Around 80% of cases of acute otitis media clear up within three or four days without treatment. Perforated eardrums also usually heal on their own without the need for treatment.

Antibiotics

While antibiotics may help to treat the short-term symptoms of a middle ear infection, there is no evidence to suggest that they make the condition clear up more quickly or reduce the chance of complications occurring.

Some bacteria that can cause the infection have become resistant to some types of antibiotics. This is due to antibiotics being used to treat minor ailments, such as coughs, colds and viral infections.

Relying on antibiotics to treat minor conditions causes the bacteria to become resistant to the medication, making it less effective at treating more serious infections.

For this reason antibiotics are not usually used to treat mild conditions. You are unlikely to be prescribed antibiotics unless you are at high risk of developing serious complications. These people include:

• heart, lung or liver disease
• neuromuscular conditions which affect the nerves and muscles 
• a weakened immune system (immunosuppression) 
• cystic fibrosis, which is an inherited condition that affects the internal organs by clogging them with mucus

Young children who are born prematurely also have a higher risk of developing complications.

Antibiotics may be prescribed to treat severe cases of middle ear infection or cases that get worse after two or three days. A long-term course of antibiotics may also help to prevent long-term or recurrent middle ear infection.

Painkillers and antihistamines

Painkillers, such as paracetamol and ibuprofen, may be used to control the main symptoms of middle ear infection (pain and fever).

Aspirin should not be given to children who are under 16 years of age.

Nose drops containing decongestants or antihistamines may be used to reduce the swelling of the membranes in the nose and at the back of the throat. This may help to keep the Eustachian tubes clear and allow mucus to drain from the middle ear. However, nose drops have not been proven to be an effective treatment for middle ear infection.

In adults with long-term (chronic) middle ear infection, drops containing antibiotic medication have been shown to help reduce the amount of pus that comes from the ear.

Tympanostomy tubes

For children with recurrent, severe middle ear infections, tiny tubes may be inserted through the eardrum to help drain fluid. These tubes are called grommets or tympanostomy tubes.

Tympanostomy tubes are not recommended in all cases because there is a chance that they may cause other problems. For example, they can become blocked or infected themselves.

Surgical procedures

Similar risks are associated with an operation called a myringotomy, which is where a small hole is made in the eardrum to allow fluid to drain out.

Removing the tonsils and adenoids (small lumps of tissue that are located at the back of the throat) may help if they are blocking the entrance to the Eustachian tube.

Otitis media with effusion

Antibiotics, steroids, antihistamines and decongestants are not recommended to treat otitis media with effusion (OME).

If OME has been present for 12 weeks or more, your GP will refer you to an ear, nose and throat (ENT) specialist.