Acute Otitis Media

Symptoms

Acute otitis media is inflammation of the middle ear with local or systemic signs of inflammation and pus formation (fluid accumulation in the middle ear). It occurs primarily in infants and young children. Possible symptoms include:

  • Earache
  • Increased temperature, fever
  • Hearing disorders
  • Feeling of pressure
  • Irritability, crying
  • Digestive disorders: Lack of appetite, abdominal pain, diarrhea, unwillingness to drink.
  • Fatigue

Children point to the ear, pulling and rubbing it. In the course of the disease, perforation of the eardrum may occur. In this case, the secretions empty into the external auditory canal and run out of the ear (otorrhea). This usually results in a pleasant relief of pain for young patients. Parents may understandably be greatly disturbed when pus suddenly flows from their child’s ear.

Causes

Acute otitis media is mainly caused by bacteria that travel from the nasopharynx through the Eustachian tube to the middle ear. The most common pathogens are , and . Viruses rarely trigger the infection, but are considered pathogens and may be involved in the disease process. Middle ear infection is usually preceded by a cold. Swelling in the upper respiratory tract causes obstruction of the Eustachi tube (tubal catarrh), which prevents the removal of secretions and germs from the middle ear. This favors the development of a secondary infection with bacteria. On the one hand, the fluid in the middle ear promotes the development and, on the other hand, triggers pain, a feeling of pressure and a reduction in hearing. Infants and young children are more susceptible to middle ear infections because of the short, horizontal, and not fully formed Eustachi tube.

Complications

Complications are very rare. The infection may spread further into the surrounding tissues and nervous system. This can lead to inflammation of the inner ear labyrinth, mastoid, meninges, or brain. Other possible complications include hearing loss, scarring of the eardrum, and chronic or recurrent disease. See under mastoiditis.

Diagnosis

Diagnosis is made by medical treatment based on history, clinical symptoms, and otoscopy, in which the tympanic membrane is evaluated. Other diagnostic methods such as tympanometry may be used. Differential diagnoses include diseases of the ears and upper respiratory tract such as simple tubal catarrh, ear plug, otitis externa, and common cold.

Drug treatment

Analgesics:

  • Such as acetaminophen, ibuprofen, or diclofenac are effective against the pain and partially against the inflammation. They are considered first-line remedies. For children, suppositories, syrups, or drops are available. The correct application must be observed.

Antibiotics:

Decongestant nasal sprays:

  • With active ingredients such as xylometazoline or oxymetazoline may be able to help improve breathing and promote the drainage function of the eustachian tube. In infants and young children, the low maximum daily doses and generally short maximum treatment duration of 5-7 days must be considered.

Pain-relieving ear drops:

  • The use of pain-relieving ear drops containing local anesthetics or NSAIDs is controversial. Scientifically, it has not been well studied. In children younger than 2 years of age, ear drops should be used only with a physician’s prescription, and use in perforated eardrums is contraindicated.