by Glickman-Simon R

Related Terms

  • Middle Ear Infection
  • Otitis Media

Acute otitis media (AOM) is an infection of the middle ear. It is the most common part of the ear to get infections.

AOM usually follows a cold or sore throat. The virus or bacteria travels through a short tube that joins the middle ear to the throat. Ear infections affect infants and children more often because the tube is shorter and narrower.

The infection causes a buildup of fluid behind the eardrum. This can lead to swelling, pain, or brief hearing loss.

Most middle ear infections go away on their own. Treatment involves a 2 to 3 day waiting period. Medications may help to ease symptoms. Antibiotics are used for suspected bacterial infections.

Natural Therapies

Some natural therapies may help to ease symptoms and prevent future ear infections. Most methods have little evidence supporting their benefits.

Likely Effective

Herbal ear drops—mix of specific herbs. At least one combination (containing mullein, garlic, St. John’s wort, and calendula) may be as effective as standard medicine for children. The drops are used to ease pain when waiting for an infection to pass.A1-3

Possibly Effective

  • Xylitol—a natural sugar used in many products as an artificial sweetener. May block the growth of certain bacteria. However, it may need to be taken several times a day over months to have a benefit.B1-B6
    • Note: High doses may cause side effects

Unlikely to Be Effective

  • Probiotics are good bacteria that live in the gut. They are unlikely to be effective in preventing ear infections.C1-3
    • Note: May be harmful for some people

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or supplements you are taking. Some may interact with your treatment plan or health conditions.

  • Herbal remedies are generally safe, but some may be irritating when used topically.
  • Xylitol is generally safe, but in doses above 30 grams a day it may cause stomach upset and diarrhea.
  • Probiotics may increase the risk of a dangerous infection in people with suppressed immune systems.


Herbal Ear Drops

REFA1 Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155(7):796-769.

REFA2 Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics. 2003;111(5 Pt 1):e574-e579.

REFA3 Levi JR, Brody RM, McKee-Cole K, Pribitkin E, O'Reilly R. Complementary and alternative medicine for pediatric otitis media. Int J Pediatr Otorhinolaryngol. 2013;77(6):926-931.


REFB1 refTapiainen T, Luotonen L, Kontiokari T, Renko M, Uhari M. Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

REFB2 Danhauer JL, Johnson CE, Corbin NE, Bruccheri KG. Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010;49(10):754-761.

REFB3 Vernacchio L, Corwin MJ, Vezina RM, et al. Xylitol syrup for the prevention of acute otitis media. Pediatrics. 2014;133(2):289-295.

REFB4 Marchisio P, Nazzari E, Torretta S, Esposito S, Principi N. Medical prevention of recurrent acute otitis media: an updated overview. Expert Rev Anti Infect Ther. 2014;12(5):611-620.

REFB5 Wargo R, Campbell M. Is xylitol effective in the prevention of acute otitis media? Ann Pharmacother. 2014;48(10):1389-1391.

REFB6 Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2016;(8):CD007095.


REFC1 Hatakka K, Blomgren K, Pohjavuori S, et al. Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study. Clin Nutr. 2007;26(3):314-321.

REFC2 Cohen R, Martin E, de La Rocque F, et al. Probiotics and prebiotics in preventing episodes of acute otitis media in high-risk children: a randomized, double-blind, placebo-controlled study. Pediatr Infect Dis J. 2013;32(8):810-814.

REFC3 Tapiovaara L, Lehtoranta L, Swanljung E, et al. Lactobacillus rhamnosus GG in the middle ear after randomized, double-blind, placebo-controlled oral administration. Int J Pediatr Otorhinolaryngol. 2014;78(10):1637-1641.

Revision Information

  • Reviewer: EBSCO NAT Review Board Richard Glickman-Simon, MD
  • Review Date: 02/2019
  • Update Date: 02/22/2019