What's the latest with ear infections?

It's time to return to a staple of my trade... ear infections. Ear infections remain one of the most common reasons that parents turn to their child's pediatrician. Often it's due to the middle of the night crying with ear pain. Sometimes it's due to the week long complaining that their child can't hear. Ear infections clearly come in several colors.
Usually, ear infections start off as a "cold" with cough and congestion, often for several days, before the classic sign of ear pain begins. Sometimes, but not always, there is fever. Often, the fever doesn't start until the children have had cold symptoms for a few days. Other times, the children will come in for a regular check up with no symptoms at all and, during their exam, we'll find an ear infection. Parents are always curious how that could possibly be true, but it is.
Probably most frustrating are the kids who complain of ear pain, have cold symptoms, come in to the office and I see no evidence of an ear infection on exam. This is probably due to eustacian tube dysfunction. Basically, the "relief valve" of the middle ear is so swollen and clogged with mucous that the children develop pain, much like the discomfort one has when ascending and descending in an airplane.
For decades, the treatment of choice for ear infections has been a round of antibiotics. That dogma is beginning to change. There have been a number of good studies demonstrating that 90-95% of ear infections resolve without antibiotic therapy. Fifty percent of them are viral infections and won't respond to an antibiotic anyways. There are also more recent studies that suggest that even if the infection is bacterial, antibiotics might not speed recovery or hasten the resolution of pain. The most recent American Academy of Pediatrics guidelines suggest that in children older than two, the pediatrician consider providing pain relief and not antibiotics for the infection. For pain relief, parents can use Motrin or Tylenol. A warm moist washcloth placed over the ear that hurts can also provide relief of pain. Some physicians recommend narcotics (codeine) though I find that these medications provide no more relief than Motrin. Finally, there are prescription ear drops that have a topical anesthetic in them that can temporarily provide relief.
However you choose to treat the ear infection, it is important that someone trained to evaluate ears look at the childs ears to confirm the presence of an ear infection as there are a large number of ears that hurt that are not infected.
As always, consult your child's pediatrician if you have specific questions.