Depending on the pathogen present, i.e. virus or bacterium, the individual situation of the immune system and the treatment of the acute middle ear infection, the course of the disease can vary. A few days after the onset of the disease, there may also be a spontaneous tearing of the eardrum, as too much pus or fluid has accumulated in the ear. The eardrum can no longer withstand the resulting pressure.
This tear, also known as a perforation of the eardrum, is usually associated with a short, sharp and very severe earache, but the earache and fever quickly improve. However, a slight and reversible hearing loss may occur again after a few days or weeks. Through the hole in the eardrum, pus can flow out of the ear, which can also be a little bloody.
This leads to pressure relief and renewed ventilation of the middle ear, which may promote the healing process as long as no germs from outside enter the middle ear through the perforated eardrum. The small tear in the eardrum usually heals on its own within 2 weeks. Antibiotic treatment of the disease can usually be postponed for one or two days, as most acute middle ear infections heal on their own, especially in children.
There are, however, some warnings, which must be followed by a doctor if they occur. These include: You should also be particularly vigilant if you have had an acute inflammation of the middle ear with serious complications in the past, if you have had repeated inflammations of the middle ear in the recent past, or if there are immunodeficiencies or previous operations on the middle ear. In these cases, an early visit to the doctor is advisable to assess the risk of complications and provide timely treatment.
- Very high, persistent fever, feverish infants under three months of age with fever above 38 degrees
- Continued vomiting
- No significant improvement on therapy after two to three days
- Disturbances of consciousness
- A seizure
- Again increasing complaints (like an increasing ear pain after initial improvement)
- Facial muscle paralysis
- A suddenly protruding ear on one side due to swelling, combined with a painful pressure
The most effective treatment of the symptoms of acute middle ear inflammation is the causal therapy, because when the pathogens causing the inflammation are fought, the symptoms also disappear. In many cases, the immune system manages to fight the inflammation on its own. However, if no improvement is in sight after two to three days, causal treatment of the disease should be started.
Bacterial inflammation should then always be treated with antibiotics, as this prevents the eardrum from rupturing and the course of the disease can be shortened. The therapy can also reduce the intensity and duration of the symptoms. In the past, the eardrum was often opened by a small incision to allow the secretion to drain away.
Nowadays, we wait and see whether the breakthrough happens by itself, as it has been observed that a torn eardrum heals better than one that has been cut open. A symptomatic therapy with painkilling medication, for example with ibuprofen, is useful, because in addition to the painkilling effect, an anti-inflammatory effect can also be achieved with the active substance. Decongestant nasal sprays can also help, as they ideally restore the connection between the throat and the tympanic cavity and thus drastically improve the symptoms. In general, it is true that physical protection can promote the progression of the disease and ensure rapid recovery and improvement of symptoms.