Acute otitis media

Synonyms in a broader sense

Medical: otitis media

acute otitis media, hemorrhagic otitis media, myringitis bullosa

English: acute otitis media


Sudden (acute) otitis media is a rhinogenic inflammation of the mucous membrane of the tympanic cavity (cavum tympani = part of the middle ear) that originates in the nose and is triggered by bacterial pathogens and usually heals within 2-3 weeks.

Figure ear

  1. Outer ear
  2. eardrum
  3. Balance organ
  4. Auditory nerve (nervus acousticus)
  5. tube
  6. Mastoid process


Patients complain of:

  • sharp pain in the ear
  • Hearing loss
  • pulse synchronous knocking in the ear /Ringing in the ears
  • a headache
  • fever
  • general malaise

In the first days of the inflammation, tenderness over the mastoid process often occurs (mastoid), since the entire middle ear mucosa including the air-filled (pneumatized) spaces that are attached to the middle ear is affected by the inflammation.

Symptoms of acute otitis media

Acute otitis media

With the typical Otitis media symptoms you have to between chronic or more acute Distinguish progressive form. In the case of acute otitis media, the symptoms start suddenly within a very short time. Most of the affected patients report stabbing Earachewhich can occur both on one side and on both sides. Another classic symptom of acute otitis media is a noticeable throbbing in the sore ear. In many cases, the pain felt by the affected patient radiates from the ear to the jaw. The other symptoms of acute otitis media are assigned to the so-called "general disease symptoms".

Many patients with this form of otitis media develop a high fever and chills over time. Furthermore, it can be caused by a possible impairment of the Inner ear to develop a pronounced Vertigo come. In the course of the normal defense reaction of the organism against viral and bacterial pathogens, different Mediators poured out. These mediators cause a typical increase in pain perception.

It also induces reddening, overheating of the skin surface and swelling of the skin and mucous membranes. In many cases, in the course of acute otitis media, the connecting duct between the middle ear and throat swell (Eustachian tube). As a result, there is a blockage in the outflow of mucus and fluid that collects within the middle ear. Ultimately, mucus and fluid trigger a significant increase in pressure. This increase in pressure causes other typical symptoms that occur more frequently in the presence of acute otitis media.

In some of the affected patients this may eardrum cannot withstand the increasing pressure for long. The eardrum ruptures. In the course of this, the secretions in the middle ear can drain. In most cases, the pain felt by the patient suddenly subsides at this point. However, acute hearing loss and severe hearing loss can occur a headache come.

Cause / origin

The inflammation affects the tube from the nasopharynx (ear trumpet, see also anatomy ear) and ins Middle ear (tympanum) over, is usually the result of a cold (see also topic sniff).
In a few cases there is a defect in the eardrum through which an infection can enter the middle ear. Rarely occurs Otitis media (otitis media) with a general infection, with bacteria or Viruses enter the middle ear by blood (haematogenous) and cause inflammation.

The typical triggering one bacterium is in the adult Streptococcus pyogenes, while common pathogens of otitis media Children Streptococcus pneumoniae or Haemophilus influenza are.

It also go viral (virus) caused or combined bacterial-viral otitis media.


The course of an acute otitis media can vary greatly depending on the immune situation of the affected patient and the extent of the inflammatory processes. If a suitable treatment is initiated promptly, acute otitis media can also occur without the administration of Antibiotics heal completely within a week. However, if the symptoms felt by the patient are rather severe, the course should be positively influenced by taking an antibiotic. They also need recurrent (frequently recurring) and / or long-lasting acute otitis media from antibiotic treatment.

If an appropriate therapy is neglected, serious complications can arise in the course of acute otitis media. For this reason, every acute otitis media that persists for longer than a week even with the use of common home remedies should urgently be treated with medication. Typical complications that can occur in the course of an acute otitis media are inflammation of neighboring structures. Even less pronounced acute otitis media can lead to rupture of the eardrum if the course is unfavorable. However, this usually grows back together completely after the inflammation has subsided. In the case of an acute otitis media, which does not completely subside even with the administration of a suitable antibiotic, there is a suspicion that the inflammatory processes have already spread to the bones behind the ear (mastoid process).

