Symptoms of acute otitis media

Synonyms in a broader sense

Medical: otitis media

acute otitis media, hemorrhagic otitis media, myringitis bullosa

English: acute otitis media


Acute otitis media is a common disease, especially in childhood. This is caused by bacteria (such as Streptococci or Staphylococci) and about a third caused by viruses.
An acute otitis media often occurs after an infection of the upper respiratory tract, as a result of which germs from the throat via the tube (Tuba auditiva) migrate into the middle ear.
There they cause characteristic symptoms, which are caused by an inflammation of the middle ear mucosa with accompanying swelling and a consequent ventilation disturbance of the middle ear.

True, this disorder can be extreme painful but it is usually harmless and without complications.

The doctor can usually diagnose the disease based on the symptoms and by looking into the affected ear.


Symptoms such as severe, stabbing or throbbing pain in the area of ​​the affected ear are the main symptoms of acute otitis media.

The inflammation often starts during or shortly after one cold with violent or also pulsating earache.

Acute otitis media also shows itself through especially in small children general unspecific symptoms such as nausea, vomiting, diarrhea, headache, loss of appetite, abdominal pain, and increased irritability.

In addition, the previous cold usually still causes cold symptoms such as sore throat, cough or runny nose.
In addition, a pain when applying pressure on the so-called Mastoid bones (Mastoid process) occur.

Furthermore, this condition occurs frequently fever on that especially in the first 24 hours stops and with a strong feeling of illness can go hand in hand.

A Hearing loss on the affected ear is also typical of acute otitis media. This can include a feeling of fullness of the ear, dizziness and throbbing, often pulse synchronous Ringing in the ears accompanied. You may also get the feeling that noises and your own voice echo in your head.

In the vast majority of cases, this hearing loss is caused by one caused by the inflammation effusion in the middle ear, which has the ability to vibrate Eardrum impaired.
This effusion can persist for several weeks after the inflammation has subsided, so there is a possibility of a slight one Hearing loss for up to 3 or 4 weeks. After 3 to 4 weeks you should also have a doctor Follow-up check occur.

Another symptom, which is usually only recognized by the family doctor or ENT doctor, is one Bulging such as color changes in the eardrum.
This is caused by the massive accumulation of the purulent secretion in the tympanic cavity and gives the treating doctor a clear indication of the presence of an acute otitis media.

What are the symptoms in the baby?

A baby with acute otitis media can only express pain through behavior.
By frequent screaming can alert them that something is hurting them. It can appear very restless and throw its head from side to side. Here, at least at the beginning of the disease, the ear symptoms are usually not in the foreground.

Other babies rub your ears increased, for example on their pillows or on their parents' shoulders.

Some babies often show a so-called at the beginning of the disease Compulsive ear. This means that they grab each other's ears more often.
In the course of acute otitis media, they may instead fight off touching the ear immensely due to the pain and respond with crying and screaming.

In addition, a Poor drinking an expression of side effects such as Difficulty swallowing, painful swallowing and abdominal pain be.
The baby can also appear more inactive, tired and exhausted overall. Some parents notice a change in skin color.

Furthermore you can Increases in temperature, chills, and fever demonstrate.
The younger the child, the more general symptoms and sometimes a high fever can be in the foreground.

Also can purulent, bloody secretion run out of the ears.

In some cases, a Hearing loss stand out. In small children, this is shown, for example, by turning the head less to an acoustic stimulus.

Toothache from an otitis media

In the context of an acute otitis media, the earache can go up to the Teeth radiate. This pain is then often perceived as a diffuse toothache.
Often times, the pain is described as a dull pressure or a pull.
Most of the time it is Upper jaw area affected by the radiating pain.

The triple nerve, the so-called Trigeminal nerve, with its various branches also supplies a large part of the ears and the tooth area at the same time. If the facial nerve becomes compressed or irritated due to an inflammation such as acute otitis media, it can also Toothache result, even with completely healthy teeth.

When the symptoms of acute otitis media subside, the referred toothache will usually also subside. If these persist, a dentist should be consulted.

It is also possible that the root cause is actually in the tooth area and the pain is radiating into the ear. Subjectively, this can incorrectly be interpreted as an acute otitis media.

Also can be a viral inflammation, a so-called Herpes zoster irritate the facial nerve and Ear and toothache trigger and lead to misinterpretation.

In addition, acute otitis media can cause sudden and severe toothache due to the changed pressure conditions in the ear. The changed pressure can be caused, for example, by tooth decay under the dental fillings Cavitation to lead. A dental check-up would be advisable in these cases.

Jaw pain with otitis media

Anatomically there is a close neighborhood relationship between the Middle ear and the Temporomandibular joint. Consequently, this can lead to jaw pain in the course of an acute otitis media.
The nerves and the surrounding muscles in the surrounding area can be irritated by the inflammatory processes.
This means that the jaw muscles, i.e. the masticatory muscles and the muscles of the mouth opening, can be restricted.

