otitis media in an 18 month old

My 18-month-old has had 3 bouts of otitis media. I am confused as some doctors say that antibiotics are needed to clear the infection and others don’t think they are needed. Can you tell me about this condition and how it should be treated?

Otitis media or middle ear infection (sometimes called ‘ear infection” which is wrong) is a frequent problem in early childhood although it can affect any age – I had it at 17 years of age. It is usually a complication of the common cold. The middle ear has a tube which drains mucus made in the middle ear into the nose. Swelling of the lining of the nose, caused by the cold, blocks the drainage of the mucus. Bacteria like to grow in any trapped fluid in our bodies and will grow in the mucus setting up a middle ear infection (otitis media).

It is possible for this infection to develop into an abscess, which in turn may burst through the eardrum causing pain and then discharge of pus out through the outer ear. For this antibiotics are compulsory. Such rupture of the middle ear drum is very rare in well-nourished basically healthy children but is common in poorly nourished third world children where it is a common cause of a permanent hole in the drum which causes significant hearing loss.

In the last 25 years we have come to realise that a well-nourished child will get over otitis media without the need for antibiotics just as fast as those given them. It has been estimated that one has to give antibiotics to 14 children with otitis media to help 1 – the other 13 will resolve their infection just as quickly without any medication. Thus, you are likely to see less and less prescribing of antibiotics for middle ear infections in future.