How contagious is otitis media? | Acute inflammation of the middle ear

How contagious is otitis media?

As a rule, acute middle ear infection is not a contagious disease. There is therefore no risk of infection in sick persons. In this context, however, a distinction must be made between simple otitis media and otitis media triggered as a symptom of a bacterial infection.

In contrast to isolated acute middle ear infection, bacterial infections of the nasopharynx, which are accompanied by earache, are highly contagious. In general, it can be assumed that the acute form of middle ear infection is much more frequently caused by bacterial pathogens than by viruses. For this reason, it is not an independent clinical picture, but a secondary disease associated with the bacterial infection.

How contagious the acute middle ear infection actually is therefore depends on the pathogen on which it is based. Measles and influenza viruses are among the most common viral pathogens that lead to the development of acute middle ear infection. Pneumococci and streptococci are at the forefront of the bacterial pathogens causing acute inflammation of the middle ear.

Therapy of acute inflammation of the middle ear

General measures for the treatment of acute middle ear inflammation are bed rest and the use of anti-inflammatory drugs (NSAIDs) and, if necessary, painkillers and antipyretics (e.g. paracetamol). In the bacterial form of the disease, the administration of antibiotics such as penicillin V, amoxicillin, cephalosporins or macrolides is indicated. These drugs are initially administered orally (tablet form) for 4 days.

If there is no improvement in symptoms after this period, antibiotic therapy via the vein using an infusion (i.v. therapy) is necessary. If a rhinitis is present at the same time, decongestant nasal drops can also be used to improve ventilation through the nose.

If the ear is running, the auditory canals should be rinsed with warm water and cleaned of secretions with cotton wool. An incision of the eardrum (paracentesis) as a therapeutic measure may become necessary if the symptoms of fever, pain and a bulging eardrum persist without a spontaneous tearing of the eardrum with discharge of secretion. Paracentesis is performed under local anesthesia or, especially in children, under general anesthesia and is performed on the anterior lower quadrant of the eardrum so that the ossicles do not risk slipping (luxate). Once the inflammation has subsided, pressure can be exerted on the middle ear (holding air and closing the nose, then exerting pressure on the ears as if to “squeeze the air out of the ears” = Valsalva manoeuvre) to ensure the permeability of the auditory tube and prevent the development of negative pressure in the tympanic cavity.


A complication of this form of inflammation is the toxic inflammation of the inner ear (labyrinthitis) with hearing loss in the high frequency range due to bacterial toxins. If the acute inflammation of the middle ear does not heal after 2-3 weeks, mastoiditis, an inflammation of the ventilated cells of the mastoid process, is suspected to develop. The duration of an acute inflammation of the middle ear can vary greatly.

It depends mainly on the extent of the inflammatory processes, the immune system of the patient concerned and the time of the start of therapy. In addition, a distinction must be made as to whether it is a virus-induced or a bacterially induced acute inflammation of the middle ear. In this context, the affected patients must be aware that virus-induced forms can usually persist for a long time.

The reason for this is that diseases caused by viruses can only be treated symptomatically. A complete cure always depends on the adequate reaction of the body’s own immune system. Bacterially caused acute middle ear infections, on the other hand, heal completely in many cases without medical intervention within a period of about one week.

By administering a suitable antibiotic, the course of the disease can be positively influenced and the duration of the acute inflammation of the middle ear shortened. On average, it can be assumed that an uncomplicated acute middle ear infection should heal completely within a period of about two weeks. If the healing time exceeds this period despite the administration of a suitable antibiotic, the inflammatory processes on the jawbone and mastoid must be prevented.