Otitis media

Synonyms in a broader sense

Medical: otitis media

acute, chronic otitis media, hemorrhagic otitis media, myringitis bullosa

English: otitis media

Definition of otitis media

The middle ear infection (otitis media) is a disease caused by bacteria or viruses of the spaces inside the ear that belong to the middle ear.

Illustration of an otitis media

Illustration otitis media

Otitis media
Otitis media

  1. Purulent secretion in the
    Tympanic cavity (Cavitas tympani)
  2. Narrowed Eustachian tube
    (Tube swells up)
  3. Pathogens -
    Viruses or bacteria
    (can have an otitis media
  4. Eustachian tube (tube) =
    Eustachian tube -
    Tuba auditiva
  5. Eardrum -
    Tympanic membrane
  6. External ear canal -
    Meatus acousticus externus
    Complaints and signs:
    A - cold, flu, tonsillitis,
    Measles disease, possibly scarlet fever
    A1 - fever, diarrhea, cough,
    Runny nose, loss of appetite,
    a headache
    A2 - H-N-O - Doctor examines the ear
    B - Decongestant nasal drops or
    Nasal sprays, pain relievers
    (Analgesics), bed rest
    C - broad spectrum antibiotics,
    Children under six months - immediately,
    older children - two days watching
    D - home remedies -
    Chamomile or onion sachets,
    Calf wrap (if you have a fever),
    drink plenty of fluids
    E - heat -
    Irradiation with red light, warm grain pillow

You can find an overview of all Dr-Gumpert images at: medical illustrations

Frequency (epidemiology)

Occurrence in the population
Mostly are small children affected until the age of two. At that age she is Otitis media extremely often, so that 80-90% of all children fall ill once, around a third also several times.


The most common complaints are pulsating earache and Hearing loss. The latter comes about through an outpouring of purulent fluid into the tympanic cavity, i.e. the space that is between eardrum and Inner ear and thus represents the most important structure of the middle ear.
The Accumulation of fluid in the tympanic cavity leads to attenuation of the over the outer Ear canal Sound reaching the inner ear, so that sufficient signal processing by the inner ear to generate the auditory impression is no longer guaranteed.
As a result of the tympanic cavity effusion, there is also often a feeling of pressure or noise in the ear.
This explains the often observed phenomenon of sick children who often hold each other's ears (hence the name “ear compulsion”). In about a third of the cases, the tympanic cavity effusion is absorbed by itself, so that no medical intervention is necessary. The so-called tragus pain (see Figure 3), which occurs when pressure is applied to the small ear cartilage below the external auditory canal, is also characteristic of otitis media.

The outer ear (figure)

  1. Helix
  2. Antihelix
  3. Tragus
  4. Antitragus

Complaints and signs

In younger children in particular, however, ear problems are not in the foreground; rather, more unspecific general symptoms and signs such as malaise, loss of appetite and nausea (gastrointestinal complaints) dominate.
Often occurs then too fever (usually <38 ° C). The course of the disease is variable: does it come to Tear of the eardrum, the earache is relieved spontaneously, secretion (purulent fluid) may flow from the external auditory canal (this is called otorrhea, Greek for "running ear").
The majority of middle ear infections then heal with appropriate treatment (see below) without consequences.
In the case of multiple illnesses, i.e. more than six times in a year, says the ENT doctor (Specialist for ear, nose and throat medicine) the otitis media as recurrent otitis media and the cause should be clarified (e.g. whether there are enlarged tonsils, medically called adenoids = polyps, which indicate a ventilation disorder of the middle ear worry and so the growth of bacteria favor).
You can find further information under our topic: Polyps


Ear mirroring

In addition to the symptoms typical of otitis media (hearing loss, tenderness, possibly fever and malaise), characteristic changes in the eardrum are indicative of the ear, nose and throat doctor.
By means of so-called otoscopy, an observational examination of the external auditory canal, eardrum and sometimes also of the tympanic cavity, the diagnosis is confirmed.
In healthy people, the mother-of-pearl, shiny, transparent and smooth eardrum appears reddened, covered with lumps and loosened up.
Changes in the position of this thin membrane can also be determined on the basis of the position of the light reflex, which is thrown back by a lamp through the normally reflective eardrum: While the light reflex is usually in the lower front area, the reflex shifts in the direction of the central hammer handle in the case of otitis media or the reflex is completely absent.
(Note for a better understanding: the hammer handle is part of the first of the three ossicles, hammer, anvil and stapes, which transmit sound from the eardrum to the inner ear).
Further information is also available under our topic: Ear
If the course is complicated or does not respond well to medication, the eardrum can also be swabbed in order to identify the causative pathogens and to select the most effective antibiotics.