Correspondingly, this can be the case with an acute otitis media Opening the mouth and the Chew difficult and painful.

Conversely, jaw problems can also lead to radiating ear pain.
Cause can Dentition and temporomandibular joint misalignments or signs of wear and tear. In addition, pain in the temporomandibular joints, cracking and pain when moving the jaw, nocturnal teeth grinding, neck tension, problems opening the jaw in combination with diffusely aching ears, noises in the ears and headaches can all indicate a problem in the temporomandibular joint.

As with toothache, it is often difficult to make a subjective assessment of whether it is a acute otitis media or a TMJ disorder acts.

Headache from otitis media

In the course of an acute otitis media can also be a side effect a headache occur. These are usually harmless and will get better as soon as the acute otitis media heals.
The cause of the pain radiating to the head can also be irritation of the facial nerve.
In addition, due to the inflammatory processes in an acute otitis media, changes in blood flow can lead to headaches.

In addition to severe tiredness, fever, impaired consciousness, confusion and severe headaches, there should also be a strong neck stiffness and a Hyperextension of the body (so-called Opisthostonus), a doctor should be consulted immediately. Even if only some of the symptoms listed are shown, meningitis should definitely be ruled out in this case.

However, this complication occurs relatively rarely in the context of an acute otitis media. However, it is possible that the pathogen causing acute otitis media is in the brain penetrate and cause severe inflammation there. One speaks of a so-called forwarded meningitis. This is an absolute emergency and requires emergency medical treatment.

Furthermore, an acute otitis media can also be erroneously suspected subjectively, although there is a disease in the head area. For example, the pain of a migraine radiate into the ears and sometimes express themselves as severe earache.

Difficulty swallowing with an otitis media

Due to the proximity to the oral cavity and the pharynx, acute otitis media can also occur in the context of an acute otitis media difficulties swallowing occur. The structure that connects these areas is called Eustachian tube (Tuba auditivia).
Usually the Eustachian tube with a so-called respiratory ciliated epithelium equipped, which ensures that germs are transported towards the throat. However, pathogens in the throat area can migrate up to the ears if this protective mechanism is disturbed.

A Tonsillitis With difficulty swallowing, it could possibly develop into an otitis media.

The difficulty swallowing can vary in severity. In some cases, they hinder food intake.

In addition, swallowing difficulties can occur due to the changed pressure conditions, which are related to the functionality of the ear trumpet.
In a healthy state, the ear trumpet opens with every act of swallowing. In addition, a small opening, the so-called Safety tube of the ear trumpet for continuous ventilation of the middle ear.

In the context of an acute otitis media, this opening or the ear trumpet can be closed. This can stand out alongside Hearing problems also express in difficulty swallowing. Often a cracking sound can be heard in the ear when swallowing.

If swallowing problems persist after the acute otitis media has healed, a doctor should be examined.

How long do the symptoms last?

The Form and duration the discomfort can vary greatly.
Usually the course of the disease is in one viral Otitis media shorter than one bacterial Otitis media.
Occurring severe earache In uncomplicated acute otitis media, they often subside after one to three days.
Usually are Earache and radiating Tooth, jaw and headache with an uncomplicated course, completely receded after a week.
Any symptoms associated with the symptoms improve just as quickly difficulties swallowing.

Viral inflammation can develop Blisters on the eardrum form. These blisters are filled with a watery-yellowish secretion and blood. The blisters can burst a few hours after the onset of inflammation and the secretion flows out of the ear.

In the case of a bacterial otitis media, purulent secretions may also escape. This usually happens after 3-8 days.

In both cases, the acute earache is reduced after the secretion has escaped.

Often an accompanying occurs Hearing loss which also regresses over the course of a week.
If in the context of acute otitis media one Timpani effusion However, hearing loss and tenderness can persist for another two to three weeks. If these persist for a longer period of time, a medical clarification is required.

If a fever has occurred, it usually goes back after three days. General pain in the limbs usually subsides with the drop in fever. Small children often complain at the onset of acute otitis media Abdominal pain and diarrheawhich normalize at about the same time as other possible complaints.

In acute bacterial otitis media, the duration of the symptoms can in some cases be targeted Antibiotics usually shortened by a few days.


Complications, which can occur in the course of an acute otitis media, can usually be recognized by specific symptoms.
So, in addition to the middle ear, inflammation can do that too Inner ear concern which, in addition to forwarding the sound information, is also used for the balance responsible for.
Inflammation of the inner ear can mainly be caused by this Dizziness and total hearing loss noticeable on one side.

Another complication is a meningitis represented by infection of the Meninges is caused.

An infection of the middle ear can also be called a Brain abscess cause. This can lead to unspecific neurological-psychological failures, which require neurological diagnostics and should be recognized quickly.

Another dreaded complication of acute otitis media is the so-called Mastoiditis. This is the inflammation of the mastoid process of the temporal bone.
Whether or not such inflammation is present can mainly be through severe pressure pain can be detected in the area behind the ear.
This area often goes with one swelling and there is a discharge of a purulent secretion from the ear.

