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Acute otitis media

Acute otitis media acuta is one of the most common diseases in children. It is usually painful, but without serious complications. Read more about symptoms, causes, diagnosis, therapy and self-help in acute otitis media.

Synonyms

Otitis media acuta

Definition

Otitis media child

Acute otitis media is an inflammation of the mucous membranes in the middle ear. This inflammation can be very painful. In most cases, however, it remains without serious consequences. In a few cases, middle ear infections develop with complications that can lead, for example, to hearing impairments, tympanic tears or meningitis.

A distinction is made between acute otitis media (otitis media acuta) and chronic otitis media (otitis media chronica).

Other ear infections

In addition to otitis media, there is also ear infection, in which the external ear canal is affected (otitis externa) and inflammation of the inner ear (the names depend on the inflamed structure).

Frequency

Acute otitis media is one of the most common childhood diseases. In contrast, children are rarely affected by the chronic form.

Symptoms

The symptoms differ according to the course. Acute otitis media often develops after a respiratory infection. Suddenly the general condition deteriorates and there is severe, sometimes stinging or pulsating earache. These increase within hours. The affected ear feels oddly full. Sometimes you have “pressure on the ear”. Hearing is increasingly restricted. Sometimes tinnitus (ringing in the ears) occurs. Rarely dizziness and balance problems accompany the ear symptoms.

Children: fever and ringing in the ears

The body temperature usually rises in acute otitis media. Fever over 39 degrees Celsius is not uncommon. In children, the so-called forced ear is striking. This means that they constantly touch the affected ear. They are also tearful and uncomfortable. Infants often complain of abdominal pain. Sometimes there is vomiting and diarrhea .

Middle ear effusion

In acute otitis media, the so-called ear trumpet (Eustachian tube or tube) sometimes swells up. The ear trumpet connects the middle ear to the nasopharynx. If this tube swells due to inflammation, the pressure balance between the middle ear and the environment is no longer guaranteed. The result is a ventilation disorder in the middle ear with a negative pressure in the middle ear. This stimulates the middle ear mucosa to form an aqueous secretion, and rarely does the middle ear mucous membrane bleed. A middle ear effusion (also called tympanic effusion or tympanum) arises. The effusion liquid collects and cannot drain as long as the ventilation is restricted.

Such an effusion is an ideal breeding ground for bacteria. These multiply and colonize the tube and middle ear. Now the mucous membrane no longer forms an aqueous liquid, but releases a viscous, purulent secretion. The result is an acute purulent otitis media with severe ear pain, reduced hearing and a feeling of pressure and fullness in the ear. Acute purulent otitis media can also develop if bacteria migrate from the inflamed nasal mucosa or the nasopharynx through the ear trumpet into the middle ear.

Complications

Complications in the course of acute otitis media can lead to permanent damage.

Eardrum

If the purulent effusion cannot drain into the nasopharynx, an increasing pressure builds up behind the eardrum. In the worst case, this leads to tearing (perforation, rupture) of the eardrum. This relieves the pressure on the middle ear and reduces the ear pain on the spot. The purulent secretion runs through the torn eardrum to the outside via the external auditory canal. The secretion can smell bad and be mixed with blood.

Mastoiditis

A feared complication in acute otitis media is inflammation of the cavities of the bony mastoid process of the temporal bone (mastoiditis). The patients report a pulse-synchronous pain in the ear and pressure pain behind the ear. The ear usually sticks out. In addition, purulent secretions run out of the ear canal. Then antibiotics and surgery are essential.

Other complications

  • If left untreated, otitis media can spread to the meninges and brain. The consequences are meningitis (meningitis), pus accumulation in the brain (brain abscess) or paralysis of the facial nerves.
  • Sometimes bacteria form poisons (toxins) that can get inside the ear when the middle ear is inflamed. This can lead to toxic labyrinthitis, i.e. inflammation of the inner ear labyrinth. This inflammation is associated with hearing loss in the inner ear and ringing in the ears. Dizziness and balance problems are also frequently observed.
  • Constantly recurring otitis media is at the expense of the eardrum skin, which can cause scarring. Furthermore, scarred or even bony adhesions can form on the ossicles in the middle ear and cause permanent hearing disorders. Doctors call this complication cholesteatoma. For detailed information, see Chronic Middle Ear Inflammation.

Causes

Acute otitis media is the result of a viral infection of the upper respiratory tract in about 80 percent of cases. This particularly affects people with frequent sinus infections or chronic runny nose. Children with enlarged nasopharyngeal tonsils (so-called polyps) also develop bacterial otitis media.

