Parents Can Tell If an Ear Infection Is Really Getting Better

March 8, 2018 by: Roy Benaroch, MD Article Tags:

Good things come in small packages. A short, sweet letter to the editor in the November, 2016 edition of JAMA Pediatrics confirms that parents can tell whether their children are getting over an ear infection, with no doctor exam required.

The letter, from four Finnish physicians, is about a page long. It summarizes a small part of their data from a much larger study on the treatment of ear infections. In the letter, they’re only looking at 160 children, aged 6 months to 3 years, who were initially treated for an ear infection without any antibiotics. Current guidelines from the US and many other countries do support treating less-severe ear infections with pain relievers only, and waiting on administering antibiotics. But these guidelines suggest that if children with ear infections aren’t given antibiotics, they need to be followed closely and re-examined to make sure they’re really getting better. These authors asked if that’s really necessary.

The 160 children were all re-examined for this study, and parents were also asked questions about whether they thought their children were improving, getting worse, or staying about the same. It turns out that among the children whose parents thought were getting better, only a very small number had worsening ear exams (less than 3%). Compare that with children thought to be getting worse – about 30% had worsening findings on their ear exams. Keep in mind that these were all children who did not receive any antibiotics. Presumably, if they had, even fewer of them would have gotten worse.

So: parents, not surprisingly, were pretty good at judging whether their children were getting better. So good that based on these numbers, a repeat exam to make sure ear infections were clearing was probably unnecessary!

Caveats: I’d be a little more cautious with children at risk for prolonged ear infections or persistent fluid behind the ears. Children with a history of difficult-to-treat ear infections should get a repeat exam, as should kids with hearing problems or developmental language delays – it’s crucial that those children get over their infections completely. But for the majority of children with ordinary ear infections that seem to be getting better, it may be reasonable to wait until their next check-up to look at those ears again. Most of the time, parents’ judgement can be just as good as an ear exam.

Roy Benaroch

Roy Benaroch, MD

Roy Benaroch, MD, FAAP is an Associate Adjunct Professor of Pediatrics with Emory University. He has produced several courses exploring medical cases for laymen in his "Medical School for Everyone" lectures, available from The Great Courses, and has also written books for parents and chapters in medical textbooks. He is also on the Board of Directors of The Children's Care Network, one of the largest clinically integrated pediatric care networks in the country. Dr. Benaroch practices general pediatrics near Atlanta, GA.