Therapy of an acute inflammation of the middle ear

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

General information

Acute otitis media is more precisely an inflammation of the mucous membrane of the middle ear. It is usually caused by pathogens that rise from the nasopharynx into the middle ear via the tube, a kind of ventilation tube from the throat to the middle ear. Acute middle ear infection typically develops after an infection of the upper airways. The symptoms are caused by the inflammatory reaction of the mucous membrane of the middle ear and are accompanied by pain and swelling, which causes the tube to move, resulting in a ventilation disorder with, among other things, negative pressure in the ear concerned. In addition, there is often an effusion that can cause a hearing disorder by impairing the ability of the eardrum to vibrate.

Fever reduction

The therapy is also based on these symptoms. Thus it is advisable and healing-promoting with every inflammation in the human body, especially when it is accompanied by fever and a feeling of illness, to give the organism the rest it needs for regeneration. In the acute stage of the illness, one should therefore not overexert oneself and, depending on the severity of the illness, also keep bed rest.

In addition, it is important to ensure a sufficient fluid intake, especially in the case of fever. Drug therapy is usually carried out symptomatically in the form of pain therapy. Ibuprofen and paracetamol are the most frequently used systemic painkillers and are very useful for alleviating the symptoms, especially in the first 3 days. Pain-relieving ear drops, on the other hand, are very controversial in their effect and are not considered in disease-specific guidelines. The effect of decongestant nasal drops has also not been proven, but can provide relief in the case of a simultaneous or previous cold by supporting the patency or function of the tube through free nasal breathing and promoting the discharge of secretions from the middle ear.


Antibacterial therapy with antibiotics is considered the treatment of choice for acute middle ear infection and is considered the only therapy that can effectively treat the cause of acute middle ear infection with a bacterial cause. The disease is considered one of the most common causes, which is why antibiotics are prescribed in Germany. This is especially true for children or infants, who are affected by the inflammation more often than adults.

The bacteria that are most often responsible for the inflammation use the ear trumpet to enter the middle ear from the throat area. Typically, pathogens such as streptococci, Haemophilus influenzae or Morraxella catarrhalis are responsible for the disease. These pathogens can be treated with common antibiotics.

The standard antibiotic recommended and frequently prescribed for the treatment of acute middle ear inflammation is amoxicilin. Since this antibiotic is a type of penicillin, if there is a penicillin allergy, another antibiotic must be used to prevent the severe allergic reaction that may occur. In these cases a so-called macrolide is usually prescribed.

The guideline for acute middle ear inflammation states that only certain groups of people should necessarily undergo immediate antibiotic therapy. This group of people includes, for example, children under 6 months of age. Children under 2 years of age should also be given antibiotics immediately, provided the inflammation affects both ears.

Even if the inflammation causes moderate pain and fever, antibiotic therapy is recommended for all age groups. If a purulent discharge from the ear is noticed, it is advisable to consult a doctor immediately, who will then initiate therapy with the appropriate antibiotic. People who have individual risk factors should be advised that inflammation of the middle ear can occur more frequently in them than in people who do not have these factors. Immediate treatment with antibiotics is recommended, for example, for people with a cochlear implant, an immune deficiency, people with trisomy 21 or severe underlying diseases.