Otitis media in toddlers


Middle ear infection (otitis media) is a common disease in young children. Almost every child is diagnosed with an otitis media by the age of 4. In this disease, the section of the ear that is located behind the eardrum (= middle part) becomes inflamed. From here there is a connection to the throat, the so-called Eustachian tube or Eustachian tube. It is normally responsible for ventilating the ear and also for balancing the pressure between the outside world and the tympanic cavity. In children, this trumpet is still very small and relatively narrow, which can easily block this passage if the mucous membrane swells. Secretion builds up there and inflammation can develop.


Signs of otitis media with toddlers, for example, can be frequent Ear rubbing, constant touching of the ear, indication of pain especially when touching the ear and frequent crying / screaming. Non-specific symptoms of the disease can also occur. For example, general weakness or restlessness, Vomit and diarrhea, fever and chills or loss of appetite is possible. If the children are already a bit older (4 years or older), they can often pinpoint the pain and also indicate that they hear worse on one side. In addition, the development of a fever is less common here than in younger ones.

Symptom fever associated with otitis media in young children

Fever is a possible symptom of otitis media (Otitis media) in the toddler. It does not have to occur inevitably, but it often occurs as an accompanying symptom. A temperature of 38.5 ° C and above is considered a fever. Temperatures between 37.6-38.5 ° C are called subfebrile. In the case of small children, one can first try to get the fever under control with leg compresses. The child should also drink a lot. If the fever does not go down within a few hours, the treating pediatrician should be consulted. He can then decide whether drug treatment is necessary to lower the fever and whether the otitis media also requires drug treatment.

Also read our topic: Fever in the toddler

Pus from the ear in a toddler otitis media

Pus occurs as part of inflammation, usually as a reaction to contact with bacterial pathogens. Often these pathogens rise to the ear after an infection of the respiratory tract or the tonsils. Due to the anatomical conditions in children, inflammation of the middle ear is more common. This has to do with the drainage from the middle ear (the Eustachian tube ear trumpet) is often relatively narrow, secretion builds up and bacterial colonization is favored. If pus forms in the middle ear, this leads to increased pressure on the eardrum and the pain increases. The doctor can see if there is pus in the middle ear, i.e. behind the eardrum, during an ear mirror. In some cases, the pressure exerted by the pus on the eardrum can be so great that the eardrum tears, this is referred to as a perforation of the eardrum. Clinically, with such a perforation, the earache suddenly decreases sharply because the pressure on the eardrum is now gone. The pus then runs out of the ear as a yellowish liquid.

Pain associated with otitis media in a young child

Pain is arguably the most typical symptom of an otitis media and will be all too familiar to most parents. This pain occurs because of the inflammatory reaction in the middle ear and the accumulating secretion that puts pressure on the eardrum. The children are often in great pain and scream a lot. The pediatrician can prescribe mild pain relievers to make the symptoms more bearable for the duration of the illness. Paracetamol or ibuprofen, for example, come into consideration here. Paracetamol is available as suppositories or tablets, ibuprofen is available as juice or in tablet form.

The child hears poorly with an otitis media

Inflammation in the middle ear causes the affected areas to swell. Often there is secretion in the ear that cannot drain off sufficiently due to the swelling. The inflammation and the accumulation of secretions often lead to the fact that the children in the affected ear have less hearing. The hearing loss usually disappears completely after the acute otitis media has subsided.



Middle ear infections in young children do not necessarily have to be Antibiotics be treated. Only about half of middle ear infections will go through bacteria caused the other half by Viruses. However, antibiotics do not help against viruses and not every bacterium can be fought by every antibiotic. As a rule, the children get an adequate fever and Pain managemente.g. With Paracetamol or Ibuprofen and decongestant if necessary Nasal drops. These can make nasal breathing easier for a short time, but they probably have no influence on the actual course of the disease. They should also not be used regularly over a long period of time.

If purulent secretions run out of the ear or if the symptoms do not improve within a few days, it may still be necessary to use an antibiotic. The children often find warmth to be pleasant. You can e.g. by a Irradiation With red light or through a warmed pad. If the otitis media persists over a longer period of time, there is the possibility of small ear tubes insert into the eardrum and thus ensure adequate ventilation of the middle ear. They also help with the drainage of secretions, so that the pressure in the middle ear is reduced. In addition, for a chronic otitis media also often so-called Polyps to be responsible. These are growths of the tissue on the palatine tonsil, which swell when the airways are inflamed and block the ear trumpet so that the secretion can no longer flow out of the ear into the throat.An operation to remove these polyps can be helpful here.

