Acute middle ear infections (otitis media acuta)

Acute middle ear infections (otitis media acuta)
International Classification (ICD) H66.9

Basics

Especially small children often whine, without you can determine what is really missing. Then they cry, constantly hang on the tail and constantly want attention. The causes for such behavior are very diverse. From hunger and bad mood to stomach ache, fever or toothache, anything is possible. Sooner or later, most children also fall ill with an acute middle ear infection, otitis media acuta in the technical term.

But it is not so easy to determine whether it is really the ears, or whether simply bad mood spoils the day. That's why you have to pay attention to even the smallest signs of illness. For example, playing with the ear more often or reddening of the auricle can indicate that the ears are hurting. Also a restriction of the hearing ability, or a stressed lying on an ear can point to an otitis media.

Causes

The middle ear is a cavity between the eardrum and the inner ear, which is filled with air. It serves to transmit sound via the ossicles from the eardrum to the inner ear, where the actual organ of hearing is located. To ensure sufficient ventilation, there is a connection to the nasopharynx - the Eustachian tube. Fluids formed in the middle ear can also drain through this tube.

Eustachian tube as pathogen transporter

Although the connection between the ear and the mouth is important, it also has a decisive disadvantage. Germs from the nasopharynx can enter the middle ear and cause inflammation there. Of course, the middle ear is particularly at risk in the presence of viral or bacterial infections of the upper respiratory tract, i.e. typical colds with sniffles, sore throats and coughs.

Favouring factors

Some children are particularly likely to suffer from acute otitis media. In addition to anatomical deviations in the structure of the middle ear and the structures around it, there are also other favouring factors. Enlarged pharyngeal tonsils, for example, can support the development of a middle ear infection because they impair nasal breathing and thus also the ventilation of the middle ear. This leads to an accumulation of moisture and germs feel particularly comfortable in warm moist places.

Inflammation from the outside

In rare cases, the pathogens can also enter the middle ear from the auricle via a no longer intact eardrum. In this case, polluted bath water or poor physical hygiene play a role in the development of otitis media acuta.

Symptoms

The inflammation causes swelling in the middle ear. This causes pain and a feeling of pressure. In addition, the transmission of sound through the ossicles is prevented, which leads to hearing loss.

Sudden onset and severe pain

Otitis media acuta starts quite suddenly with severe ear pain. The pain can be felt in one ear only or in both ears with varying intensity. This is often accompanied by fever and sometimes a pulsating ringing in the ears.

Hearing loss is a good indicator

Parents recognize acute otitis media mainly by the fact that a more or less pronounced hearing loss occurs. This is because it can be detected in almost all cases and is often clearly perceptible.

If the acute middle ear infection progresses, it can also lead to an injury of the eardrum. This then leads to purulent discharge from the ear, after which fever and pain usually subside within a very short time.

Diagnosis

The diagnosis of otitis media acuta is made primarily by taking a medical history and examining the ear with an otoscope. Here, a reddening of the eardrum is seen, especially at the beginning. As the disease progresses, the vessels become more visible and the eardrum thickens.

Quantifying hearing loss

In addition, other tests can sometimes be done, mainly to determine whether hearing loss is present and how it can be quantified. These can then also rule out early damage to the inner ear structures, which can occur as an early complication.

Swabbing of secreted tissue

In some cases, it may be useful to have a swab taken if pus is leaking from the ear to determine which pathogen has caused the middle ear infection and how best to combat it. This is especially important if the middle ear infection persists for more than a week.

Therapy

The therapy of otitis media depends above all on the respective stage of the disease. Often the inflammation of the middle ear heals spontaneously.

Keeping the Eustachian tube open

In order to stop the germ from spreading and thus prevent a middle ear infection, decongestant nasal drops can be administered at a very early stage and possibly also supported with inhalation of camomile vapour.

And even if the otitis media acuta has already occurred, one should do everything to open the connection again, so that the inflammatory secretion can flow off and the inflammation can heal. In addition, of course, the pain should be addressed.

Antibiotics for persistent inflammation

If there is no improvement in the earache within the first 36 to 48 hours, it is advisable to administer an antibiotic. This should be taken for at least seven to ten days in order to kill the germs that cause the earache.

Tympanostomy tubes for repeated middle ear infections

Children often have repeated acute middle ear infections, but these pass within a few days. However, if this occurs several times a year and over several years, or if the inflammation is always particularly severe, a so-called tympanostomy tube can be inserted into the eardrum. This then allows the middle ear to be ventilated and the fluid to drain away to the outside.

Do not administer ear drops

The administration of ear drops, which was so popular in the past, is now obsolete, so it is no longer done. As the name suggests, the inflammation takes place in the middle ear, that is, behind the eardrum. In most cases, the eardrum is still intact, which is why the active substances administered with the drops do not reach the site of the infection at all. Only if purulent discharge already occurs, it may be useful to give ear drops.

Forecast

The prognosis is very good. Even without great drug therapy, the acute otitis media heals within a few days, without any subsequent damage. However, as these are still possible and occur frequently, especially if the inflammation lasts for a longer period of time, a medical clarification is definitely advisable.

In addition, frequent middle ear infections can lead to a permanent loss of hearing. For this reason, even minor colds should be treated well so that the unpleasant earache does not occur in the first place.

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