I hear frequently from parents across the United States that their family doctors and pediatricians don't seem to know much about the treatment of ear infections. Some of the older doctors were trained to do lancing or myringotomies for bulging middle ear infections but now that seemed to be a thing of the past. With the otoscopes or instruments that are now mostly used by doctors, there is no way that an ear canal can be cleaned or a myringotomy done under direct visualization. I have done a myringotomy even on a six-week-old baby who came in for a well baby check, but who I found had a bulging, bright red ear drum. I was amazed at the amount of pus that came out. This was a baby who could easily have developed meningitis or mastoiditis.
The signs of ear infections are variable and depend somewhat on the age of the child. Babies may just be irritable or cry a lot. Also they may or may not have a fever. Some will cut down on their milk or food intake. Older children may pull at the affected ear or keep their head turned to the side where the ear is painful. If there is a thick, pus-containing discharge coming from the ear then the ear drum has probably broken because of an ear infection. I then would see a pediatric ear-nose-and throat doctor and probably not bother to see a pediatrician or family practice doctor unless they have had wide experience treating ear infections.
With the increase in hearing loss among children and teens in the U.S., ear infections must be taken very seriously. Sometimes doctors put children on many courses of antibiotics without referring them to an ENT specialist. Thus parents must be agressive and take their child to see a pediatric ENT doctor. Nurse practitioners and physician assistants should not treat infants or children with ear infections. If the doctors are not doing a very good job with ear infections, it is not fair to expect someone with half as much training and often little pediatric training to treat ear infections.