Only about 20 percent of bacteria get into the middle ear and cause inflammation of the middle ear. Pathogens very rarely get into the middle ear through a hole in the eardrum – for example through bath water – and cause acute otitis media.

Any acute otitis media should take you to the doctor. Do not, on your own, sneeze at the inflamed ear! This applies especially to acute otitis media in children.

Examination

The diagnosis of acute otitis media should be made by an ear, nose and throat doctor (ENT specialist) or a pediatrician. For diagnosis, the eardrum, nose and nasopharynx, throat and sinuses are examined first. This is often followed by a hearing test. Ear secretions are sent to the laboratory for examination. Imaging procedures such as X-rays and computed tomography of the head rarely follow.

Treatment

Various medications and measures are available to the doctor for the treatment of acute otitis media.

Nose drops

As a rule, the doctor will prescribe decongestant nasal drops, for example with the active ingredients oxymetazoline, xylometazoline or tramazoline. These open the ear trumpet so that the middle ear can be ventilated again. According to the latest studies, decongestant nasal drops should be given for 8 to 10 days in the case of acute otitis media. According to these studies, dependence on decongestant nasal drops only develops after daily or weekly use for weeks. However, the practice often looks different. Many doctors therefore warn against using decongestant nasal drops for longer than a week.

Antibiotics

In the case of purulent otitis media, your doctor will prescribe an antibiotic that is tailored to the causative agent of the inflammation and the age of the person affected. Proven antibiotics for otitis media are amoxicillin, azithromycin or clarithromycin.

Ear drops

Ear drops are usually no longer given today. If a doctor still prescribes such drops, they may only be added if the eardrum is intact. Ear drops often contain phenazone and salicylic acid compounds.

Aspirate secretion

If secretion runs out of the ear, the ENT doctor can aspirate the secretion. He will then clean, disinfect (for example with octenidine and phenoxyethanol) and care for the ear canal skin (for example with dexpanthenol). In this phase, you must make sure that no water gets into the ear canal (for example, when showering or bathing). You shouldn’t swim until it heals completely.

Paracentesis and timpani tubes

To empty a middle ear effusion, a small incision (so-called paracentesis) is made in the front, lower part of the eardrum. The effusion can be suctioned off. Such paracentesis takes place in adults under local anesthesia, children are given general anesthesia.

After paracentesis, the opening in the eardrum would close again within a few days. To avoid this, a small plastic, titanium or gold tube is inserted into the cut. The simulated secretion can continue to flow through this. In addition, the middle ear is ventilated and can heal under normal pressure conditions.

The body usually rejects the tympanic tube on its own within 6 to 12 months. Otherwise the tube is surgically removed. The tube is also removed if the hole keeps clogging up with thickened secretion or ear wax. The eardrum usually heals itself afterwards. [H3] Self-help in the case of acute otitis media There are a number of measures that can be used to support the healing process in the case of acute otitis media.

Enzymes for acute otitis media

To support the healing process, you can take tablets with anti-inflammatory and decongestant herbal remedies. The active ingredients bromelain and papain are suitable, for example.

Reduce pain

Tablets or coated tablets with anti-inflammatory and decongestant substances such as diclofenac and ibuprofen have an analgesic effect. In children, the use of paracetamol is recommended, which also has an antipyretic effect.

Onion sachets and ear candles

The placement of so-called onion bags and the burning of ear candles make many ENT doctors nonsensical. Nevertheless, many parents swear by these home remedies. From a medical point of view, it can be said that if the medically prescribed therapeutic measures are used, these home remedies can at least not hurt.

No warmth

With another widely used home remedy, however, it looks very different. Heat applications in acute otitis media can only be discouraged. Warmth like red light or hot water bottle sometimes worsen the course of the disease.

Prevention

To prevent acute middle ear infections, try not to clean your ears (and children’s ears) with cotton swabs and never with hard objects. This would disrupt the ear canal self-cleaning mechanism. There is also an increased risk of injury. It is enough to wash the ear and the auricle during daily cleaning, more is not necessary.

Sensitive ears should be protected when bathing with special bath wool from the pharmacy. Please do not use conventional cotton for this. It swells when it comes into contact with water and may no longer be removable from the ear.

Strengthen the immune system

Strengthen your immune system to prevent respiratory infections and thus acute otitis media. In addition, a vitamin and nutrient-rich diet is recommended. Alcohol should only be drunk in moderation, ideally smokers quit smoking. You will also strengthen your immune system if you exercise regularly, go to the sauna and avoid excessive stress. Dietary supplements and herbal medicines to improve the immune system have no demonstrable effect in otherwise healthy people.

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