Cause/Genesis

The typical triggering bacterium in adults is Streptococcus pyogenes, while common otitis media pathogens in children are Streptococcus pneumoniae or Haemophilus influenza. Bacterial-viral middle ear inflammation can also be viral or a combination of both.

History

The course of an acute inflammation of the middle ear can vary greatly depending on the immune status of the affected patient and the severity of the inflammatory processes. If suitable treatment is initiated promptly, an acute inflammation of the middle ear can heal completely within a week, even without the administration of antibiotics. However, if the symptoms experienced by the patient tend to be severe, the course of the disease should be positively influenced by the administration of an antibiotic.

In addition, recurrent (frequently recurring) and/or long-lasting acute middle ear infections also require antibiotic treatment. Failure to provide suitable therapy can lead to considerable complications in the course of the acute inflammation of the middle ear. For this reason, any acute inflammation of the middle ear that persists for more than a week, even with the use of common household remedies, should be treated with urgent medication.

Typical complications that can occur in the course of an acute inflammation of the middle ear are inflammations of neighbouring structures. Even mild acute inflammation of the middle ear can lead to a rupture of the eardrum if the course is unfavourable. However, the eardrum usually re-grows completely after the inflammation has subsided.

In the case of an acute inflammation of the middle ear, which does not subside completely even after the administration of a suitable antibiotic, it is suspected that the inflammatory processes have already spread to the bone behind the ear (mastoid process). In the case of this inflammation of the bones, which occurs in the course of the acute inflammation of the middle ear, it is known as mastoiditis. As the disease progresses, purulent fluids may be secreted and stored in the air-filled cavities of the mastoid process. If no extensive therapy is initiated in the affected patients at this time, other neighbouring structures can be affected. In the worst case, inflammatory processes in the area of the meninges (meningitis) or inflammation of the inner ear, which is accompanied by pronounced rotational vertigo, may develop in the course of the disease.

Diagnosis

In the course of an uncomplicated inflammation, certain changes in the eardrum (tympanum) occur in the following order With the onset of ear-running, the earache suddenly improves, as the perforation relieves the eardrum of the pressure and tension of the secretion and the middle ear is freed from the irritating secretion. In reverse order of the above-mentioned eardrum findings, the inflammation heals. Often a scar remains on the eardrum, which turns whitish when the eardrum is examined.

In the case of an inflammation of the middle ear caused by influenza viruses (haemorrhagic otitis media, myringitis bullosa), blood bubbles are found on the eardrum, which, when bursting, empty blood-serious secretions into the ear canal. – Vascular imaging (injection) at the hammer handle, which lies against the eardrum. – Vascular drawing on the entire eardrum.

Redness and protrusion of the upper quadrant of the eardrum. This finding recedes or moves on to the next stage (4). – Diffuse redness and protrusion of the entire tympanic membrane and the wall of the auditory canal. – The eardrum spontaneously tears and yellowish-clear (serous) and later purulent (putrid) fluid (secretion) flows out through the resulting pinhead-sized opening. – The ear “runs” (otorrhoea), i.e. mucusy-purulent secretion from bacterial inflammation and serous-bloody secretion from the external auditory canal in viral infections.