Medical: Otitis media
Acute otitis media, haemorrhagic otitis media, myringitis bullosa
English: acute otitis media
Acute otitis media is a very common disease that can occur at any age, but is more common in infants. Statistically, more than fifty percent of all infants in the first year of life already suffer from acute otitis media.
Most acute acute otitis media are caused by pathogens, which rise from the pharynx via the so-called tube (a type of ventilation tunnel for the middle ear) into the middle ear. The inflammation is caused mainly by bacteria, such as staphylococci or streptococci. However, viruses also occur very frequently as pathogens and often form the basis for a subsequent bacterial infection.
Often, middle ear infections occur after a previous upper respiratory tract infection.
There are various forms of acute otitis media. So there is the mild course in the so-called otitis media catarrhalis, which is usually viral and associated only with mild general symptoms, such as mild pressure and moderate ear pain. Fever rarely occurs in the mild form of acute otitis media. This form of otitis media usually resolves itself within a few days and does not require antibiotic therapy.
By contrast, the more severe form of the otitis media purulenta can last much longer and, above all, produce stronger symptoms. An acute onset with severe ear pain and fever is characteristic here. Furthermore, significant hearing impairment can occur. An often strong feeling of illness usually decreases after the first four days. This may also be associated with spontaneous tearing of the eardrum (perforation), which is often accompanied by purulent discharge from the ear. However, a complete cure of severe otitis media with disappearance of symptoms may take up to three weeks. This usually results in complete recovery of the hearing. An eardrum breakthrough usually heals again within 2 weeks of the onset of inflammation.
Acute otitis media can last from one day to 3 weeks. Any otitis media lasting longer than 3 weeks is counted among chronic middle ear infections. Acute otitis media, known in technical jargon as otitis media acuta, is the overriding factor for all inflammatory diseases in the middle ear, characterized by a rapid onset and a short duration. Because of their multiple causes and dependence on different factors, the duration of the disease is very variable. An uncomplicated otitis media lasts an average of one week.
However, this can take significantly longer in complications or immunocompromised sufferers. On the other hand, uncomplicated otitis media can be completely healed, especially in children, after one to two days. If the middle ear inflammation occurs more often than 6 times a year, it is called a recurring otitis media, a so-called recurrent otitis media acuta.
How long an acute middle ear infection lasts in a baby depends on various factors. An important aspect is the baby's immune system. When the baby is born, it is protected until about nine months of life by the colloquial "nest protection" and must first build its own immune system. From the 2-3 months of life, the "nest protection" is already declining, while the baby's own immune system is developing slowly. The supplied "nest protection" does not protect against all illnesses, but only those, which the mother experienced herself or against which she was vaccinated. But even here there are exceptions, so that the baby can still get certain diseases.
The middle ear infection in babies and children is usually triggered by pneumococci and Haemophilus influenza . If the mother was vaccinated against it during pregnancy, it is likely that the baby has received this protection. If this is not the case and the baby is suffering from otitis media, the immature immune system has to build up during the illness. Thus, a middle ear infection may take longer than compared to infants.
In addition, the middle ear inflammation manifests itself predominantly in the form of general symptoms. The rule is that the younger a child is, the greater is the general complaint, rather than the local local symptoms. Some babies touch their ears due to earache - but not all of them do. As a result, the immediate detection of otitis media is often difficult, the harmonious treatment delayed and thus prolongs the duration of the middle ear infection. When the middle ear infection is detected, antibiotics only help with bacterial infections. These can then accelerate a healing. However, babies can not tolerate all antibiotics. In addition, these are ineffective in the case of a viral infection, as they occur in about a quarter of cases of middle ear infections.
Further information can be found here: otitis media of the baby
A good sign of middle ear inflammation in babies are temperature increases and fever. This is also a sign that the healing process is accelerating in some way. The fever is a sign that the immune system is fighting against the pathogens. Since the baby can hardly afford any resistance to the inflammation due to immature immune system, the fever of the body is "the drug of choice". The fever usually lasts several days and is divided into three phases: fever, fever and fever. If the baby is adequately supported in these three phases, fever can reduce the duration of otitis media to a few days.
In contrast to the baby has the toddler no "nest protection" more, but its own immune system, which is still under construction. Again, the duration of otitis media depends on various factors. The duration of an acute middle ear infection in a toddler can take less time in a good, own immune system as a baby. This means that it can partially heal completely after a single day to a few days. In a toddler, with less good immune system, the middle ear infection may take longer, compared to the baby, which has received a good "nest protection" from the mother.
Also, the duration of the middle ear infection can be slowed down by the toddler's urge to move, if it is difficult to get to rest and "raging" around. To heal the middle ear infection requires physical rest. A toddler can not necessarily understand this. Some infants who feel ill as part of the middle ear infection, looking for peace and sleep a lot. Other toddlers are more upset and can not keep up well with physical rest, which often delays the healing process. A vaccination against pneumococci and Haemophilus influenza is possible from the 2nd month of life. An infant who has been vaccinated against these pathogens has a lower risk of getting middle ear infection.
