make it harder for fluid to drain out. When fluid builds up in the ear, an infection may come next. Middle ear infections usually develop during a viral illness.

Inner ear infections (labyrinthitis and vestibular neuritis) 

Inner ear infections, or labyrinthitis and vestibular neuritis, affect the inner structures of the ear, like the inner ear canals, cochlea, and vestibular nerve. These structures help the body perceive movement as well as sound. Inner ear infections are usually caused by viruses. They cause uncomfortable symptoms like vomiting, nausea, and dizziness. But they are uncommon.

EXPERT PICKS: WHAT TO READ NEXT

• Swimmer’s ear: Did you know there are three types of ear infections: outer, middle, and inner? People of all ages can get outer ear infections (swimmer’s ear), especially in warmer months.

• Middle ear infections: Children are more likely to get middle ear infections (otitis media). But adults can get middle ear infections, too. 

• Inner ear infections: Inner ear infections are uncommon and usually go away on their own. But they can cause uncomfortable symptoms, here’s how to find relief.

How are ear infections treated? 

If you or your child have symptoms of an ear infection, it’s a good idea to get them checked out. Your healthcare professional will typically examine the ears with an instrument called an otoscope to diagnose an ear infection.

Treatment for an ear infection depends on the type of ear infection you have. For outer and middle ear infections, this often includes antibiotics and over-the-counter (OTC) pain relievers. 

However, treating an ear infection isn’t a one-size-fits-all approach. Your age, symptoms, and infection type come into play when deciding whether you need an antibiotic for an ear infection.

1. Watchful waiting

If your child has mild symptoms of a middle ear infection, your healthcare professional may recommend the “watch-and-wait” approach.

This is exactly what it sounds like. It involves waiting 2 to 3 days to see if their symptoms improve without an antibiotic. Most ear infections are actually caused by viruses, so antibiotics won’t help your child fight off the infection. It’s impossible to tell whether an ear infection is from a virus or bacteria just by looking at the eardrum. There may be other clues that can point to a bacteria or virus as the culprit. But sometimes, it’s not possible to know for sure. 

Waiting 2 days gives the immune system a chance to fight off a virus. If symptoms get better and the ear doesn’t look as swollen, that means a virus was causing the infection. If things aren’t getting better, then the infection is more likely from a bacteria and it’s time to start antibiotics. Mild ear pain, a temperature lower than 102.2°F, and symptoms lasting less than 2 days fit the checklist for potentially using the watch-and-wait strategy. 

However, as a parent, you need to be comfortable with this approach. Some parents prefer to opt for antibiotics right away, and this is OK, too.

2. Pain relievers

Pain relievers won’t treat the underlying cause of an ear infection, but they can make it more tolerable.

Oral OTC pain relievers — like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil) — can help alleviate short-term pain and fever from any type of ear infection. You can take them alone or switch back and forth between them.

Keep in mind: Ibuprofen should generally be avoided in children younger than 6 months unless your healthcare professional recommends it. Aspirin is an NSAID that should also be avoided in kids and adolescents younger than 19 years because of the risk of Reye’s syndrome. This is a dangerous condition that can cause brain swelling, liver damage, and other serious complications.

3. Antibiotics for kids

Many antibiotics can treat middle ear infections in kids. But kids with one infected ear and mild symptoms may not need an antibiotic — the infection could go away on its own. Kids often only need an antibiotic in these situations:

• They’re younger than 6 months.

• They’re younger than 2 years with an infection in both ears.

• They’re at least 6 months old with moderate or severe ear pain that lasts at least 2 days.

• They’re at least 6 months old with a temperature of 102.2°F or higher. 

• A repeat ear exam after 2 days (48 hours) doesn’t show signs of improvement.

Amoxicillin is a first-choice antibiotic for treating middle ear infections in kids. A type of penicillin antibiotic, it comes as tablets, capsules, and an oral suspension (liquid). Amoxicillin dosages in kids are based on body weight, but it’s often taken by mouth 2 times a day. Treatment usually lasts 10 days, but your child’s symptoms should start to improve within about 3 days.

