Symptoms of acute otitis media

Synonyms in a broader sense

Medical: Otitis media acute otitis media, hemorrhagic otitis media, myringitis bullosa English: acute otitis media

General information

Acute inflammation of the middle ear is a frequently occurring disease, especially in children. It is caused by bacteria (such as streptococci or staphylococci) in about two thirds of cases and by viruses in about one third. Acute otitis media often occurs after an infection of the upper airways, as a result of which germs migrate from the throat via the tube (tuba auditiva) into the middle ear.

There they cause characteristic symptoms caused by an inflammation of the mucous membrane of the middle ear with accompanying swelling and a consequent ventilation disorder of the middle ear. Although this disease can be extremely painful, it is usually harmless and without complications. The doctor can usually diagnose the disease by looking at the symptoms and by looking into the affected ear.


Symptoms such as severe, stabbing or throbbing pain in the area of the affected ear are the leading symptoms of acute otitis media. The inflammation often begins during or shortly after a cold with severe or even pulsating ear pain. Especially in small children, acute middle ear infection is also manifested by unspecific general symptoms such as nausea, vomiting, diarrhoea, headaches, loss of appetite, abdominal pain and increased irritability.

In addition, cold symptoms such as sore throat, cough or cold are usually still present due to the previous cold. Pain can also occur when pressure is exerted on the so-called mastoid bone (mastoid process). Furthermore, this illness is often accompanied by fever, which lasts for the first 24 hours in particular and can be accompanied by a strong feeling of illness.

Hearing loss in the affected ear is also typical of an acute middle ear infection. This can be accompanied by a feeling of fullness in the ear, dizziness and throbbing, often pulse-synchronous, noises in the ear. There may also be a feeling that sounds and even your own voice reverberate in your head.

In most cases, this hearing loss is caused by an effusion in the middle ear caused by the inflammation, which impairs the ability of the eardrum to vibrate. This effusion can persist for several weeks after the inflammation has subsided, and thus there is a possibility of mild hearing loss for up to 3 or 4 weeks. After 3 to 4 weeks, a medical check-up should be carried out.

A further symptom, which is usually only recognised by the family doctor or ENT specialist, is a protrusion and changes in the colour of the eardrum. This is caused by the massive accumulation of purulent secretion in the tympanic cavity and gives the attending physician a clear indication of the presence of an acute middle ear infection. A baby suffering from an acute inflammation of the middle ear can only express its pain through its behaviour.

By crying frequently, it can draw attention to the fact that something is hurting him or her. It can seem very restless and throw its head from one side to the other. Here, at least at the beginning of the illness, the ear symptoms are usually not the main focus.

Other babies rub their ears more often, for example on their pillow or on their parents’ shoulders. Some babies often show a so-called ear compulsion at the beginning of the disease. This means that they rub their ears more often.

In the course of the acute middle ear infection, they may instead react immensely to any touching of the ear because of the pain and react to it with crying and screaming. In addition, a weakness in drinking can be an expression of accompanying symptoms such as difficulty swallowing, pain when swallowing and abdominal pain. The baby may also appear more inactive, tired and exhausted.

Some parents notice a change in skin colour. In addition, temperature increases, chills and fever can also be seen. The younger the baby is, the more general complaints and sometimes high fever can be the main symptoms.

In addition, purulent blood secretion can run from the ears. In some cases, hearing loss may be noticeable. In small children, for example, this is manifested by a reduced turning of the head into an acoustic stimulus.

In the context of an acute inflammation of the middle ear, the ear pain can radiate to the teeth. This pain is then often perceived as diffuse toothache. The pain is often described as a dull pressure or a pulling.

Mostly the upper jaw area is affected by the radiating pain. The triplet nerve, the so-called trigeminal nerve, with its various branches also supplies a large part of the ears and the tooth area simultaneously. If the facial nerve is compressed or irritated due to an inflammation, such as an acute inflammation of the middle ear, toothache can also result, even if the teeth are completely healthy.

When the symptoms of acute otitis media subside, the radiating toothache will usually subside. If these persist, a dentist should be consulted. It is also possible that the actual cause is actually in the tooth area and the pain radiates into the ear.

This can be interpreted subjectively as an acute inflammation of the middle ear. Also, a viral inflammation, a so-called herpes zoster, can irritate the facial nerve and cause ear and tooth pain and lead to misinterpretation. In addition, an acute inflammation of the middle ear can cause sudden and severe toothache due to the changed pressure conditions in the ear.

The changed pressure can lead to the formation of cavities under the tooth fillings due to caries, for example. In these cases, a dental check-up would be advisable. Anatomically, there is a close neighbourhood relationship between the middle ear and the temporomandibular joint.

