Synonyms in a broader sense
Medical: Otitis media acute otitis media, hemorrhagic otitis media, myringitis bullosa English: acute otitis media
General information
Acute otitis media is a very common disease that can occur at any age, but it is preferred in young children. Thus, statistically over fifty percent of all infants are already suffering from acute middle ear infection within the first year of life. In most cases, the acute middle ear infection is caused by pathogens that ascend from the throat via the so-called tube (a kind of ventilation tunnel for the middle ear) into the middle ear.
The inflammation is mainly caused by bacteria, such as staphylococci or streptococci. However, viruses also occur very frequently as pathogens and often form the basis for a subsequent bacterial infection. Middle ear infections often develop after a previous infection of the upper airways.
Forms of progression
There are various forms of acute middle ear inflammation. There is the mild course of the so-called otitis media catarrhalis, which is usually viral and only accompanied by mild general symptoms such as a slight feeling of pressure and moderate ear pain. Fever rarely occurs in the mild course of acute otitis media catarrhalis.
This form of otitis media usually subsides of its own accord within a few days and does not require antibiotic therapy. The more severe form, known as otitis media purulenta, on the other hand, can last much longer and above all cause more severe symptoms. An acute onset with severe ear pain and fever is characteristic here.
Furthermore, considerable disturbances of hearing can occur. A frequently severe feeling of illness usually subsides after the first four days. This may also be associated with a spontaneous tearing of the eardrum (perforation), which is often accompanied by purulent discharge from the ear.
However, a complete healing of the severe middle ear inflammation with disappearance of the symptoms may take up to three weeks. This usually results in a complete restoration of hearing. A perforated eardrum usually heals on its own within 2 weeks after the inflammation has subsided.
General duration of acute otitis media
An acute inflammation of the middle ear can last from one day to 3 weeks. Any inflammation of the middle ear that lasts longer than 3 weeks is considered chronic inflammation of the middle ear. An acute inflammation of the middle ear, known in the technical jargon as otitis media acuta, is the generic term for all inflammatory diseases of the middle ear, which is characterized by a fast onset and short duration.
Due to their multiple causes and dependence on various factors, the duration of the disease is also highly variable. An uncomplicated inflammation of the middle ear lasts on average one week. However, it can take considerably longer in the case of complications or immunocompromised patients.
On the other hand, especially in children, an uncomplicated middle ear infection can be completely healed after one to two days. If the inflammation of the middle ear occurs more than 6 times a year, it is called recurrent otitis media acuta, or recurrent otitis media acuta. How long an acute inflammation of the middle ear lasts in a baby depends on various factors.
One important aspect is the baby’s immune system. When the baby is born, it is protected by the colloquial “nest protection” until about 9 months of age at the most and must first build up its own immune system. From the 2-3 months of life, the “nest protection” is already decreasing, while the baby’s own immune system is slowly developing.
However, the “nest protection” provided does not protect against all diseases, but only those that the mother herself has experienced or against which she has been vaccinated. But there are exceptions to this rule, so that the baby can still get certain diseases. Inflammation of the middle ear in babies and children is usually caused by pneumococcus and Haemophilus influenza.
If the mother was vaccinated against them during pregnancy, it is likely that the baby has received this protection. If this is not the case, and the baby develops otitis media, the immature immune system must build up during the illness. This means that middle ear infection can last longer than in infants.
In addition, the inflammation of the middle ear mainly manifests itself in the form of general symptoms. The rule is that the younger the child is, the more general symptoms rather than local local symptoms are more important. Some babies touch their ears because of earaches – but not all of them do so.
This often makes it more difficult to recognise an otitis media immediately, delays the appropriate treatment and thus prolongs the duration of the middle ear infection. Once the middle ear infection has been diagnosed, antibiotics only help in the case of bacterial infections. These can then accelerate healing.
However, babies cannot tolerate all antibiotics. They are also ineffective in a viral infection, which happens in about a quarter of middle ear infections. A good sign of middle ear infection in babies is a rise in temperature and fever.
This is also a sign that the healing process is accelerated in some way. The fever is a sign that the immune system is fighting the pathogens. Since the baby’s immature immune system means that it can otherwise hardly defend itself against the inflammation, the body’s fever is the “remedy of choice”.
The fever usually lasts several days and is divided into three phases: fever rise, fever stasis and fever fall. If the baby is adequately supported in these three phases, fever can reduce the duration of a middle ear infection to a few days. In contrast to the baby, the infant no longer has “nest protection”, but has its own immune system, which is still being built up.