The otitis media is mostly caused by bacteria caused.
These reach the middle ear via the so-called Eustachian tube (named after Bartolomeo Eustachius, 1520-1574). The Eustachian tube is a 3-4 cm long and 3-4 mm wide connection between the nasopharynx and the middle ear.
The task of this also as "Tuba auditiva“Called connecting channel consists in the ventilation of the middle ear.
The normally closed duct is supplied by its own muscles, whose contraction when chewing, yawning or swallowing open the tube.
The most common bacteria that cause otitis media in children are pneumococci (these are also dreaded pathogens in children lung infection - medical: pneumonia and purulent meningitis - medical: meningitis) and Haemophilus influenzae (this germ also occurs in healthy people in the pharynx, so it is usually only children whose immune system has not yet developed enough of their own protective proteins, so-called antibodies, against the rod-shaped bacterium).
Other pathogens are more common in adults, e.g. the round streptococci that can be colored in the Gram stain (i.e. gram-positive) and therefore belong to the group of pathogens known as cocci. Most of the time, the otitis media occurs on one side.

However, various viruses can also trigger otitis media; then both ears are usually affected. These viruses include the typical causes of colds (the so-called respiratory syncytial viruses and adenoviruses) as well as flu viruses (medical: influenza and parainfluenza viruses).
You can find further information under our topic: sniff

How contagious is an otitis media?

Is a Otitis media contagious? Yes and no. A Otitis media as such is not contagious. The underlying cause of one Otitis media however, it can very well be contagious. Certain forms of Otitis media are infectiousi.e. one suits them Virus or bacterial infection underlying. Children in particular are often affected by this. Most of them are Pneumococci, Staphylococci, Streptococci and Influenza. It is more often bacterial than viral pathogens that cause a Otitis media condition. The pathogens achieve this Middle ear at a Upper respiratory tract infection on the Nasopharynx. That means that with a flu or one cold the pathogens in the ear Otitis media can evoke. Colds and flu-like infections are contagious. The cause of the Otitis media is thus contagious, but not this as such. Pathogens can also use the Blood way or with one external eardrum damagecan also reach the ear from the outside, for example through the bath water. In the context of general illnesses such as Scarlet fever and measles also kick Otitis media on. These diseases are also contagious and, in the final analysis, can also affect those affected who have been infected with them Otitis media cause. This is particularly common Measles, scarlet fever and flu otitiswhich are associated with precisely these infectious diseases.

Children in particular are often infected with pathogens in kindergarten or school and therefore more often develop an infectious one Otitis media. Usually one heals Otitis media by itself after a few days. Bacterial infections can with the help of Antibiotics be fought. Help to relieve the discomfort Nasal sprays and anti-inflammatory pain relievers how Ibuprofen.

Middle ear infection in the baby / child

Otitis media in the baby

Children are particularly often affected by otitis media. This is more often an acute than a chronic course of the disease. An otitis media in children is mostly related to a cold, flu, or measles. Children often experience scarlet fever with an otitis media.

However, children and babies are more prone to middle ear inflammation than adults. This is because the so-called ear trumpet, also known as the Eustachi tube, is particularly narrow in children and so swells up more easily. It represents the connecting duct between the middle ear and the nasopharynx. Pus and inflammatory secretions can no longer flow out of the ear so easily. Children suffer from otitis media more frequently between the ages of four and six, but babies also get otitis media at least once in the first three years of life.

The cause of otitis media in small children and babies is in most cases a previous flu infection. The symptoms can be divided into a non-specific and a specific ear symptoms. Non-specific symptoms are a weakened general condition and, for example, fever. In addition, there are the typical cold symptoms such as cough, runny nose, loss of appetite and headache. The otitis media typically leads to very severe ear pain and a feeling of pressure in the ears. There is also a hearing loss. This is difficult to determine, especially in babies. However, they touch the irritated ear more often and are generally more whiny. Furthermore, they sleep restlessly and drink little or no drink. It can also be observed that infants prefer to lie on the sick side and move their head restlessly back and forth. The good thing is that middle ear infections usually heal spontaneously after a few days. Only antipyretic drugs such as ibuprofen are prescribed for treatment. These effectively calm the pain so that the children can sleep and eat well again. Your general condition improves so quickly. However, sometimes an antibiotic is essential. Here parents should make sure that the antibiotic is completely consumed so that all pathogens are killed. It is important to drink enough fluids to prevent fluid loss in the event of a fever. Particular attention must be paid to this in infants, as fluid losses are significantly more serious here than in adults. Decongestant nasal sprays improve breathing and the drainage of inflammatory secretions, such as Nasic® nasal spray for children.