Home remedies for otitis media in toddlers

Home remedies for otitis media: Onion and chamomile sachets are tried and tested home remedies for relieving symptoms of otitis media.

Read more on the topic: Home remedies for earache

Here, chopped pieces of onion or chamomile flowers are placed in a thin cloth bag and placed on the sore ear several times a day for about half an hour. A red light lamp that warms the affected ear a little is also good for many children. Calf compresses are a home remedy for high fever. Towels are given water that is slightly cooler than body temperature, wrung out and then wrapped around the calves. The cloths that have become warm can be replaced 2-3 times. These drugs are used to relieve symptoms, but are not a substitute for medical treatment. A child with otitis media should definitely be presented to the treating pediatrician.

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When does my child need antibiotics for an otitis media?

In the past, most otitis media were treated with antibiotics. Nowadays it's a little different, but in different countries the administration of antibiotics for otitis media is handled very differently. While almost all children with otitis media in the USA are treated with antibiotics, in Germany it is only about 1/3. The general use of antibiotics is no longer common here. Mainly because studies have shown that the disease heals spontaneously (i.e. without antibiotics) just as quickly as with antibiotics. In special cases, however, antibiotic therapy should be started early. Studies show that antibiotics can be useful, for example, in children under 2 years of age with bilateral otitis media and a high fever, as well as in children in a poor general condition and children who have previously had otitis media with complications. In most uncomplicated cases, however, otitis media heals completely within a few days, even without antibiotics. If symptoms do not improve after 48 hours with symptomatic measures such as painkillers and nasal drops, antibiotic therapy should be started. Of course, only after consulting the treating pediatrician.

Which antibiotic is best for otitis media in toddlers?

The drug of first choice for antibiotic treatment of otitis media in children is amoxicillin. For children with a known allergy to penicillin, so-called macrolides such as erythromycin can be used as an alternative. Nowadays there are pathogens that can cause otitis media, but are resistant to amoxicillin. A combination therapy consisting of amoxicillin and clavulanic acid can help here, for example. Antibiotic therapy should - after consultation with the doctor - usually last at least 5 days.

Homeopathy for otitis media in toddlers

There are various homeopathic remedies that are supposed to help relieve symptoms of otitis media: Aconitum napellus (blue monkshood), Belladonna (deadly nightshade), Chamomilla (chamomile), Ferrum phosphoricum (iron phosphate), Pulsatilla pratensis (meadow pasque flower), Dulcamara (bitter sweet), Heparisis (Lime sulfur liver), Kalium bichronicum (potassium dichromate). Three globules or one tablet of Aconitum napellus, Belladonna, Chamomilla, Ferrum phosphoricum, Pulsatilla pratensis and Dulcamara can be taken every half hour. Hepar sulfuris and Kalium bichronicum should not be taken more than three times a day. The trusted homeopath should be asked more precisely which of the remedies should be best used in each individual case. A homeopathic treatment is in no way a substitute for a medical consultation.

Duration of otitis media in toddlers

Acute otitis media heals completely within 7-14 days in most children. In the vast majority of cases, the symptoms decrease significantly after 2-3 days. If this is not the case, the treating pediatrician usually starts antibiotic therapy.

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When is my child allowed to swim again after an otitis media?

During an acute otitis media, the child should not go swimming, as further germs can get into the already inflamed ear via the water. The child should not go back into the water until the symptoms of the inflammation have completely subsided, usually no sooner than after one to two weeks. In each individual case, the treating pediatrician should be asked when the child can safely go swimming again.

Is otitis media contagious in children?

No, otitis media is not contagious. Often, however, the trigger for otitis media is an infection of the respiratory tract. This is contagious. However, it does not have to automatically lead to an otitis media in another child. A child with otitis media will usually have to stay home for a few days because of the symptoms. However, there is no risk of infection, so this is no reason for the sick leave if the child is otherwise fine.

Please also read our topic: How contagious is otitis media?

Consequences and complications

In most cases, the eardrum remains undamaged and the inflammation disappears completely. However, it can happen that an effusion remains in the middle ear, which then gives the child a permanent feeling of pressure and, in rare cases, can also lead to hearing loss and ear pain. If a child is often affected by otitis media, repeated tears in the eardrum can cause it to become scarred and stiff. As a result, incoming sound waves can no longer be completely guided to the inner ear and the children hear less as a result. Complications during an otitis media are also rare. You should therefore always watch your child carefully, pay attention to possible warning signals and, if necessary, see a doctor early on.

