For children/babies | Therapy of an acute inflammation of the middle ear

For children/babies

Acute inflammation of the middle ear is a disease that is particularly common in children and infants. The symptoms of this inflammation can be recognised by a paediatrician who looks into the ear canal of the affected child and examines the eardrum there. Typically, children also grab the ears in the presence of otitis media, which is why such behaviour combined with severe pain can be a sign of an acute otitis media infection.

The therapy for children or infants is similar to the therapy recommended for adults. For infants under 6 months of age, immediate antibiotic administration is recommended. The same applies to children under two years of age if the otitis media occurs in both ears at the same time.

Immediate therapy should also be initiated if a doctor’s monitoring of the course of the disease is unlikely to be maintained. For all children older than two years of age, depending on the individual assessment of the treating physician, a wait of up to two days should be allowed before antibiotic therapy is started. Should the inflammation recede, the administration of antibiotics may be dispensed with under certain circumstances.

The standard antibiotic of first choice is amoxicilin, as is the case with adults. The duration of antibiotic therapy for children depends on their individual age. For example, antibiotic therapy of 10 days is recommended for children up to the age of two years, as well as for children with serious illnesses.

For children between the ages of two and six years, a 7-day therapy is recommended. From the age of 6, antibiotic treatment for 5-7 days is usually sufficient. Even in children, if the symptoms do not improve despite the administration of antibiotics, a so-called paracentesis, i.e. an opening of the eardrum, can be performed.

In any case, if an acute inflammation of the middle ear is suspected in an infant or child, a doctor should be consulted who can examine the sick child and, under certain circumstances, confirm the diagnosis and initiate appropriate therapy. The individual disease situation of the sick child or infant must always be weighed up before therapy can be initiated. Furthermore, in order to avoid complications and to assess individual risk factors, the patient should refrain from self-therapy exclusively with home remedies without consulting the treating physician.


If there is no satisfactory improvement even after changing the antibiotic, any complications should be ruled out and, in the event of a protrusion of the eardrum, which the doctor can detect, a so-called paracentesis should be performed with a microbiological examination of the draining secretion. This involves making a small incision in part of the eardrum under local anaesthetic – in children under anaesthetic – so that the secretion or pus can flow out of the middle ear. This is then further examined and an adequate therapy is sought.

This procedure also leads to a relief of pressure, which should be accompanied by an improvement of the pain. The pressure in the middle ear can also spontaneously lead to a tearing of the eardrum (perforation of the eardrum). This usually manifests itself as a sharp, brief pain, as a result of which the pain decreases.

This is also indicated by “ear running“, i.e. the emergence of middle ear secretions from the outer ear. An acute inflammation of the middle ear should be treated with antibiotics after a perforation of the eardrum, as further germs can penetrate from the outside, which can worsen the inflammation. In addition, when the ear is running, the ear canal should be rinsed with water at body temperature, but only by a doctor to avoid the spread of germs, and the ear canal should be carefully wiped with cotton swabs.

A perforation of the eardrum or a small incision in the eardrum usually heals on its own within 2 weeks without complications. After the acute inflammation has subsided, the so-called Valsalvam manoeuvre can also provide short-term relief. In this procedure, the air in the mouth is pressed firmly with the mouth closed and the nose closed, creating excess pressure in the throat area. This can cause the usually closed and swollen tube to open and thus ventilate the inner ear and eliminate the negative pressure that has meanwhile developed there. Chewing chewing gum or the like can have a similar effect, since the chewing movement enables the tube to be opened.