In the case of this bone inflammation occurring in the course of acute otitis media, one speaks of a so-called Mastoiditis. As the disease progresses, purulent fluids can be secreted and deposited in the air-filled cavities of the bone process. If extensive therapy is not initiated in the affected patient during this period, other neighboring structures can be affected. In the worst case, inflammatory processes develop in the area of ​​the meninges (meningitis; meningitis) or inflammation of the inner ear, which is accompanied by pronounced vertigo.


In the course of uncomplicated inflammation, certain changes in the eardrum (tympanum) take place, which occur one after the other in the following order:

  1. Vascular representation (injection) on the hammer handle, which rests against the eardrum.
  2. Vascular drawing on the entire eardrum.
  3. Redness and bulging of the upper quadrant of the eardrum. This finding recedes or goes to the next stage (4).
  4. Diffuse reddening and bulging of the entire eardrum and the wall of the ear canal.
  5. The eardrum tears spontaneously and through the resulting pin-head-sized opening, yellowish-clear (serous) and later purulent (putrid) fluid (secretion) flows off.
  6. The ear "runs" (otorrhea), i.e. slimy-purulent secretion emerges from the external auditory canal in the case of bacterial inflammation and serous-bloody secretion in viral infections.

With the onset of ear rushing, the ear pain suddenly improves, as the perforation relieves the pressure and tension of the secretion on the eardrum and the irritating secretion is removed from the middle ear.

In reverse order of the eardrum findings mentioned above, the inflammation heals. Often a scar of the eardrum remains, which appears whitish when the eardrum is mirrored.

In the case of otitis media caused by influenza viruses (hemorrhagic otitis media, myringitis bullosa), blood bubbles can be found on the eardrum which, when bursting, empty blood-serous secretions into the ear canal.

How contagious is an otitis media?

As a rule, acute otitis media is not a contagious disease. There is therefore no risk of getting infected with sick people. In this context, however, a simple otitis media must be differentiated from otitis media caused as a symptom of a bacterial infection. In contrast to isolated acute otitis media, bacterial infections of the nasopharynx, which are associated with ear pain, are highly contagious.

In general, it can be assumed that the acute form of otitis media is triggered much more frequently by bacterial pathogens than by viruses. For this reason, it is not a separate disease picture, but a secondary disease associated with the bacterial infection. How contagious the acute otitis media actually is depends on the underlying pathogen.The most common viral pathogens that lead to the development of acute otitis media include Measles- and Flu viruses. Stand on the side of the bacterial pathogen causing acute otitis media Pneumococci and Streptococci at the top.

Therapy of acute otitis media

General measures for the treatment of acute otitis media include bed rest and the use of anti-inflammatory drugs (NSAIDs) and, if necessary, pain relievers and fever killers (e.g. paracetamol).
In the bacterial form of the disease, the administration of antibiotics is indicated, e.g. Penicillin V, amoxicillin, cephalosporins or macrolides. These drugs are initially administered orally (tablet form) for 4 days. If the symptoms do not improve afterwards, antibiotic therapy via the vein using an infusion (IV therapy) is necessary.

Read more on the topic: Home remedies for earache

If you have a cold (rhinitis) at the same time, you can also use decongestant nasal drops to improve ventilation through the nose.

If the ear is running, the ear canals should be rinsed with warm water and cleaned of secretion with cotton.

An incision in the eardrum (paracentesis) may be necessary as a therapeutic measure if the symptoms of fever, pain and bulging eardrum persist without a spontaneous tear in the eardrum with secretion drainage. Paracentesis is performed under local anesthesia or, especially in children, under general anesthesia and is performed on the anterior lower quadrant of the eardrum so that the ossicles do not threaten to slip (luxate).

After the inflammation has subsided, by exerting pressure on the middle ear (holding your breath and closing your nose and then exerting pressure on the ears, as if you wanted to "squeeze the air out of your ears" = Valsalva maneuver) the permeability of the ear trumpet (tube) and one Prevent negative pressure development in the tympanic cavity.

Read more on the topic: Treatment of acute tonsillitis


A complication of this form of inflammation is toxic inflammation of the inner ear (labyrinthitis) with hearing loss in the high frequency range due to bacterial toxins.

