Middle ear infection or otitis media is a painful disease in the area of the middle ear. It can occur acutely, as well as chronically. Triggers are mostly bacteria and viruses. Otitis media often occurs in young children. Typical signs are earache, hearing loss, fever and fatigue. A middle ear infection should be distinguished from an inner ear infection.
What is a middle ear infection?
A middle ear infection is also called otitis media in the medzin. It can occur acutely, as well as chronically. Typical signs of a middle ear infection are zuemist on both sides occurring ear pain. In addition, knocking in the ear, headache, fever and dizziness are also acute symptoms. Middle ear infection is mostly caused by bacteria and only in rare cases viruses are known to be the cause. In Germany, mostly babies and children suffer from this disease. The middle ear itself, is a cavity in the ear, which is filled with air. It is separated from the eardrum and thus also from the external auditory canal. In the middle ear are also the well-known ossicles anvil, hammer and stirrup. You can find out more about hearing here: Hearing.
Causes
The causes of otitis media can be of various reasons. Almost always, bacteria are responsible. More rarely, however, viruses also come into consideration. The viruses are often flu viruses, which can trigger a middle ear infection in the context of a cold. Among the bacteria already mentioned are the bacame streptococci, pneumococci and Haemophilus influenzae. In young children and babies, the disease is often triggered by the bacterium Staphylococcus aureus. As already mentioned, acute otitis media often develops in the course of a simple cold. The pathogens then penetrate through the nasopharynx into the middle ear. Sometimes, however, germs can also trigger the disease in the case of an eardrum injury. Another cause can also be a spread infectious disease, such as scarlet fever, which then leads the pathogens to the ear through the blood. As a last cause, a connection with throat infections should also be mentioned. In this case, there may be a disturbance of the ventilation of the middle ear and the pharynx. There is a congestion of fluid, which can subsequently lead to a middle ear infection due to pathogens. Chronic middle ear infection is rare, but can occur as part of a congenital disorder in the pharynx, such as cleft palate. Similarly, polyps are also considered to trigger chronic otitis media.
Symptoms, complaints and signs
The leading symptom of otitis media is severe ear pain. In acute otitis media, there is a general feeling of illness with fever, nausea, and weakness. The ear pain may be unilateral or bilateral. Touching or pressing the ear also causes pain in most cases. The pain may be throbbing and increase with movement. The eardrum may show a bulge and be very red. The areas in and around the ear may also be red and tender. The pressure conditions in the middle ear change due to the inflammation restrict sound transmission. Middle ear infection also causes headaches in some people. A middle ear infection that has become chronic, on the other hand, still presents with additional symptoms, all of which have an impact on hearing. Thus, chronic otitis media can lead to tinnitus. Often there is watery or purulent discharge from the ear. Inflammatory tissue may begin to proliferate and spatially constrict the middle ear. At the latest, a chronic middle ear infection is associated with hearing difficulties. Hearing loss consists of a sensation of a muffled speaking environment and a persistent ringing in the ear. Again, both ears or only one ear may be affected.
Disease progression
Schematic diagram showing the anatomy of the ear in otitis media. Click to enlarge. The course of acute otitis media is characterized as follows. If left untreated, the disease usually heals on its own within 14 days. If this is not the case, and the disease persists, there is a suspicion of a mastoid process, which can develop into mastoiditis in the further course. This leads to the formation of pus in the middle ear or bony process.If this circumstance is not treated by a doctor, meningitis can develop. Typical signs are then additionally strong dizziness and vomiting. It is not uncommon for tears to occur in the eardrum (perforation) in the event of a middle ear infection. Accumulated pus then runs out of the ear and the earache subsides. A middle ear infection should be examined and treated by a doctor in order to prevent complications in time. In addition, measures can be initiated to alleviate the discomfort, such as earache and headache. In addition, medical treatment should also be used as prevention against chronic otitis media.
