Middle ear infection

How it develops and is treated

Severe, throbbing earaches that occur mainly in the evening or at night are a characteristic feature of an acute middle ear infection. Otitis media acuta, as the doctors call it, is a painful infection of the ear that can occur on one or both sides and at any age. However, children from three months to three years are particularly often affected: According to statistics, every second European child suffers from otitis media at least once in the first year of life. By the age of seven, every child has suffered from a middle ear infection. The disease occurs more frequently in boys than in girls.

How a middle ear infection develops

A harmless cold can be just as much the starting point for a middle ear infection as a respiratory tract infection or tonsillitis. Viruses or bacteria then ascend via the nasopharynx to the middle ear.

  • Either a cold or flu caused by viruses is the trigger,
  • or: The viral infection was the initial trigger for an additional bacterial infection, in which bacteria now cause a purulent inflammatory reaction in the middle ear area.

Via the eustachian tube, which connects the nasopharynx and the middle ear, the bacteria or viruses enter the middle ear, multiply and cause severe, pulsating or throbbing pain in the ear.

Since the "connecting piece" between the ear and the nasopharynx is still different in children and is also very short and wide, children are particularly susceptible to middle ear infections. Germs can penetrate the middle ear more easily. The older a child gets, the more the eustachian tube grows in length. This is a fortunate circumstance, because it makes it less likely that middle ear infections will still occur as a child gets older.

Middle ear infection: The signs

Symptoms of an acute middle ear infection usually appear suddenly. Those affected particularly often complain of:

  • piercing/pulsating ear pain (on one or both sides)
  • ringing in the ears
  • fever
  • hearing loss
  • difficulty sleeping
  • headaches
  • pain behind the ear
  • nausea, vomiting and diarrhoea (rare)
  • Unspecific abdominal pain (especially in children)

A bilateral inflammation is more often associated with fever, and the affected person suffers more from the pain.

Children often wake up crying from sleep because of the stabbing earache. They are noticeably restless, drink badly and constantly touch their ears. This reflex is called "ear compulsion" and is a very reliable indication of a middle ear infection.

If the inflammation in the ear has already exerted so much pressure on the eardrum that it has given way and broken through, cloudy, watery (serous), purulent or slightly bloody secretions will run out of the ear.

If these symptoms occur, especially after an infection, a paediatrician or ear, nose and throat specialist should be consulted.

This is how the diagnosis is made

An ear, nose and throat (ENT) doctor will look at the condition of the eardrum with an ear funnel (technical term: otoscope) to make a diagnosis. The examination is not painful and does not take long. Of course, a paediatrician can also do this examination of the ear canal and eardrum. The colour of the eardrum is enough to tell if it is inflamed. If the eardrum is not greyish but pink, and if it bulges outwards because purulent secretion has already formed behind it, these are sure signs of an acute middle ear infection.

If patients - children and adults - have already had to deal with ear infections several times, a hearing test may also be indicated. For babies and very young children who might not yet be able to cooperate properly with such a test, there is the possibility of testing hearing with a special measurement procedure.

How to treat a middle ear infection

  • Combating the pain with certain painkillers is the first step in treatment.
  • The treating doctor can recommend decongestant nasal drops or a corresponding spray to achieve better ventilation of the ears.

An acute middle ear infection usually heals without consequences after a few days. For children over two years of age and adults, medical observation and control are recommended for the first two to three days. If there is no improvement after that and the symptoms worsen, the doctor may advise the administration of an antibiotic.


Possible complications of otitis media

If a middle ear infection develops again and again in small children, it can damage their hearing in the long run. This may also affect the child's speech development. In order to prevent this, an ENT doctor should definitely determine the exact cause of the susceptibility to infection - and treat it accordingly.

Constantly recurring infections in the middle ear sometimes leave scars on the eardrum, which can then cause hearing impairment. In children, enlarged palatine tonsils are often one of the causes of the eustachian tubes being squeezed shut, so ENT doctors may advise removing the tonsils. Such a procedure can often prevent an acute middle ear infection from becoming chronic.

If a middle ear infection does not subside despite medication, so-called tympanostomy tubes can be inserted into the eardrum. These support the ventilation of the middle ear and allow secretions to drain better. Since the passageway between the middle ear and the pharynx swells so much during a middle ear infection that mucus and fluid can no longer drain off well, the tympanostomy tubes prevent another reservoir for germs from forming. The tiny tubes are rejected by the body within six to twelve months, and the eardrum heals on its own.

Dangerous complications such as inflammation of the bone behind the auricle (mastoiditis), meningitis or facial nerve paralysis are rare, but justify that earaches should always be examined by a doctor.

Can a middle ear infection be prevented?

There is no really reliable way to prevent middle ear infections. However, scientific evidence suggests that vaccination against pneumococcus and Haemophilus influenzae type b (Hib) can protect against middle ear infections. These bacteria can trigger the painful inflammations. The Standing Commission on Vaccination at the Robert Koch Institute in Berlin therefore recommends immunisation as a standard vaccination. Whether vaccination is advisable should be discussed with a specialist. More information about the recommended time frame for the most important vaccinations in infancy can be found here.

To avoid damaging the sensitive inner part of the ear and creating an entry point for bacteria, it is also not recommended to use cotton swabs to clean the ear.

Other scientific studies have shown that breastfeeding during the first six months of life and a tobacco smoke-free environment reduce the risk of acute otitis media. Experienced paediatricians also point out that intensive "soothering" and sucking while lying flat can promote middle ear infections.


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