If the acute otitis media does not heal after 2-3 weeks, there is a suspicion that mastoiditis, an inflammation of the ventilated cells of the mastoid process, is developing.
You can also find more information under our topic: Mastoiditis


The duration of an acute otitis media can vary widely. It mainly depends on the extent of the inflammatory processes Immune system of the affected patient and from the time the therapy was started. In addition, a distinction must be made whether it is a through Viruses triggered or bacterially induced acute otitis media. In this context, the affected patients must be aware that virally triggered forms can usually persist over a long period of time. The reason for this is the fact that diseases caused by viruses can only be treated symptomatically. A complete healing always depends on the adequate reaction of the body's own immune system.

Bacterial Acute otitis media, on the other hand, heal completely in many cases within a week or so without medical intervention. By giving a suitable antibiotic, the course of the disease can be positively influenced and the duration of acute otitis media shortened. On average, it can be assumed that an uncomplicated acute otitis media should heal completely within a period of about two weeks. If the healing time exceeds this time despite the administration of a suitable antibiotic, the spread of the inflammatory processes to the jawbone and the mastoid must be excluded.


If there are no complications such as bacterial inflammation of the mastoid process (Mastoiditis) or a chronic one Otitis media occur, the otitis media heals with normal hearing.

Special forms of acute otitis media
Scarlet fever (scarlet fever
) or Measles notitis (measles) are caused by the transfer of bacteria into the ear via the bloodstream and often lead to a cell-destroying (necrotizing) inflammation of the mucous membrane and an inflammatory melting of the eardrum.
The spread of otitis media to the mastoid process cells as well as to the Inner ear are possible complications of otitis media. Eardrum defects remain, which increase the risk of chronic otitis media.

The Infant otitis occurs in newborns who still have a short and wide tube. The path of inflammation from the nasopharynx to the Middle ear is short due to this anatomical condition. The sick children compulsively hold their ears (ear compulsion) and have a reddened eardrum.

Can you fly with an acute otitis media?

In most cases, acute otitis media is a very painful condition. Patients with severe ear pain should not get on an airplane. Regardless of whether the planned flight is a long distance or only a short distance is to be covered. Flying is not recommended for patients with acute otitis media. Specialists in ear, nose and throat medicine point out that the restricted ventilation of the ear caused by inflammatory processes can be problematic during flight.

As an acute otitis media can lead to the almost complete closure of the connection between the ear and throat, air and inflammatory gases are trapped in the middle ear. This air exerts itself strongly due to the lower air pressure at high altitudes (i.e. during flying) and exerts enormous pressure on the eardrum. In this context, patients who fly despite acute otitis media can experience severe pain and pronounced balance disorders. In the worst case, the pressure acting on the eardrum can become so high that the affected eardrum tears.

According to specialists, equalizing the pressure while flying is not enough to adequately prevent this risk. For this reason, doctors point out that patients suffering from acute otitis media should rather stay on the ground and cancel planned flights. However, in cases where flying is absolutely unavoidable, good preparation can help alleviate possible discomfort. Decongestant nasal drops should be used before and during flight. In this way, a narrow passage between the middle ear and throat can be created under certain circumstances. In addition, pressure equalization while flying can be made easier by using earplugs and / or chewing gum. Patients who get on a plane despite having an acute otitis media should definitely have pain relievers (ibuprofen ideal) on hand.

Similar topics you might be interested in: Can you fly with a cold?

Otitis media in pregnancy

Even during the pregnancy otitis media can develop. However, since the use of medication during pregnancy is extremely limited, it should be carefully considered which medication is most suitable before initiating suitable treatment. Symptomatic acute otitis media that occurs during pregnancy can be treated with special nasal sprays.

In this way, the swelling of the mucous membranes in the nasopharynx can be promoted and the ventilation of the middle ear improved. In the presence of a pronounced acute otitis media, it may be necessary to take an antibiotic.
But the choice of safe antibiotics is also very limited during pregnancy. In most cases, your doctor will give you one penicillin-Preparation prescribed.
You can find out more about the topic here: Antibiotics in Pregnancy