Further information on the topic can be found here: Middle ear infection in toddlers
With acute middle ear infection triggered by bacteria rather than uncomplicated middle ear infection, antibiotic therapy can shorten the duration of the disease by minimizing complications. After 2-3 days, after antibiotic therapy usually the risk of infection is over. Nevertheless, the antibiotic must be continued to avoid so-called resistance. Depending on the type of antibiotic, it is usually taken between 5 and 7 days.
In addition, the person is no longer contagious, but it is therefore not healthy. In order to completely heal the otitis media, it is important that the person concerned continues to spare himself until he has completely recovered from the inflammation. If you have a middle ear infection that has not been treated with antibiotics, the risk of infection is usually a bit longer. Also, the regeneration phase may take a few days longer. However, the antibiotics do not work in a viral infection. In this case, middle ear infection with and without antibiotics would probably take the same amount of time. However, treatment with antibiotics may cause side effects and may delay the healing process. Whether it should be treated with a middle ear infection with or without antibiotics, is to weigh individually with the doctor and decide.
Depending on the cause, age, immune system and severity of the middle ear infection, it can be completely healed without antibiotics after just a few days, or it can last up to a few weeks. If a middle ear infection lasts more than a few days, a doctor should be consulted. If you do not want to take antibiotics, because it is not a bacterial infection or for personal reasons, then this should be discussed with your doctor if you have persistent or recurring otitis media.
A middle ear infection is usually accompanied by a hearing loss. When the inflammation subsides, often afterwards a tympanic effusion forms. This can persist beyond the inflammation, for further days and weeks. The drumming obstructs the sound transmission in the ear. Consequently, sufferers complain of a muffled hearing and a pressure on the ear. This can be very uncomfortable for the person concerned, but it is basically harmless.
At the latest after a few weeks, the hearing loss will stop and there will usually be no damage. It is different if, as part of the middle ear infection bacteria from the middle ear to the inner ear. There they can damage the inner ear and cause inner ear hearing loss. The inner ear damage is not reversible. A distinction of hearing loss in a tympanic effusion from a hearing loss in an inner ear injury can best make the ENT doctor. Therefore, if hearing loss persists, 2-3 weeks after the ear infection, it should be examined by an ENT specialist.
In the case of damage to the inner ear, urgent treatment is required to avoid serious damage. Usually a tympanic section, a so-called paracentesis is recommended to avoid permanent severe damage. Even in children with pronounced otitis media and immunocompromised sufferers a tympanic section is recommended to prevent a permanent hearing loss.
This article may also interest you: Hearing loss
As a rule, with uncomplicated otitis media, a sick leave of one week is sufficient. If you experience fever, hearing loss, severe pain or other discomfort and complications, then you need to continue treatment and extend the sick leave. Especially in the first few days there is a risk of infection, even if antibiotics are taken. Therefore, it is important that those affected stay away from kindergarten, school and work. But even if the risk of infection is over, many sufferers are still not fully healthy and not yet able to participate in the everyday kindergarten, school and work routine. This should be discussed individually with the doctor.
In uncomplicated otitis media, the acute, severe ear pain usually clears after 1-3 days. If fever has occurred at the same time, it usually goes back after 3 days. In the context of the fever, it can lead to general limb pain, which also form in the case of fever, usually back. If tympanic effusion has developed as part of otitis media, hearing loss and pressure pain may persist for a few days to 2-3 weeks.
If the acute middle ear infection still does not heal after three weeks, there is a risk of serious complications, such as the development of mastoiditis with bone fusion. A doctor should be visited again in each case.
In any form of acute otitis media, however, it may come to an outpouring (so-called Paukenerguss), which affects the vibratory ability of the eardrum and thus causes a reduction in hearing. The fluid in the middle ear must first be slowly degraded and thus it may take up to several weeks for a hearing impairment caused by the effusion to disappear, even after the acute inflammatory phase has already passed.
In case of special circumstances, such as the disease of very young children, perforation of the eardrum, fever that exceeds a temperature of 38 degrees or a very pronounced clinical picture should be initiated immediately antibiotic therapy. Normally, on the other hand, it can be seen whether an improvement of the symptoms occurs within the next 1-2 days. If this is the case, a medical check-up must be made after 3-4 weeks. However, if there is no improvement, a doctor must be consulted, if not already done. When given an antibiotic, the symptoms should improve within 48 hours. If this is not the case then you have to go to a doctor again.
It should be noted, however, that the otitis media has not completely subsided, even after the symptoms have disappeared after a few days (with or without the administration of an antibiotic). So you should continue to protect the affected ear, which is why, for example, swimming pool visits in the following days is strongly discouraged, as a burden with the existing bacteria in the water could ignite the inflammation of new.
As a rule, however, the acute middle ear infection has a harmless course. About 80 percent of the diseases heal completely without complications. A timely response to the onset of symptoms and consultation with a physician can help prevent possible complications, and a quick and straightforward recovery is likely to occur.