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    Understanding Ear Infections: Diagnosis and Treatment

    Medicine for Ear Infections continued...

    But many doctors, particularly in the U.S., are concerned that without antibiotics, bacteria lurking inside the middle ear can grow out of control, possibly causing hearing loss or mastoiditis. After all, they point out, these complications have become rare, largely as a result of antibiotic therapy. To be on the safe side, many American doctors treat all ear infections as if bacteria are present.

    Amoxicillin is the antibiotic of choice for treating bacterial ear infections. The drug is highly effective: A single course of amoxicillin can usually knock out an ear infection in seven to 10 days, at little cost.

    However, some types of bacteria have grown resistant to amoxicillin; critics of heavy antibiotic use in the U.S. point out that the millions of prescriptions of amoxicillin for ear infections that were not bacterial in origin helped to create these resistant bacterial strains.

    Whatever their origin, amoxicillin-resistant bacteria have shown up in a number of communities, leading many doctors to prescribe other antibiotics for ear infections. Some of these substitutes, which tend to be more expensive than amoxicillin, are taken from a class of medications called cephalosporins. Others are combination drugs -- amoxicillin and clavulanate, for instance. For those allergic to amoxicillin, doctors may prescribe sulfamethoxazole and trimethoprim, or azithromycin.

    If an ear infection causes serious complications or if fluid remains in the ear for more than three months, physicians may suggest myringotomy with PE (pressure equalizing) tube insertion surgery to eliminate infection or drain the middle ear. Because not enough air is coming through the Eustachian tube to ventilate and dry out the middle ear, a little tube, less than half an inch long, is placed into the ear drum. The tube, which will usually fall out on its own in about a year, keeps a hole open in the eardrum so that air can get into the middle ear space and dry it out. A ventilation tube reduces pain, improves hearing, and cuts down on the number of infections your child may have.

    This procedure rarely leads to infection or scarring and usually provides long-term results. If after the tubes come out the ear infections return, it means your child hasn’t outgrown the problem and a second set of tubes may be recommended. This time, an adenoidectomy -- surgery to remove the adenoids -- will also be suggested in an attempt to unblock the Eustachian tube as much as possible, and to avoid inserting a third set of tubes.

    Tonsillectomy is generally not considered helpful for recurrent ear infections and is not usually recommended.

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