Acute otitis media is the most common disease of the auditory system, which mainly affects infants and toddlers. It has a rapid onset and usually begins with a respiratory viral disease of the upper respiratory tract, on which it can superimpose as a bacterial superinfection. What are the symptoms and course, how is the disease diagnosed, treated and how to recognize when to go to the emergency room?
Content: Inflammation of the middle ear – symptoms, course and treatment
What is otitis media?
Inflammation of the middle ear in children and adults
Otitis media and symptoms
Course and duration of otitis media
Diagnosis and treatment of otitis media
Home treatment and midwife advice for otitis media
Complications of otitis media
When with inflammation to the emergency room
What prevention is there
Acute otitis media is a viral or bacterial disease that causes painful and often purulent inflammation of the middle ear mucosa .
What is otitis media?
Acute otitis media (Latin otitis media acuta , OMA) is a viral or bacterial disease that causes painful and often purulent inflammation of the middle ear mucosa . It is often initially a viral infection of the upper respiratory tract , which penetrates the middle ear through the ear canal (Eustachian tube) or hematogenously and is followed by a bacterial infection.
Inflammation of the middle ear tends to have a sudden onset and is particularly painful in its initial phase . However, with proper and timely treatment, it usually heals quickly and without complications. Otitis media itself is not contagious , only the infection that caused it is contagious, explains MUDr. Veronika Horáková, general practitioner for adults and doctor of EUC PLS occupational medicine services.
Inflammation of the middle ear in children and adults
Otitis occurs predominantly in babies , i.e. infants and toddlers. With increasing age, the frequency of occurrence decreases, while on average up to 75% of the population will experience at least one otitis media . In young children, it is often bilateral, while the younger the patient’s age, the more likely the otitis media can return later.
In general, the occurrence is more frequent in the winter and also among children who attend collective facilities (nursery, etc.) or live in worse hygienic conditions. Although it is a disease typical for young patients, it can also occur in adults , e.g. in case of insufficient rest during inflammation of the paranasal sinuses, during changes in air pressure or diseases of the teeth, tonsils or larynx.
Chronic otitis media is usually without temperature or fever, it is not so painful and manifests itself rather with burning or itching in the ear .
Otitis media and symptoms
With acute otitis media, the following symptoms may appear:
- ear pain – a typical symptom in only about 50% of children with acute otitis media;
- sudden hearing loss along with respiratory tract infection (difficult to identify in very young children);
- diarrhea– accompanying symptom in infants;
- sudden discharge from the ear – can appear even after relatively inconspicuous symptoms;
- restlessness and sleep disturbances, loud screaming;
- sensitivity to touch;
- headacheand abdominal pain;
- loss of appetite and vomiting;
- increased temperature, up to fever.
Acute otitis media can be inferred on the basis of pain , redness, warmth and swelling of the surrounding skin or mucous membrane. If the ear canal swells, fluids and mucus cannot drain and accumulate in the middle ear. If the pressure in the ear is too much, a tear can form in the eardrum and the inflammatory fluid leaks out. A tear in the eardrum usually heals without any problems. Inflammation of the middle ear practically does not occur without a runny nose .
Chronic otitis media is usually without temperature or fever, it is not so painful and manifests itself rather with burning or itching in the ear . In addition, the patient may experience a blocked ear, buzzing or pressure in the ear. Chronic inflammation of the middle ear in adults and children can also cause hearing loss.
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Course and duration of otitis media
The clinical course of otitis media can be divided into the following periods:
- First period– inflammation develops and escalates to spontaneous perforation. It often begins with a stabbing pain and a feeling of stuck ear in acute rhinopharyngitis. The temperature rises, loss of appetite, constipation and vomiting appear. Pain in the ear and surrounding area is the main symptom here, in case of spontaneous perforation (rupture) it disappears with the discharge of pus. In milder cases, the fever is mild, in more severe cases it rises above 39 °C.
- The second period– begins with a perforation with a break of subsiding acute symptoms. The discharge from the ear is purulent and odorless. The pain is alleviated, the temperature drops, the general condition improves, the appetite returns, and sleep improves. The hearing impairment persists, but does not worsen, and after about a week the discharge from the ear decreases and the hearing improves.
- Third period– symptoms disappear completely, local inflammatory changes recede and discharge gradually disappears. The perforation closes and other changes on the eardrum also disappear. In an uncomplicated course, the inflammation heals after about 3 weeks, and hearing can be restored later.
Diagnosis and treatment of otitis media
Acute otitis media is usually accompanied by typical symptoms. The doctor determines the diagnosis using otoscopy , or an examination of the ear drum with an otoscope. The diagnosis can often only be confirmed by examinations using special instruments (e.g. a tympanometer).
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The goal of treatment is to alleviate the symptoms of inflammation, speed up the absorption of middle ear secretions, cure conductive hearing loss, minimize the return of the disease, complications and their consequences. Treatment always depends on the age of the patient and the severity of the disease. Unpleasant symptoms can be temporarily relieved with cold compresses.
With the non-purulent variant, drops are administered into the nose . Pain and fever can be reduced by administering analgesics, antipyretics or a combination of both ( ibuprofen , paracetamol ). If it is a purulent bacterial inflammation , antibiotics or antibiotic ear drops are usually used . If pus in the ear oppresses the eardrum, the inflammation must be removed by piercing the eardrum and suctioning out the pus (paracentesis, popularly known as ear piercing). This procedure brings great pain relief.
The transition of acute otitis media to chronic inflammation can only be prevented by properly ending the treatment of acute inflammation and stopping all medications . An important part of the treatment is also keeping the ear canal clean, performing the correct blowing method (from one nostril) and taking care of the nasal cavity (rinsing with a kettle, sea water, nasal drops better than a spray, applying them while lying down).
Home treatment and midwife advice for otitis media
With otitis media, it is in no way recommended to rely on self-medication, natural treatment or proven old-fashioned advice, such as putting garlic in the ear, etc. Even with the mere suspicion of acute otitis, it is always necessary to consult a doctor (especially in young children), who will perform a professional diagnosis and suggest an adequate method of treatment.
Complications of otitis media
The child reacts to the inflammatory focus in the body as a whole. Therefore, with any unclear febrile illness in a newborn or infant who cries at night, is restless, or vomits or loses weight, ear disease should also be considered.
Untreated otitis media can cause very serious complications – for example, a rupture of the eardrum due to pus (leading to deafness) or inflammation of the bones behind the ear, which can progress to meningitis . Because the facial nerve is located near the middle ear, its temporary paralysis can also occur.
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When with inflammation to the emergency room
Otitis should not be underestimated. Therefore, especially in the case of small children, it is always necessary to seek medical help and undergo the prescribed examinations. This is the only possible way to detect any developing complications.
Doctors also appeal to the patient to always take the prescribed antibiotics – despite the rapidly disappearing symptoms. If there is a sudden explosion of pain with a sharp rise in temperature at night, we recommend an urgent trip to the emergency room.
What prevention is there
For small children (e.g. in addition to correct positioning during breastfeeding) reasonable ear protection and reasonable bracing of the child are also important measures . Also for adults, increasing the body’s resistance, gradually hardening and preventing colds and other inflammations is a suitable prevention.
Taking care of the nasal cavity is very important, especially in the morning phase of an acute upper respiratory tract infection.
Currently, it is possible to protect children against pneumococcal infections by vaccination as early as 2 months of age. The doctor’s approach to the patient in the treatment of otitis media must be very individual. Only the helpful cooperation of a pediatrician, a general practitioner, an otorhinolaryngologist and a microbiologist will bring success in the sense of reducing the risk of acute inflammation becoming chronic.
