Therapy for acute otitis media

Synonyms in a broader sense

Medical: otitis media

acute otitis media, hemorrhagic otitis media, myringitis bullosa

English: acute otitis media


The acute otitis media is an inflammation of the Mucous membrane of the middle ear. This is usually caused by pathogens from the Nasal / pharynx through the tube, a kind of ventilation tube from the pharynx to the middle ear, ascend into the middle ear. Typically, acute otitis media develops after one Upper respiratory tract infection. The symptoms are caused by the Inflammatory response the middle ear mucosa and are associated with pain and swelling that obstructs the tube, resulting in a Ventilation disturbance among other things with negative pressure leads on the ear in question. In addition, often imagines effusion, caused by the impairment of the ability of the eardrum to vibrate Hearing impairment can cause.

Lowering of fever

Therapy is also based on these symptoms. This is the case with every inflammation in the human body, especially when it is with fever and Feeling sick goes hand in hand, advisable and healing, to give the organism the rest it needs for regeneration. In the acute stage of the disease one should therefore not overexert oneself and depending on the severity of the disease bed rest adhere to. In addition, ensure that you drink enough fluids, especially if you have a fever.

Drug therapy is usually symptomatic in the form of pain therapy. Ibuprofen and Paracetamol are the most commonly used systemic pain relievers and especially in the first 3 days very useful for alleviating the symptoms. Pain reliever Ear drops however, their effects are very controversial and are not taken into account in disease-specific guidelines.
The effect of decongestant Nasal drops has also not been proven, but can provide relief from a simultaneous or previous cold by using a free nasal breathing support the patency or the function of the tube and the Discharge of secretions promote from the middle ear.


The use of antibiotics should be handled cautiously because of possible side effects and the possible development of resistance. Around 80% of all acute otitis media in children heal on their own without complications. So if the symptoms are not particularly severe, no complications have occurred and no rupture of the eardrum has occurred, an antibiotic can be used for 2 to 3 days (for children under 2 years of age about 24 hours) to see whether the inflammation has resolved lays itself back very quickly. If this is not the case, an antibiotic can be given if the symptoms persist, which is usually given for 5 to 10 days. If the otitis media does not improve within 48 hours after administration of the antibiotic, a doctor should be consulted again and a change of the antibiotic should be considered (see also: Fever despite antibiotics - what to do?). The first choice antibiotic is amoxicillin from the penicillin group. In the case of a penicillin allergy, what are known as macrolides are used, azithromycin or erythromycin in particular.

Please also read our article on this Antibiotic side effects

Antibacterial therapy with antibiotics is considered the treatment of choice for acute otitis media and is considered to be the only therapy that can effectively treat the cause of acute otitis media caused by bacteria. The disease is one of the most common causes why antibiotics are prescribed in Germany. This is especially true in children or infants, who are more likely to be affected by the inflammation than adults.

The bacteria most commonly responsible for the inflammation use the ear trumpet to enter the middle ear from the throat area. Typically, pathogens are like Streptococci, Haemophilus influenzae or Morraxella catarrhalis responsible for the disease. These pathogens can be treated with common antibiotics. The standard antibiotic recommended and often prescribed for the treatment of acute otitis media is the so-called Amoxicilin. Since this antibiotic is a type penicillin If you are allergic to penicillin, you have to switch to another antibiotic in order to prevent the severe allergic reaction that may occur. In these cases, a so-called Macrolide prescribed.

The guideline for acute otitis media stipulates that only certain groups of people should necessarily be given immediate antibiotic therapy.

This group of people includes, for example, children who are under 6 months old. Children under 2 years of age should also be given antibiotics immediately, provided the inflammation affects both ears. Even if the inflammation causes moderate pain and a fever occurs, antibiotic therapy is recommended for all age groups.

If a purulent discharge from the ear is noticed, it is advisable to consult a doctor immediately, who will then initiate therapy with the appropriate antibiotic.

People who have individual risk factors should be advised that inflammation in the middle ear can occur more frequently in them than in people who do not have these factors. Immediate antibiotic therapy is recommended, for example, for people with a cochlear implant, immunodeficiency, people who have trisomy 21 or serious underlying diseases.


The Duration of therapy depends on the treatment method, the individual immune system as well as the pathogen that is responsible for the acute otitis media.

If the sick person does not belong to the group of people for which an immediate Administration of antibiotics recommended, antibacterial therapy is generally not used in the first two days. In most cases, acute otitis media can occur without an antibiotic heal by itself. However, if after two to three days If there is no improvement in the symptoms, or if the sick person has risk factors, antibiotic therapy can be started. The antibiotic should always be taken strictly as directed by the doctor. In no case should the antibiotic be discontinued before the date agreed with the doctor. Even if symptoms subside a few days after starting therapy, an antibiotic should be used to prevent resistant strains of bacteria always taken to the end become!

On the other hand, symptomatic therapy with antipyretic and pain reliever medication should only continue for as long as the fever and pain occur and can be safely discontinued after the symptoms have subsided.

Home remedies for otitis media

There are a number of different home remedies that are popularly used for the treatment of acute otitis media and that have healing effects. There is no scientific evidence that any of these home remedies help against the cause of the inflammation. This is made more difficult because the inflammation is in the middle ear, which is sealed off from the outside by the eardrum.

The usual home remedies rely on putting the substances contained, which are supposed to have antibacterial effects, on the ear or filling them into the external auditory canal. However, since the eardrum, if it is intact, does not let any of these substances through, these home remedies cannot develop their effect in an acute otitis media. If the eardrum is damaged due to the inflammation, it is not advisable to put substances into the external ear canal, as this can lead to the spread of germs, which could significantly worsen the course of the disease.