With an otitis media you can annoylocalized near the middle ear, are impaired and thus temporarily lead to paralysis.
This mainly concerns the Facial nerve (Facial nerve), which if it fails can paralyze areas of the face. This can be seen by a drooping corner of the mouth and an inability to completely close one eyelid.

Arguably one of the most serious complications of acute otitis media is one sepsis (colloquial Blood poisoning), which is caused by a transfer of the pathogens from the middle ear to the blood.
Sepsis is on one pronounced shock symptoms recognizable. This includes a fast breathing, one increased heartbeat as well as a increased body temperaturer a.

Frequent middle ear infections can do this eardrum be so damaged that it scarred. Since the eardrum plays a major role in amplifying the perceived sound, scarring of this structure goes with a permanent one Hearing loss hand in hand.

For this reason, frequent middle ear infections with a rupturing eardrum should be prevented as far as possible.


The causes of the typical symptoms of acute otitis media lie in the body's reaction to being colonized by pathogens.

In the case of an acute otitis media, in most cases bacteria the cause of the infection, being too Viruses may be responsible for the disease.

The typical pathogens of acute otitis media are also pathogens that typically cause infections of the respiratory tract in the human organism.
These are mainly bacterial pathogens like Streptococci, Morraxella catarrhalis, or Hemophilus Influenza, or viral pathogens like that Influenza virus or Herpes viruses.

The path of infection that the pathogens take when the middle ear is infected is the passage, which the throat connects to the middle ear: the so-called Eustachian tube (Tuba auditiva).
If this duct is swollen as a result of the infection, the middle ear or the tympanic cavity can no longer be adequately ventilated, which leads to an accumulation of secretion in the same leads.

This accumulation of inflammatory secretions can explain a number of typical symptoms of acute otitis media.


Depending on the present Pathogen, i.e. virus or bacterium, the individual location of the Immune system and the Treatment of acute otitis media the disease can one different course to take.

A few days after the onset of the disease it can also lead to a spontaneous tearing of Eardrum come as too much pus or. liquid has accumulated in the ear. The eardrum can no longer withstand the resulting pressure.
That tear, too Eardrum perforation is usually associated with a short, sharp, and very severe earache, after which the earache and fever quickly improve.
A slight and after a few days to weeks reversible hearing loss can occur again here.

The pus can now flow out through the resulting hole in the eardrum and it closes Discharge from the earwho is definitely something bloody can be. This leads to a Pressure relief and again ventilation of the middle ear, what the Healing process promotes as long as no germs migrate from the outside through the perforated eardrum into the middle ear, which is why with a perforated eardrum usually a antibiotic is prescribed.
The small tear in the eardrum usually heals within 2 weeks by itself.

Usually, antibiotic treatment for the condition can be waived a day or two, especially since the Childhood most acute otitis media heal on their own.

Read more about this at: Otitis media in the baby and in the toddler

There are a few, however Warning noticesconsult a doctor again if they occur.
This includes:

  • Very high, persistent fever, febrile infants under three months of age with a fever over 38 degrees
  • persistent vomiting
  • no significant improvement after therapy two to three days
  • Impaired consciousness
  • a seizure
  • complaints getting worse again (like an increasing ear pain after initial improvement)
  • Facial muscle paralysis
  • a suddenly protruding ear caused by swelling on one side, combined with tenderness

You should also be particularly vigilant if an acute otitis media with serious complications preceded it, or if otitis media have occurred repeatedly in the recent past, or if so Immunodeficiency or Previous operations exist on the middle ear.
Here is an early visit to the doctor to estimate the Risk of complications and timely treatment advised.


The most effective treatment for the symptoms of acute otitis media is causal therapy, because as the causative agents of the inflammation are combated, the symptoms will also disappear.

Read more on the topic: Home remedies for earache

In many cases, the immune system manages to fight the inflammation on its own. However, if there is no improvement in sight after two to three days, causal treatment of the disease should be started.

A bacterial inflammation should then be treated with antibiotics in any case, as this prevents the eardrum from breaking through and the course of the disease can be shortened.
The therapy can also reduce the intensity and duration of the symptoms.

In the past, the eardrum was often opened by making a small incision so that the secretion could drain away. Nowadays it is waited to see if the breakthrough will happen by itself, as it has been observed that a torn eardrum heals better than one that has been cut open.

Symptomatic therapy with pain reliever medication, for example with ibuprofen, makes sense, since in addition to the pain reliever effect, an anti-inflammatory effect can also be achieved with the active ingredient.

Decongestant nasal sprays can also help, since with their help the connection between the throat and the tympanic cavity is ideally restored and a drastic improvement in the symptoms can be achieved.

As a general rule, physical restraint can promote the course of the disease and ensure a quick recovery and improvement of the symptoms.

You can find more information on this topic here: Therapy for acute otitis media