When does earache require antibiotics?

BUFFALO, N.Y. (WIVB) - It's a question many parents wrestle with every year: when should you bring your child to the doctor if he or she has an ear infection?

Dr. Howard Faden said, "Ear infections are the most common reason why parents bring their children to a pediatrician."

Dr. Faden is professor of pediatrics at UB and chief of the infectious disease service at Children's Hospital. He points out that pain is the first symptom, but many kids can't tell you about it.

"Young kids will cry, or tug at their ears, or really be very restless, and not sleep through the night," Dr. Faden explained. "That's an indication to the parents that something is going on."

Those kids should be brought to a doctor for an examination.

The middle ear is a chamber behind the eardrum. In a significant ear infection, the middle ear fills with fluid and the eardrum bulges out. The doctor can see that and make a diagnosis.

"The eardrum has to be bulging, so if you have pain and you have bulging, you now have the diagnosis of acute ear infection, or acute otitis media," Dr. Faden said.

That child would be treated with antibiotics. But if the eardrum isn't bulging, you can wait.

Dr. Faden noted, "85 percent of children who have an ear infection will get better within the first 48 to 72 hours, even without treatment. The doctor, in consultation with the family, can say, 'Would you be comfortable if we just watch and wait for 48 to 72 hours?'"

You can give the child some pain medication, and if the child doesn't get better, or gets worse, then you bring the child back to the doctor for treatment. The idea is to use antibiotics only when they're really needed.