On the one hand, it can lead to so-called mastoiditis. This is a bacterial infection of the air-filled cavities of the mastoid process in the temporal bone of the skull. These are lined with mucous membrane and can be noticeable through pressure pain, swelling and redness in the area behind the earlobe, fever, throbbing in the ear or even ear discharge. Mastoiditis must be treated with antibiotics so that the inflammation does not spread to the bones. If the pathogens spread further, it can also lead to meningitis, or meningitis. This is a very serious illness that can be life threatening and requires immediate treatment. Symptoms of meningitis include fever, headache, nausea, stiff neck, impaired consciousness and photophobia.

Symptoms can vary widely in young children younger than 2 years. For example, they may have general weakness and are sensitive to touch, and high-pitched screaming or whimpering is also common. There may also be circulatory problems, for example an increased breathing and heart rate or shortness of breath. The child should be taken to a hospital emergency room immediately so that treatment can begin as soon as possible and there is no permanent harm. In rare cases, an otitis media can also damage the inner ear.

Invading bacteria give off their toxins, which spread from the middle ear to the inner ear and cause "toxic labyrinthitis" here. The sensory cells of the inner ear are damaged and the patients report hearing impairment up to deafness as well as ringing in the ears and tinnitus. In some cases, dizziness and imbalance can occur because the balance organ is located in the inner ear. If you notice any of the above symptoms in your child, visit your doctor early so that chronic damage can be prevented.

Read more about this under Hearing impairment in children

Complication: burst eardrum in a toddler otitis media

The eardrum perforation, i.e. the tearing of the eardrum, is not uncommon in an otitis media. The secretion and pus collect in the middle ear and accumulate there because they cannot drain sufficiently through the ear trumpet due to swelling of the mucous membrane. If the pressure in the middle ear becomes too strong from this fluid, the eardrum may no longer withstand it and tear. As a result, the severe earache suddenly decreases significantly. The crack usually heals again without any external assistance. However, the eardrum should be checked by means of an ear mirror in order to assess the healing process. Incidentally, in children with very severe pain who do not respond adequately to pain medication, a small hole is sometimes intentionally cut in the eardrum so that the secretion can drain off and the pain is reduced. One speaks of a Paracentesis.

Also read our topic: Torn eardrum

Can my child fly with an otitis media?

Theoretically yes. In practice, however, a flight should be avoided if possible if you have an otitis media. In a pure otitis media, flying does no additional damage to the ear. However, due to the increased pressure on the ears, the pain in a child with acute otitis media can increase significantly in intensity. Even for adults, air travel with acute otitis media can be very painful. If a flight is absolutely unavoidable, decongestant nasal drops and, if necessary, painkillers should be used shortly beforehand. The treating pediatrician should be asked about this. He should also examine the ear by means of an ear mirror before starting the flight. If there is evidence of damage to the eardrum or middle ear, air travel may be contraindicated.


Parents should consult a doctor for the above symptoms. He will ask you in detail about the current symptoms and the history of your child. This is followed by a physical examination, in which the ear in particular is thoroughly examined and, if necessary, the body temperature is measured. The doctor looks at this during the ear examination eardrum with a Otoscope on. This is an instrument equipped with a magnifying glass and a small lamp that makes it possible to Ear canal to inspect closely. In addition, the hearing ability is checked in further steps and examined whether the eardrum can move freely.

In addition to the symptoms described by the parents, there are other diagnostic indications of inflammation of the middle ear in the toddler. These include red eardrum and an outwardly curved, immobile and non-transparent eardrum, which indicates a build-up of fluid behind the eardrum. If the eardrum tears due to excessive pressure, it can cause a Secretion leak come. A yellowish, purulent, sometimes bloody liquid then runs (through the Tear in the eardrum) from the ear and the child's symptoms abruptly subside.


Often, otitis media occur in small children accompanied by an infection, e.g. one a flu-like infection, one flu or one Sore throat on. Viruses get into the throat area and the mucous membranes swell, also in the area of ​​the ear trumpet. This causes a build-up of secretion in the ear and the small pathogens can work their way into the ear, settle there and multiply. This situation then results in inflammation of the middle ear and the child experiences the symptoms mentioned above. As already mentioned, the polyps can also be responsible for the development and also promote it allergic reaction or Inflammation of the sinuses the development of otitis media.

Other risk factors include using a pacifier, attending daycare centers or similar care services, and passive inhalation of tobacco smoke, which is the greatest risk factor because it is immune system weaknesses in children and thus promotes infections of the respiratory tract. Diet also has a protective effect Breast milk instead of milk from the bottle.