Again, the duration of the middle ear infection depends on various factors. The duration of an acute middle ear infection in an infant can be shorter with a good immune system than in a baby. This means that it can sometimes be completely cured after a single day or even a few days.
In a toddler with a less good immune system, the middle ear infection can last longer compared to the baby who has a good “nest protection” provided by the mother. The duration of the middle ear infection can also be slowed down by the infant’s urge to move around if he or she is difficult to rest and is “raving” around. Physical rest is necessary for the otitis media to heal.
A small child cannot always necessarily understand this. Some toddlers who feel ill as a result of the middle ear infection seek rest on their own and sleep a lot. Other toddlers are more upset and are not able to maintain physical rest well, which often delays the healing process.
A vaccination against pneumococcus and Haemophilus influenza is possible from the 2nd month of life. An infant who has been vaccinated against these pathogens has a lower risk of developing otitis media. In the case of an acute inflammation of the middle ear caused by bacteria, which is not an uncomplicated inflammation of the middle ear, antibiotic therapy can shorten the duration of the disease by minimising complications.
After 2-3 days of antibiotic therapy, the risk of infection is usually over. Nevertheless, the antibiotic must still be taken to avoid so-called resistance. Depending on the type of antibiotic, the antibiotic is usually taken for between 5 and 7 days.
In addition, although the person concerned is no longer infectious, he or she is not necessarily healthy. In order for the middle ear infection to heal completely, it is important that the person concerned continues to take it easy until he has completely recovered from the inflammation. If the middle ear infection has not been treated with antibiotics, the risk of infection is usually somewhat longer.
The regeneration phase can also take a few days longer. However, the antibiotics do not work in a viral infection. In that case, middle ear infection with and without antibiotics would probably take the same amount of time.
However, antibiotic treatment might cause side effects and these might delay the healing process. Whether or not antibiotics should be used to treat middle ear infection is something that needs to be considered and decided individually with the doctor. Depending on the cause, age, immune system and severity of the middle ear infection, it can be completely cured after a few days or last up to a few weeks without antibiotics.
If an inflammation of the middle ear lasts longer than a few days, a doctor should be consulted. If you do not want to take antibiotics because it is not a bacterial infection or for personal reasons, you should discuss this with your doctor if the middle ear infection persists or recurs. Otitis media is usually accompanied by hearing loss.
When the inflammation subsides, a tympanic effusion often forms afterwards. This can persist for days or weeks after the inflammation. The tympanic effusion hinders the transmission of sound in the ear.
As a result, those affected complain of muffled hearing and a feeling of pressure on the ear. This can be very unpleasant for the affected person, but it is in principle harmless. After a few weeks at the latest, the hearing loss subsides and there is usually no damage.
It is different when bacteria from the middle ear reach the inner ear as part of the middle ear infection. There they can damage the inner ear and cause inner ear hearing loss. The damage to the inner ear is not reversible.
The ENT doctor is the best person to differentiate between hearing loss caused by tympanic effusion and hearing loss caused by damage to the inner ear. Therefore, if the hearing loss is persistent, 2-3 weeks after the middle ear infection, it should be examined by an ENT specialist. In the case of damage to the inner ear, treatment must be carried out urgently to prevent serious damage.
In most cases, an incision of the eardrum, a so-called paracentesis, is recommended in order to avoid permanent serious damage. An incision of the eardrum is also recommended for children with a pronounced inflammation of the middle ear and immunocompromised patients to prevent permanent hearing loss. As a rule, a sick leave of one week is sufficient for uncomplicated middle ear inflammation.
If fever, hearing loss, severe pain or other complaints and complications occur, further treatment and an extension of the sick leave are necessary. Especially in the first few days there is a risk of infection, even if antibiotics are taken. It is therefore important that those affected stay away from kindergarten, school and work.
But even when the danger of infection is over, many affected people are still not completely healthy and not yet able to participate in the daily kindergarten, school and work routine. This should be discussed individually with the doctor. In the case of an uncomplicated middle ear infection, the acute, severe ear pain usually subsides after 1-3 days.
If a fever has occurred at the same time, it usually subsides after 3 days. In the course of the fever, general aching limbs can occur, which usually subside even when the fever drops. If a tympanic effusion has formed in the course of the inflammation of the middle ear, hearing loss and pressure pain can last from a few days to 2-3 weeks.