Read more on the topic: Nasic® nasal spray for children.

All in all, an otitis media in children is quite normal and occurs more often. However, close monitoring by the pediatrician is necessary to prevent possible complications. In very rare cases, otitis media can spread to the meninges. However, parents shouldn't worry too much about this, because in most cases otitis media in children subside without complications and spontaneously after a few days.

Read more on the topic:

  • Otitis media in the baby
  • Otitis media in toddlers

Therapy / treatment

In most cases, the administration of decongestant nasal drops and pain relievers (analgesics) is sufficient.
If there is no improvement within 2-3 days Broad spectrum antibiotics (antibiotics that are effective against a wide variety of bacteria).
If this measure does not lead to success either, a pathogen smear must be made in order to identify the causative pathogen and selectively Antibiotics to be able to select (see above).

Home remedies for otitis media

Onions and potatoes can help.

There are several home remedies that can relieve the symptoms of otitis media. If you want to use these, it is advisable to discuss them with a doctor anyway, especially if they are to be used on children. However, experience has shown that they help to relieve acute symptoms. If you have an otitis media, you should drink a lot and stay in bed.

Read more on the topic: Home remedies for earache

An overview of common home remedies follows.

1. Onions

The soothing effect of onions is mainly used in children with otitis media. You cut an onion into small pieces and place the pieces in a linen cloth. You can use a baby bib for this, for example. The onion sachet should then be heated over hot steam. It should be as warm as possible, but not scalding hot. You put this sachet on the affected ear. Especially with toddlers and babies, the temperature should definitely be tested on your own ear. As babies often sleep on the affected side, the sachet can be placed under the affected ear at night. Leave the onion packet on your ear for about half an hour. The process can be used several times a day. For adults, you can also take chamomile or garlic instead of onions. You can also fry the onions until they are translucent and then wrap them warm in towels, this has the same effect. There is also the option of squeezing the onion and pouring the juice directly into your ear.

2. potatoes

Similar to the onion parcels, warm potato sachets also help with otitis media. To do this, you boil the potatoes and mash them. The puree is wrapped in towels and pressed to the ear while still warm. Both methods relieve the discomfort with warmth. This warmth can of course also be achieved with red light lamps. However, you should be careful not to hold the lamp too close to your ear, otherwise you could burn yourself.

3. Leg wrap

Often those affected suffer during one Otitis media also under fever. Here you can Calf wrap Take remedial action. For this purpose, cloths are immersed in water, which has to be a little colder than body temperature. The towels are wrung out and wrapped around the calves. The wraps are changed two or three times when they are warm.

You can find a lot more information on this topic at: Home remedies for otitis media


Homeopathic Remedies depend on the primary clinical symptoms of the Otitis media. According to the rule of similars one takes exactly that homeopathic remedies one that would trigger exactly these symptoms in a healthy person if he were to take it. According to this, depending on the specific symptoms of otitis media, the following homeopathic remedies can be used:

  • Red, severe, sharp pain on one side? Chamomilla
  • severe and sudden pain, high fever? Aconite
  • Severe pain, fever, red head, very sensitive hearing? Belladonna
  • Purulent, damaged eardrum? Silicea
  • Fever, creeping development, cold? Ferrum phosphoricum
  • Viscous nasal secretions, red ear, sharp pain? Pulsatilla.

homeopathy cannot replace conventional medicine. Whether there is a significant effect is highly questionable. Rather, it can serve the moral support of those affected and the subjective feeling of health than that it eliminates organic causes for pathological conditions.

Duration of an otitis media

The Duration of otitis media depends on the nature of this. Acute otitis media differ in their duration depending on whether they are bacterial or viral.

In the first phase of otitis media, the inflammatory phase, severe symptoms occur Pain and fever on. This usually takes time 2 to 3 days. Viral inflammations usually subside here.