Consequently, this can lead to jaw pain in the course of an acute inflammation of the middle ear. The nerves and also the surrounding muscles in the surrounding area can be irritated by the inflammatory processes. This means that the jaw muscles, i.e. the chewing muscles and the muscles of the mouth opening, can be restricted.

Accordingly, in the case of an acute inflammation of the middle ear, opening the mouth and chewing can be difficult and painful. Conversely, jaw problems can also lead to radiating ear pain. The cause can be malpositioned teeth and jaw joints or signs of wear and tear.

In addition, pain in the temporomandibular joints, cracking and pain during jaw movements, teeth grinding at night, neck tension, problems opening the jaw in combination with diffuse pain in the ears, ringing in the ears and headaches can indicate a problem in the temporomandibular joint. Just as with toothache, it is often difficult to make a subjective assessment of whether it is an acute middle ear infection or a temporomandibular joint disorder. In the course of an acute inflammation of the middle ear, headaches can also occur as an accompanying symptom.

These are usually harmless and improve as soon as the acute inflammation of the middle ear heals. The cause of pain radiating into the head can also be irritation of the facial nerve. In addition, due to the inflammatory processes in an acute middle ear infection, altered blood flow conditions can lead to headaches.

If, in addition to severe fatigue, fever, clouding of consciousness, confusion and severe headaches, severe neck stiffness and hyperextension of the body (so-called opisthostonus) occur, a doctor should be consulted immediately. Even if only some of the listed complaints are evident, meningitis should be excluded in this case. However, this complication occurs relatively rarely in the context of acute inflammation of the middle ear.

It is possible, however, that the pathogens causing the acute inflammation of the middle ear penetrate into the brain and cause an inflammation with serious consequences. This is known as a so-called “secondary meningitis“. This is an absolute emergency and requires emergency medical treatment.

Furthermore, an acute inflammation of the middle ear can also be subjectively suspected by mistake, although there is a disease in the head area. For example, the pain of a migraine can radiate into the ears and sometimes manifest itself as severe ear pain. Due to the proximity of the oral cavity and the throat, swallowing difficulties can also occur in the context of an acute middle ear infection.

The structure that connects these areas is called the auditory tube (Tuba auditivia). Normally the auditory tube is equipped with a so-called respiratory ciliated epithelium, which ensures that germs are transported towards the throat. However, pathogens in the throat area can migrate upwards to the ears if this protective mechanism is disturbed.

A tonsillitis with difficulty swallowing could therefore possibly develop into an inflammation of the middle ear. The severity of the swallowing difficulties can vary. In some cases, they hinder food intake.

In addition, swallowing difficulties may occur due to the altered pressure conditions which are related to the functionality of the auditory tube. In a healthy state, the Eustachian tube opens with every act of swallowing. In addition, a small opening, the so-called safety tube of the Eustachian tube, ensures continuous ventilation of the middle ear.

In the course of an acute inflammation of the middle ear, this opening or the Eustachian tube can be closed. In addition to hearing problems, this can also result in difficulty swallowing. Often a cracking sound in the ear can be heard when swallowing.

If the swallowing difficulties persist after the acute middle ear infection has healed, a medical examination should be carried out. The severity and duration of the symptoms can vary greatly. In most cases, the course of the disease is shorter in the case of a viral middle ear infection than in the case of a bacterial middle ear infection.

Severe earache that occurs in an uncomplicated acute middle ear infection often subsides after one to three days. As a rule, earache and radiating toothache, jaw pain and headaches disappear completely after one week if the course is uncomplicated. Any swallowing difficulties that may have accompanied the symptoms also improve similarly quickly.

In the case of a viral inflammation, blisters can form on the eardrum. These blisters are filled with a watery yellowish secretion and blood. The blisters can burst within a few hours after the inflammation begins and the secretion flows out of the ear.

In the case of a bacterial inflammation of the middle ear, purulent secretion may also be discharged. This usually happens after 3-8 days. In both cases, the acute ear pain is reduced after the secretion has been discharged.

An accompanying hearing loss often occurs, which also subsides in the course of a week. However, if a tympanic effusion has formed in the course of the acute inflammation of the middle ear, a hearing loss and pressure pain can persist for another two to three weeks. If these last longer, a medical examination is required.

If a fever has occurred, it usually subsides after three days. General aching limbs usually subside as the fever subsides. At the beginning of an acute inflammation of the middle ear, small children often complain of abdominal pain and diarrhoea, which normalise at about the same time as other possible complaints. In the case of a bacterial acute middle ear infection, the duration of the complaints can in some cases be shortened by a few days in most cases by using targeted antibiotics.