Otitis media

Introduction

Otitis media (inflammation of the middle ear) is an acute disease of the ear. In most cases, the inflammation is caused by bacteria, more rarely by viruses. Children are particularly affected by middle ear infections in infancy and early childhood, as their connecting passage between the middle ear and throat - the so-called eustachian tube - is still very short. In adults, the Eustachian tube runs upwards, whereas in children it runs horizontally. The horizontal position favours the ascent of pathogens from the pharynx into the middle ear.

The inflammation often begins with stabbing ear pain, dizziness, fever and a general feeling of illness. Acute otitis media is often treated with antibiotics, nose drops, painkillers and the application of heat directly to the ear. The symptoms usually subside within a few days. Permanent damage is rare.

Symptoms

Acute otitis media usually begins with a stabbing earache, a throbbing sensation in the ear, dizziness and fever. As the body tries to fight off the bacteria or viruses, redness, warming and swelling of the skin or mucous membrane also occur. Other symptoms of otitis media include a general feeling of illness, hearing loss and headaches. Affected infants are also restless, whiny, drink poorly and often grab their ears. The younger the children are, the more frequently they complain of other non-specific symptoms such as loss of appetite, abdominal pain or diarrhoea.

Chronic middle ear inflammation can be accompanied by hearing loss, ringing in the ears, persistent excretion of fluid from the ear and inflamed and proliferating tissue.

Generally speaking, middle ear infections do not cause any permanent damage if treated correctly.

Course

In most cases, an acute middle ear infection - whether caused by a bacterial or viral infection - runs its course without complications. However, it is important to contact a doctor if you have symptoms. If the symptoms are treated in good time, they will disappear within two weeks. In most cases, the inflammation heals completely.
If otitis media is caused by a viral infection, such as a cold virus, the mucous membranes become inflamed. The swollen mucous membranes obstruct the conduction of sound in the ear, resulting in pain, ringing in the ears and fever. This condition lasts for a few days and then disappears.

More frequently, however, bacteria attack the weakened mucous membranes. In this case, the fever rises rapidly, the earache increases, hearing deteriorates and both ears are affected. The pain feels dull and the pressure in the ear increases. If the pressure in the middle ear becomes too great, the eardrum ruptures, the fluid drains and the pus drains out of the ear. After this process, the pain suddenly subsides. If the eardrum ruptures, the affected person should take an antibiotic and not go swimming for the next four weeks. The eardrum will heal on its own.

However, if the symptoms last longer or return constantly, this may indicate a chronic course or complications. The most common complication of otitis media is inflammation of the bone behind the ear - the mastoid process. This causes pus to enter the air-filled cavities of the bony process. Without treatment, the inflammation spreads and can lead to meningitis or inflammation of the inner ear with dizziness or vomiting. Thanks to surgery, however, it usually heals without consequential damage. The chronic course of otitis media can lead to hearing loss and ringing in the ears.

Causes

In most cases, acute otitis media is caused by bacteria, more rarely by viruses. The inflammation often arises from a cold when the bacteria or viruses ascend from the nasopharynx. The connecting passage between the middle ear and the throat - the so-called Eustachian tube - becomes swollen. As a result, mucus and fluid no longer drain away and collect in the middle ear. The swelling or mucus also impedes the ventilation of the middle ear and favours the multiplication of pathogens.

Children of infant and toddler age are particularly affected by middle ear infections, as their eustachian tubes are still very short. While the eustachian tube runs upwards in adults, it lies horizontally in children. This position favours the ascent of pathogens from the pharynx into the middle ear.
It is less common for germs to enter directly from the external auditory canal in the event of a defect or injury to the eardrum. Another possible cause is the spread of viruses or bacteria via the blood - for example in the case of an illness such as scarlet fever.

Enlarged tonsils in the throat or frequent sore throats also disrupt the ventilation between the middle ear and throat and prevent fluid from draining. Changes, such as cleft palate, also favour otitis media in children. Chronic middle ear inflammation can also be the result of obstructed nasal breathing caused by adenoids.

Diagnosis

Otitis media requires a precise diagnosis and treatment by a doctor. In most cases, the suspicion of otitis media is confirmed by the typical symptoms. Thanks to the clear symptoms and an appropriate medical history, otitis media can be easily diagnosed by a telemedicine specialist over the phone or by video.

For a more in-depth confirmation of the diagnosis, the telemedicine specialist can refer the patient to an ear, nose and throat specialist (ENT specialist). He or she will examine the ear, or rather the eardrum, with the help of an otoscopy. Due to the dilated blood vessels, the eardrum has a pink instead of a pale grey colour. If pus has accumulated, the pressure causes the eardrum to bulge outwards. If the doctor discovers redness or a bulging eardrum, this is otitis media. A hearing test will also show whether hearing problems already exist.

Treatment

Acute otitis media is often treated with nose drops, painkillers and the application of heat directly to the ear - in exceptional cases, antibiotics are prescribed. Those affected should always take it easy physically. In most cases, otitis media heals spontaneously and without complications. However, a consultation with a doctor is always advisable, as they will assess the course of the infection and the necessary treatment.

• Decongestant nasal drops ensure that the accumulated fluid can drain away better and the middle ear is better ventilated. However, pharmaceutical nasal sprays should not be used for longer than five to seven days, as some ingredients can attack the nasal mucous membranes if used for longer.
• Painkillers with active ingredients such as paracetamol or ibuprofen relieve pain, inhibit inflammation and reduce fever. Ear drops, on the other hand, are not very effective as a treatment as they do not reach the middle ear.
• Home remedies can supplement and support the treatment and alleviate the symptoms. If the middle ear infection leads to a fever, those affected should drink enough; calf compresses can reduce the fever or the increased temperature.
• Chamomile or onion poultices are also suitable home remedies. Patients should fill cloth bags with pieces of onion or camomile flowers and place them on the affected ear. Traditional heat therapy, for example treatment with red light, also alleviates the symptoms.

Prevention

An acute middle ear infection can hardly be prevented. It is advisable to contact a doctor if you have symptoms of otitis media - sharp ear pain, knocking in the ear, dizziness and fever. If you are prone to otitis media, it is advisable to take decongestant nasal sprays, Ibuprofen and Sinupret early on if you have a cold. This can prevent a build-up of mucus in the middle ear and subsequent inflammation. Timely treatment can also prevent chronic middle ear inflammation.
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