Calf compresses are helpful home remedies that can treat the frequently occurring high temperature. The body temperature can be effectively reduced by placing damp cloths on the calves of the person affected.

In general, a doctor should definitely be consulted so that the therapy options can be discussed with him. In conversation with the attending physician, the harmlessness of the home remedies can also be asked.

Read a lot more information on this topic at: Home remedies for otitis media


Homeopathic substances are often used in diseases for which antibacterial drugs are normally used. There is currently no scientific evidence that homeopathic substances have been able to demonstrate significant effectiveness.

However, there is nothing medically against taking the homeopathic remedies available in addition to conventional medicine. It is only important that the disease is not played down and complications are accepted. Because of this, it should a doctor should be consulted in any casewhen symptoms of acute otitis media occur.

In a detailed doctor-patient conversation, therapy options can be discussed and the possibilities of taking homeopathic remedies in addition to conventional medical methods.

in children / babies

The acute otitis media is a disease that is particularly common in children and infants. The symptoms of this inflammation can be detected by a pediatrician who looks into the affected child's ear canal and examines the eardrum there. Children typically also grab their ears if they have an otitis media, which is why such behavior combined with severe pain can be a sign of an acute otitis media.

The therapy for children or infants is similar to the therapy that is recommended for adults. For infants who are under 6 months old, a immediate antibiotic administration recommended. The same goes for children under two years of age if the otitis media appears in both ears at the same time. Immediate therapy should also be initiated if it is unlikely that a doctor can monitor the course of the disease.

For all children older than two years, depending on the individual assessment of the attending physician, you can wait up to two days before starting antibiotic therapy. If the inflammation recedes, the administration of antibiotics may be dispensed with.

The standard antibiotic of first choice, as with adults with the disease, is Amoxicilin. The duration of antibiotic therapy in children depends on their individual age. For example, in children up to the age of two, as well as in children who have severe illnesses, antibiotic therapy is one Duration of 10 days recommended. For children between the ages of two and six, a 7-day Therapy started. From the age of 6, antibiotics for 5-7 days are usually sufficient.

Even in children, if antibiotics are given, no improvement in symptoms can occur, a so-called Paracentesis, i.e. an opening of the eardrum.

In any case, if an acute otitis media is suspected in an infant or child, a doctor should be consulted who will examine the sick child and possibly confirm the diagnosis and initiate appropriate therapy. The individual disease situation of the sick child or infant must always be weighed up before therapy can be initiated. In addition, in order to avoid complications and to assess individual risk factors, you should refrain from self-therapy exclusively with home remedies without consulting the treating doctor.


If there is no satisfactory improvement even after changing the antibiotic, possible complications should be excluded and, if the eardrum bulges, which the doctor can determine, a so-called Paracentesis be carried out with a microbiological examination of the draining secretion. A small incision is made in part of the anesthesia for children under local anesthesia Eardrum set so that secretion or the pus can leak out of the middle ear. This will then be examined further and adequate therapy aimed at. This procedure also leads to a Pressure reliefwhich should be accompanied by an improvement in pain.

It can also become one spontaneously due to the pressure in the middle ear Tearing of the eardrum (Eardrum perforation) come. This is usually expressed by a sharp, short one pain, as a result of which the complaints decrease. That too "Ear loops“, Ie the exit of Middle ear secretions from the outer ear is a sign of this. Acute otitis media should occur after perforation of the eardrum antibiotic be treated as from the outside more germs which can worsen the inflammation. You should also keep your ear running Ear canal irrigation with water at body temperature, but only through the doctor for a Spread of germs to avoid, made and the ear canal carefully wiped with cotton swabs. An eardrum perforation or a small cut in the eardrum usually heals within 2 weeks by itself without complications.

After the acute inflammation has subsided, the so-called Valsalva maneuvers Bring relief. This is done by firmly pressing the air in the mouth with the mouth and nose closed Overpressure generated in the pharynx, which can cause the tube, which is usually closed and swollen, to open and thus ventilate the inner ear and remove the negative pressure that has now developed there. Chewing gum or the like can have a similar effect, as it causes Chewing motion an opening of the tube is made possible.


A Heat treatment of the ear can also improve the pain in acute otitis media, for example with a hot water bottle, a heating pad or exposure to red light. However, this should not be done if complications have already occurred. However, there is still no scientific study that proves its effectiveness. Also the hanging of Onion or chamomile sachets brings relief, according to experience reports, even if there is no study-based evidence for this either.

In the case of acute otitis media that occurs again and again, it is advisable to consult a doctor specifically. In addition, a vaccination against certain bacteria, how Pneumococci, Bring success. A distance enlarged Pharynx or one Antibiotic prophylaxiswhich, however, is controversial because of the potential for resistance, can also prevent further otitis media.

About 3 to 4 weeks After the diagnosis of an acute otitis media, a follow-up check should be carried out, unless a doctor's visit was necessary beforehand due to persistent complaints, in order to assess the eardrum and hearing performance and to determine whether the otitis media has healed. It should also be remembered that after a severe otitis media, the inflammation is not necessarily completely healed after the symptoms have subsided. So you should still take it easy - even if you are feeling better - and take the time to get really healthy. From Swimming pool visits in the days after an acute otitis media is strongly discouraged in order not to encourage the inflammation to flare up again.