Augmentin (amoxicillin/clavulanate) is a go-to medication for kids who have taken amoxicillin in the past 30 days. It’s also a good choice if your child has pink eye and an ear infection at the same time. 

Remember: Let your healthcare professional know if your child has a penicillin allergy. They can recommend a safer antibiotic for otitis media, such as azithromycin or a cephalosporin antibiotic like cefdinir.

4. Antibiotics for adults

Adults with middle ear infections should receive an antibiotic to prevent potential complications down the line. The best options are similar to those for kids.

Amoxicillin is a first-choice antibiotic for adults with otitis media. It’s typically taken by mouth 2 to 3 times daily for 5 to 10 days. Your symptoms should start to improve within 3 days after starting it. Augmentin is a common alternative if amoxicillin isn’t effective.

Like kids, adults with a penicillin allergy have other options. These include cephalosporin antibiotics, such as cefdinir or cefpodoxime. Azithromycin could also work. 

5. Ear drops

Adults and children with swimmer’s ear usually need treatment with ear drops. You may need to use antibiotic ear drops like Floxin (Oxflacin) or a combination ear drop that contains both antibiotics and a steroid like ciprofloxacin / dexamethasone (Ciprodex). The steroids help calm inflammation in the ear canal. This can reduce pain and make it easier for antibiotics to get into the ear. 

Acetic acid ear drops can also help with swimmer’s ear. These are mild antiseptics. They’re often combined with steroids to help calm inflammation and fight off the ear infection.

You may need to take oral antibiotics if you don’t get better with antibiotic ear drops.

Antibiotic ear drops can treat ear infections in kids who have ear tubes due to frequent ear infections. Swimmer’s ear can also be treated with antibiotic ear drops. Ciprodex (ciprofloxacin/dexamethasone) and ofloxacin are two examples.

6. Cough and cold medicines

Middle ear infections usually develop during a viral illness. Cough and cold medications won’t cure a middle ear infection. But they may relieve some cold symptoms, like congestion and stuffiness, and make you more comfortable. 

7. Natural and home remedies for an ear infection

There are some simple things you can do at home to keep yourself comfortable, including:

• Drinking lots of fluids 

• Getting plenty of rest

• Applying a warm or cool compress to your outer ear

• Adjust your sleeping position so you don’t sleep on the side with an ear infection

It’s equally important to mention remedies that should be avoided. For instance, ear candles should never be used. This involves placing a lit candle inside the ear in an attempt to remove earwax or other buildup. This practice can cause serious side effects, such as burns or a ruptured eardrum.

You shouldn’t put cotton swabs (like Q-tips) in your ears either. While it can be tempting to try and remove discharge, cotton swabs can actually make things worse by irritating your ear canal and pushing debris further back into your canal. 

When should you seek medical care for an ear infection?

Some middle ear infections go away on their own. Mild swimmer’s ear can go away on its own too, but it usually takes a few weeks.

But ear infections can lead to more serious infections and may cause complications down the road. Getting treatment can help you avoid complications and feel better faster. It’s a good idea to get care within 24 to 48 hours of developing ear infection symptoms. 

But you should reach out to your healthcare professional right away for immediate help if you or your child experience:

• Fever

• Hearing loss

• Fluid, pus, or discharge from the ear

• Eye redness or discharge

• Swelling, redness, or pain behind the ear

• Headaches

How can you prevent ear infections in the first place?

You can prevent middle ear infections by staying up to date with vaccines. Studies show that pneumonia and flu vaccines may help prevent otitis media. Pneumonia vaccines protect against common bacteria that cause ear infections, while flu vaccines protect against viruses that may lead to ear infections. The Hib vaccine (ActHIB, Hiberix, PedvaxHIB) can also help.

You can prevent swimmer’s ear by not getting water in your ears. Make sure to dry the outside of your ears after swimming. 

Washing your hands often with soap and water can prevent the spread of germs and lower your risk of picking up viruses that cause middle and inner ear infections. 

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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