The conventional treatment of otitis media—most commonly antibiotics and tympanostomy tubes (“ear tubes”)—has been increasingly questioned. According to Family Practice News (October 15, 1998; page 30), physicians in the Netherlands generally do not use antibiotics as a first-line treatment for otitis media, instead relying on decongestants. Antibiotics are reserved for cases in which other measures fail.
In the United States, concern has been raised that antibiotics are overused in treating ear infections. An article in Family Practice News (June 15, 1996; page 43) attributed the rising prevalence of antibiotic-resistant bacteria in part to routine antibiotic use for otitis media. The article reported that resistant strains of Streptococcus pneumoniae increased from 6% to 20% between 1992 and 1995. In 1994 alone, otitis media accounted for approximately 29.6 million physician visits, and 85% of patients received antibiotic prescriptions.
The Dutch approach may be relevant, as allergies appear to play a significant role in many cases of otitis media. Research published in Otolaryngology—Head and Neck Surgery (May–June 1981;89:427–431) evaluated 119 patients with fluid present in the ear and a history of otitis media within the previous six months. Of these patients, 93.3% were found to have allergies confirmed by positive RAST testing. After one year, 91.6% of patients who were evaluated and treated for allergies experienced improvement—substantially better than the 52.2% success rate observed in a surgically treated comparison group. Additional research published in Otolaryngology—Head and Neck Surgery (1996;114:531–544) found that 89% of 103 patients with otitis media, middle-ear effusion, or both also had allergies.
There is also evidence that some children with otitis media may respond to nutritional support. A study published in the Annals of Otology, Rhinology, and Laryngology (July 2002;111[7, Part 1]:642–652) examined 44 children with low levels of eicosapentaenoic acid (EPA), vitamin A, and selenium. Seven children received cod liver oil (a source of EPA and vitamin A) along with selenium supplementation. During the supplementation period, five of these children experienced no ear infections, and overall, the supplemented group required antibiotics for otitis media on 12% fewer days compared with baseline.
The use of tympanostomy tubes has also been questioned. An article in Family Practice News (December 15–31, 1990;20[24]:1,30) noted that tube placement may increase the risk of hearing loss. Some studies have compared outcomes in children who had a tube placed in one ear but not the other. While tubes may provide short-term benefit—generally lasting six months or less—long-term outcomes are less favorable. One study following 98 children over five years found a 21% higher incidence of deafness in the ear that received tube placement.
In the United States, the standard approach to otitis media typically involves antibiotic therapy, followed by tube placement for recurrent cases. However, accumulating evidence suggests that routine antibiotic use may offer limited benefit—effective in only about 14% of cases—and that surgical intervention may carry long-term risks. These findings raise questions about the automatic use of antibiotics and ear tubes in the management of otitis media.
