Treatment of otitis media

Synonym

Otitis media treatment “The middle ear is located between the eardrum (lat. : membrana tympania) and the inner ear. This includes the tympanic cavity (lat.

: Cavitas tympanica) with the ossicles hammer, anvil and stirrup, as well as the auditory tube (lat. : Tuba auditiva) and the eardrum. In the case of an inflammation of the middle ear, the inner mucous membranes are inflamed.

Those affected can complain of earache, hearing loss, ringing in the ears, general feeling of illness, headache and fever. The most common cause is a spread of infections in the area of the throat or nose. The ear trumpet, also known as a tube, is located between the middle ear and the nasopharynx.

When swallowing, yawning or speaking certain sounds, it opens and creates a pressure equalization. This ensures that the pressure in the middle ear corresponds to the pressure in the nasopharynx or the outside air. However, pathogens can “rise” into the middle ear in this way and cause an inflammation.

In rare cases, an injury to the eardrum can be an entry port for germs into the middle ear. Scarlet fever and measles are a special form of middle ear inflammation. Chronic inflammation of the middle ear causes severe hearing loss, as fluid accumulation due to inflammation restricts the mobility of the ossicles.

In this context, a distinction is made between chronic mucosal suppuration and chronic bone ulceration. Both variants of chronic otitis media cause little pain, but a chronic ear discharge. Among the most feared complications of middle ear inflammation are the passage of the pathogens into the inner ear, damage to the mimic facial nerve (facialis nerve), the spread of the inflammatory processes to the meninges and/or brain and the formation of a blood clot in the area of the skull.

1) Pain therapy Earache is almost always the main symptom of middle ear infection and should be treated. In principle, many painkillers (analgesics) are suitable for this purpose, but in practice tablets containing the active ingredient paracetamol or ibuprofen are usually used. Ear drops usually do not reach the site of the pain.

Only in the case of a “perforating middle ear infection“, i.e. if there is a tear in the eardrum, do the drops reach the middle ear. Frequently, however, draining secretion prevents sufficient effectiveness. For this reason, ear drops should be viewed very critically in pain treatment.

2) Nose drops Many doctors recommend the use of nasal spray or drops to reduce swelling of the mucous membranes. They reduce the swelling of the nose and the mucous membrane of the tube, thereby improving the ventilation of the middle ear. However, the application is not suitable for a longer period of time, as the active ingredients contained in the product dry out the nose and even make it “dependent”.

In addition, only special products developed for this age group may be used in children. 3) Antibiotics Experts have been engaged in major discussions in recent years about the real benefits of antibiotic treatment for middle ear infections. For many years, it was for the most part the therapy of choice.

However, in the age of increasing resistant germs (“problem germs”) the application is being questioned. In principle it must be decided in individual cases whether an antibiotic is necessary. Studies have shown, however, that in about 85% of cases a spontaneous improvement of the symptoms occurs within the first two to three days.

In practice, those affected are therefore often asked to undergo a second check-up about 2 days after the onset of symptoms. If the symptoms nevertheless worsen during this period, you should of course consult a doctor earlier. Nevertheless, in certain cases of middle ear infection, antibiotics must be taken immediately.

These include: Children < 6 months of age Children > 2 years of age, with bilateral middle ear infection, even with only slight pain and fever < 39 degrees Severe pain and fever > 39 degrees Persistent purulent ear discharge Risk factors (e.g. immunodeficiency, mastoiditis, Down syndrome) In general, the doctor will first decide on amoxicillin as the antibiotic of choice. In most cases, one application for about five to seven days is sufficient to eliminate the symptoms. If the treatment does not work, alternative agents can be chosen.4) Surgical therapy If there is no improvement of the symptoms despite antibiotic treatment, a so-called “pathogen detection” must be carried out.

For this purpose, the eardrum is opened with a small incision (paracentesis) and the underlying, usually purulent, fluid is sucked out. Afterwards, bacteria can be detected from the fluid and a suitable antibiotic can be selected. The procedure is not painful.

In adults it is performed under local anesthesia, in children under general anesthesia. If the secretion is too thick to be sucked out, the doctor must place a small plastic tube (tympanic tube) in the incision of the eardrum. This allows the secretion to drain off by itself and prevents dreaded complications such as bone ulceration or abscesses.

After a few months, the eardrum grows back and the tubes are rejected. 5) Home remedies Some home remedies can relieve the symptoms of middle ear infection. Basically, affected persons should drink a lot and take it easy.

However, if the symptoms persist for a longer period of time, it is essential to consult a doctor. The following household remedies are recommended:

  • Children < 6 months of age
  • Children > 2 years, with bilateral otitis media, even with only slight pain and fever < 39 degrees
  • Severe pain and fever > 39 degrees
  • Persistent purulent ear discharge
  • Risk factors (e.g. immunodeficiency, mastoiditis, Down syndrome)
  • Red light warmth: Special red light lamps cause a pleasant warming of the inflamed middle ear. Make sure you keep a sufficient distance from the light source and protect your eyes from infrared radiation.
  • Onion sacks: For the production, 1-2 raw, fresh onions are chopped and beaten in a small cotton cloth or kitchen paper.

    Then warm it to body temperature and place the bag on the diseased ear. To fix it better, you can loosely use a cap or a headband. After about 20 minutes, the onion sac is removed again.