Complications
Because acute otitis media usually heals after about two weeks, complications are rare. In some cases, however, there is a risk of serious sequelae. One of the most common complications of otitis media is mastoiditis. It is predominantly seen in babies and young children. Mastoiditis is a purulent inflammation of the bony mastoid process. The inflammation is noticeable by a reddened and painful swelling of the skin behind the auricle, which also protrudes. In the case of mastoiditis, medical treatment is absolutely necessary, because otherwise further complications such as meningitis (meningitis) or a brain abscess are imminent, which in the worst case can assume life-threatening proportions. Also conceivable is the occurrence of an otogenic inflammatory facial paresis (facial paralysis). In this case, the facial nerve, whose bony canal is located in the immediate vicinity of the middle ear, is affected, which in turn can lead to unilateral paralysis. Another sequela of acute otitis media is toxic labyrinthitis. It results from bacterial toxins migrating from the middle ear toward the inner ear. In the further course, tinnitus (ringing in the ears) and inner ear hearing loss may occur. Dizziness and balance disorders are also possible. Sinus vein thrombosis is also conceivable. This is a consequence of mastoiditis. In this complication, blood clots form within the large collecting veins of the brain. In this case, immediate medical treatment is necessary.
When should you see a doctor?
Otitis media can occur in many different degrees of severity, so in some cases a visit to the doctor may not be necessary. Children under 12 years of age are affected many times more often than adults. If symptoms of a severe middle ear infection exist in a child, a doctor should be consulted as soon as possible. In many cases, such an inflammation does not occur without accompanying symptoms. Rhinitis, fever and other cold symptoms are also very common accompanying symptoms in connection with a middle ear infection. Such an inflammation can be counteracted very well with appropriate medication. However, anyone who does not take anti-inflammatory medication at this point is sometimes taking a great risk. If not treated, pus formation may occur under certain circumstances. This is always a sign of a significant aggravation of the existing inflammation. A visit to the doctor must not be delayed any longer, as in the worst case a blood poisoning can develop. An inflammation in the ear does not always necessarily require medical treatment and medication. However, if there is no significant improvement after two to three days, medical treatment is urgently advisable. It is imperative that the inflammation be contained and alleviated, otherwise an abscess may form.
Treatment and therapy
Treatment of otitis media should be carried out by a physician. In the best case, the primary care physician will refer the patient to an ear, nose, and throat specialist. The physician will most often provide treatment with the use of antibiotics. In addition, nasal drops can be used to improve the drainage of accumulated pus and ventilate the middle ear. Ear drops are rarely used, as they cannot reach the middle ear for anatomical reasons. Sufferers can independently relieve some discomfort with red light and earache medication prescribed by a doctor. If the eardrum is already affected and complications occur, surgery may have to be considered.Nevertheless, often the damaged eardrum heals on its own. Chronic middle ear infections are treated surgically if bone erosion occurs. The same is true for mastoiditis.
Outlook and prognosis
The prognosis for otitis media is considered very good. The inflammation heals without consequences within a few days in approximately four-fifths of all those affected, and there is no fear of permanent damage or other problems. The speed of healing is not influenced by symptomatic medication. However, prescribed antibiotics are relevant and must continue to be taken even after a symptomatic phase of otitis media, depending on the prescription. Otherwise, there is a risk of relapse. In a few cases, chronic otitis media develops, which is correspondingly long-lasting and painful. Therapy is also more difficult. Rapid treatment of acute otitis media is therefore a priority. If the infection moves further, for example to the mastoid process of the skull bone, complications can arise. In the worst case, meningitis occurs, and a good prognosis here depends on rapid prognosis and prompt treatment. Otherwise, the course can become very dangerous. In children, it is possible that repeated middle ear infections always seem to heal without consequences. However, it may happen that from the middle ear, the inner ear in particular is also affected, resulting in damage to the structures necessary for hearing. Hearing loss is possible.
What you can do yourself
For acute otitis media, painkilling medications such as ibuprofen or acetaminophen have proven effective, as have decongestant nasal sprays. These help to open the eustachian tube so that the middle ear is ventilated again. It should be noted that nasal sprays should not be taken for longer than seven days due to the habituation effect and drying of the mucous membranes. Onion bags are recommended as a home remedy. For this purpose, an onion is cut into small pieces and placed on a clean cotton or linen cloth. The cloth is rolled up and placed on the aching ear and fixed with a band. Many sufferers find it beneficial if the onion sachet is warmed in the microwave beforehand. The onion has an anti-inflammatory and pain-relieving effect due to its antioxidant sulfur compounds. The onion bag should be left on the affected ear for half an hour to an hour. In the case of a middle ear infection, heat helps to cure the disease more quickly. It makes sense to use a red light lamp or a hot water bottle. Heat helps to liquefy secretions and allow the inflammation to subside. Sufferers should drink as much as possible, rest and protect the aching ear from drafts. Air travel is not recommended because of the increased pressure; likewise, ear drops are not recommended because they cannot reach the middle ear through the eardrum.