Bacterial inflammation then enter the next phase, the Defense phasewhich takes about another five days. Characteristic of this is a spontaneous one Rupture of the eardrum With Discharge of pus. Pain and fever subside here. Antibiotics shorten this phase significantly by killing the bacteria. After another 2 to 4 weeks, the otitis media heals completely.

Chronic otitis media do not heal spontaneously. Their duration cannot be precisely predicted, but sometimes they can for years consist. However, they often provide one Indication for an operation represent.

How can you prevent otitis media?

Otitis media probably everyone goes through in the course of his life and especially in the course of his childhood. However, there are a few things you can do to prevent otitis media.

Babies should necessarily breastfed for the first three months become. That has a positive effect on the general development of the child and that immune system out. Smoking in the presence of children should be avoided so as not to impair their development. In general, smoking makes the upper respiratory tract more susceptible to infection and therefore also increases the risk of infectious otitis media.

To further prophylaxis is recommended Vaccinate against influenza and Pneumococci. That's how you bend flu-like infections in front. These often cause otitis media. Help with a cold nasal decongestant sprays, the Middle ear better ventilate. However, these should not be used for more than a week. Furthermore, babies who frequently suckle on pacifiers seem to have more otitis media. This could have something to do with the constant vacuuming of the Pressure conditions in the ear to be changed. However, this assumption is not confirmed. However, pacifiers can of course transmit infections if they are not cleaned. With an existing Eardrum perforation the middle ear is more prone to acute otitis media than if the eardrum is intact. To prevent otitis media, you should wear hearing protection when showering and bathing. This is how to prevent Bath water in the earwhich can be infectious.


One possible complication is chronic otitis media.

Complications of otitis media include reaching over to structures adjacent to the middle ear, such as the mastoid cells.
The mastoid cells are air-filled, mucous membrane-covered bone spaces behind the ear.
The inflammation, correspondingly known as "mastoiditis", is then noticeable as tenderness behind the ear (this region is also known colloquially as the mastoid process; in medicine it is called "mastoid").
In the context of an uncomplicated otitis media, this symptom often occurs, but then disappears quickly with treatment. The recurrence of pain after a symptom-free interval, accompanied by a strong feeling of illness and fever, then points to the inflammation of the mastoid process, which is still potentially threatening today. The bone can melt down (medically: osteolysis) and the suppuration can break through the bone wall. The result is one behind the ear swelling (see Swelling behind the ear)and a protruding auricle.

Then imaging tests are like one Computed tomogram (CT for short, an X-ray image reconstructed from many slices) is displayed in order to determine the extent of the inflammation and to repair it surgically (medical: “mastoidectomy”).
You can find further information under our topic: Mastoiditis

If an otitis media does not completely heal but persists, the so-called. chronic otitis media (chronic otitis media).
This can run in different ways: In the mesotympanic form (named after the Greek mesos = middle, i.e. a form limited to the middle ear) is the Inflammation of the mucous membrane the tympanic cavity in the foreground. Sick people suffer from persistent hearing loss and discharge from the ear. The defect of the eardrum (a perforation), which by definition accompanies chronic inflammation of the middle, is typically located in the center.
The treatment consists of a surgical closure of the eardrum (a so-called tympanoplasty).
As with all chronic courses, it is important to clarify the underlying cause of the poor healing process or the constant recurrence of the otitis media (see above). Rarer forms of chronic otitis media (chronic otitis media) represent the Tympanic fibrosis in which there is an accumulation of connective tissue in the tympanic cavity behind an apparently intact, whitish thickened eardrum, as well as tympanosclerosis, in which, due to the long-lasting inflammatory process, degeneration and calcification of the connective tissue of the eardrum occurs.
You can find further information under our topic: chronic otitis media.

Can you fly with an otitis media?

Whether you want to fly or not with an otitis media is up to you. However, it is in no way advisable. The pressure conditions in the aircraft are very stressful for that ear. A damaged one Middle ear can hardly provide the necessary pressure compensation and that then leads to severe pain. Even if the Otitis media is already healed, a doctor should do this before starting the trip eardrum examine. Otherwise there is a risk of a new otitis media if the mucous membranes have not yet completely recovered. In addition, the dry, air-conditioned air in the aircraft is not good for the inflamed ear. Anyone who has already flown with an otitis media will confirm it: The pain is extremely excruciating and difficult to bear, especially when landing. But not only flying should be avoided. In general, you should refrain from activities in which you are exposed to pressure differences. This includes elevator travel over several floors and rides in amusement parks and at fairs.