Middle Ear, Eustachian Tube, Inflammation/Infection Follow-up

Updated: May 01, 2020
  • Author: Robert B Meek, III, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Further Outpatient Care

After 3 months, re-evaluate patients treated conservatively for otitis media with effusion (OME). Ninety percent of effusions that are going to clear without surgical treatment do so by 90 days. If no resolution of effusion occurs, consider myringotomy and ventilation tube insertion.


Further Inpatient Care

Inpatient care is seldom required for uncomplicated otitis media (OM). Patients may need admission for IV antibiotics and surgical drainage for extracranial/intracranial complications of acute or chronic otitis media (OM).


Inpatient & Outpatient Medications

See the list below:

  • First-line antimicrobials used for otitis media (OM) include amoxicillin, trimethoprim/sulfamethoxazole, and erythromycin/sulfisoxazole. Despite the prevalence of resistant strains, the low cost and effectiveness in most patients supports continued use of these drugs.

  • Second-line antimicrobials for otitis media (OM) include amoxicillin/clavulanate, cefuroxime, clarithromycin, and azithromycin. These antibiotics and others in their class offer a broader spectrum of coverage. A 2- to 3-week course of a second-line antibiotic has been shown to improve the resolution of OME in 15% more patients compared with no treatment at all. Multiple courses of antibiotics have shown no benefit.

  • Pseudoephedrine is an ingredient found in oral decongestants. Oral decongestants are used in the treatment of eustachian tube dysfunction (ETD) and can help decrease peritubal edema provoked by allergies or URI.

  • Oxymetazoline is an ingredient found in topical decongestants. Topical decongestants can be used acutely for eustachian tube dysfunction (ETD) but must be discontinued after a maximum of 5 days to prevent rebound swelling.

  • Budesonide, fluticasone, beclomethasone, mometasone, triamcinolone, and flunisolide are steroids used in nasal sprays. Steroid nasal sprays are used in the hope of decreasing the peritubal edema on a long-term basis. These agents are most helpful in patients with allergic rhinitis. The results of one study suggest that intranasal steroid sprays alone do not help eustachian tube dysfunction. [20]



Evaluation by an otolaryngologist is recommended for any signs of extracranial/intracranial complications or for chronic effusions with hearing loss.



See the list below:

  • Environmental modification is recommended.

    • Breastfeeding is recommended for at least 3-6 months. A meta-analysis reported a 13% reduction in the frequency of otitis media (OM) associated with breastfeeding for this period of time.

    • Smoking in proximity to the children is not recommended. Two meta-analyses reported the relative risks (1.2-1.7) of passive smoke in the development of otitis media (OM).

    • Limit pacifier use to the moments when the child is falling asleep. A recent study revealed a 29% lower rate of acute otitis media (AOM) in children with limited pacifier usage.

    • Limit daycare exposure when possible; limited exposure can help decrease the frequent development of URTIs. Daycare enrollment is a greater risk factor for otitis media (OM) than parental smoking.

  • Vaccination is the main form of prevention currently available.

    • Haemophilus influenzae type B vaccination is administered to infants for prevention of meningitis and other invasive infections. H influenzae type B causes only approximately 2% of otitis media (OM). Nontypeable H influenzae accounts for a larger percentage of otitis media (OM); however, a common antigen that would cross protect against the various strains of this bacteria has not been developed.

    • Heptavalent pneumococcal conjugate vaccines currently are administered to infants at age 2, 4, and 6 months with a booster dose administered at age 2 years. A significant reduction in otitis media (OM) caused by the serotypes contained in the vaccine was demonstrated in a 2000 Kaiser Permanente vaccine study. [22] Ambulatory visits were reduced by 42.7% for acute otitis media (AOM), and antibiotic prescriptions were reduced 41.9% from 1997-99 to 2004.

    • With the decrease in pneumococcal infections, B-lactamase–producing H influenzae has increased. Luckily, the disease course has been less virulent although more difficult to eradicate with first-line antibiotics.

    • A vaccine for Moraxella catarrhalis is currently being investigated. M catarrhalis has been isolated in approximately 10% of patients with acute otitis media (AOM). URTI is the common denominator in many causes of otitis media (OM).

    • Viral vaccines are currently under investigation including vaccines against adenovirus, respiratory syncytial virus, and influenza. A Finnish study investigating an influenza vaccine showed a reduction in the incidence of URTI and acute otitis media (AOM) in infants who attended daycare during an influenza epidemic.



See the list below:

  • Tympanic membrane perforation

  • Hearing loss

  • Cholesteatoma

  • Meningitis

  • Brain abscess

  • Subdural empyema

  • Subperiosteal abscess

  • Petrositis

  • Labyrinthitis

  • Sigmoid sinus thrombophlebitis

  • Otitic hydrocephalus

  • Facial paralysis

  • Death



Prognosis is excellent if infection is not permitted to spread beyond the middle ear and eustachian tube. Permanent sequelae are usually rare.


Patient Education

Education of parents in the form of risk factor reduction is useful. Modifiable risk factors include breastfeeding exclusively for at least 3 months, avoidance of parental cigarette smoke, feeding the baby in an upright position, limiting pacifier usage to just when the infant is falling asleep, and avoidance of daycare attendance, if possible.