Otitis media is a common disease in infancy. Almost every child falls ill until the age of four with a otitis media. In this disease, there is an inflammation of the ear section, which is located behind the eardrum (= middle part). From here there is a connection to the throat, the so-called Eustachian tube or Eustachian tube. It is usually responsible for the ventilation of the ear and also for the pressure balance between the outside world and the tympanic cavity. In children, this trumpet is still very small and relatively narrow, which can easily lead to blockage of this passage in a swelling of the mucous membrane. Then there accumulates secretions and inflammation can occur.


Signs of otitis media in toddlers may include, for example, frequent ear rubbing, constant contact with the ear, pain especially in the ear, and frequent crying. Nonspecific disease symptoms may also be added. For example, a general weakness or restlessness, vomiting and diarrhea, fever and chills or loss of appetite are possible. If the children are a bit older (4 years or older), they can often locate the pain accurately and also state that they are hearing worse on one side. In addition, the development of a fever is less common here than in younger ones.

Symptom fever in a middle ear infection in toddlers

Fever is a possible symptom of middle ear inflammation ( otitis media) in toddlers. It does not necessarily occur, but is often a concomitant symptom. As a fever is a temperature from 38.5 ° C upwards. Temperatures between 37.6-38.5 ° C are called subfebrile. In the case of young children, an attempt can first be made to control the fever with calf rolls. The child should also drink a lot. If the fever does not fall within a few hours, the treating pediatrician should be consulted. He can then decide whether a drug treatment to reduce fever is necessary and whether in addition the middle ear inflammation requires a drug treatment.

Pus from the ear in a middle ear infection in toddlers

Pus arises as part of an inflammation, usually in response to contact with bacterial agents. Often these pathogens rise after infection of the airways or tonsils to the ear. Due to the anatomical conditions in children, inflammation of the middle ear occurs more frequently. This has to do with the fact that the drainage from the middle ear (the Eustachian tube or Eustachian tube ) is often relatively narrow, it accumulates secretions and a bacterial colonization is favored. If pus forms in the middle ear, this leads to an increased pressure on the eardrum, the pain increases. The surgeon can see if there is pus in the middle ear, ie behind the eardrum. In some cases, the pressure exerted by the pus on the eardrum can be so great that the eardrum tears, a tympanic perforation is referred to. Clinically, in such a perforation the earache is very strong after the pressure on the eardrum is now gone. The pus then runs out of the ear as a yellowish liquid.

Pain in a middle ear infection in the toddler

Pain is probably the most common symptom of otitis media and will be well known to most parents. Due to the inflammatory reaction in the middle ear and the accumulating secretions, which puts pressure on the eardrum, it comes to this pain. The children are often in pain and scream a lot. The pediatrician may prescribe mild analgesics to make the condition more bearable for the duration of the disease. Here are, for example, acetaminophen or ibuprofen in question. Paracetamol is available as a suppository or tablet, ibuprofen is available as a juice or in tablet form.

The child hears badly in a middle ear infection

Inflammation in the middle ear area leads to swelling of the affected areas. Often there is secretion in the ear, which can not drain sufficiently due to the swelling. The inflammation and secretion congestion often cause the children to hear worse on the affected ear. The hearing loss usually disappears completely after the acute middle ear infection subsides.



Middle ear infections in infants do not necessarily have to be treated with antibiotics. Only about half of the middle ear infections are caused by bacteria, the other half by viruses. But antibiotics do not help against viruses and not every bacterium can be controlled by any antibiotic. As a rule, the children are given adequate fever and pain treatment, for example with paracetamol or ibuprofen and, if necessary, decongestant nose drops. These may facilitate nasal breathing in the short term, but probably have no influence on the actual course of the disease. They also should not be used regularly for a long period of time.

If purulent discharge from the ear or the symptoms do not improve within a few days, but in spite of all the use of an antibiotic may be necessary. Often, warmth is felt by the children as pleasant. This can be done, for example, by irradiation with red light or by a heated pad. If the middle ear infection persists for a longer period of time, then it is possible to insert small tympanic tubes in the eardrum and thus to ensure adequate ventilation of the middle ear. In addition, they help with secretion drainage, so that the pressure in the middle ear is reduced. In addition, so-called polyps can often be responsible for chronic middle ear infection. These are growths of the tissue on the palatine tonsil, which swell in airway inflammation and block the Eustachian tube, so that the secretion can then no longer flow from the ear into the pharynx. Here an operation can be helpful in which these polyps are removed.

Home remedy for a middle ear infection in toddlers

Home remedies for middle ear inflammationAs well-proven home remedies for the relief of complaints in case of middle ear inflammation, for example, onion and chamomile sachets apply.

Here, chopped onion pieces or chamomile flowers are placed in a thin cloth bag and placed several times a day on the aching ear for about half an hour. Even a red light lamp that warms the affected ear a little, does many children good. As a home remedy for high fever are calf. Towels are water that is slightly cooler than body temperature, wrung and then wrapped around calves. The warm towels can be renewed 2-3 times. These remedies are for symptom relief, but do not replace the medical treatment. A child with otitis media should always be presented to the treating pediatrician.

When does my child need antibiotics for a middle ear infection?

Earlier, most middle ear infections were treated with antibiotics. Today, this is a bit different, but in the different countries antibiotics in middle ear inflammation are handled very differently. While in the US almost all children are treated with a middle ear infection antibiotic, it is in Germany only about 1/3. The general use of antibiotics is no longer common here. Mainly because studies have shown that the disease heals spontaneously (ie without antibiotics) as quickly as when given antibiotics. In special cases, antibiotic therapy should be started early. For example, studies show that the use of antibiotics may be useful, for example, in children below 2 years with bilateral otitis media and high fever, as well as in children in poor general condition and children who have previously had middle ear infections with complications. In most uncomplicated cases, the middle ear infection heals completely without antibiotics within a few days. If the symptoms do not improve after 48 hours under symptomatic measures such as painkillers and nose drops, antibiotic therapy should be started. Of course only after consultation with the attending pediatrician.

Which antibiotic is best for a middle ear infection in toddlers?

The drug of first choice in the antibiotic treatment of otitis media in children is amoxycillin. In children with a known penicillin allergy, alternatively so-called macrolides such as erythromycin can be used. There are now pathogens that can cause a middle ear infection, but are resistant to amoxicillin. For example, a combination therapy with amoxicillin and clavulanic acid helps here. The antibiotic therapy should - after consultation with the doctor - usually take place for at least 5 days.

Homeopathy for a middle ear infection in toddlers

There are several homeopathic remedies to help alleviate the symptoms of otitis media: Aconitum napellus (blue monkshood), belladonna (belladonna), chamomilla (chamomile), ferrum phosphoricum (iron phosphate), pulsatilla pratensis (meadow cowbell), dulcamara (bittersweet), hepar sulfuris (Kalkschwefelleber), potassium bichronicum (potassium bichromate). From Aconitum napellus, Belladonna, Chamomilla, Ferrum phosphoricum, Pulsatilla pratensis and Dulcamara can be taken every half hour three globules or a tablet. Hepar sulfuris and potassium bichronicum should not be taken more than three times a day. The homeopath of trust should be asked more exactly which of the funds should best be used in each case. A homeopathic treatment does not replace the medical consultation in any case.

Duration of middle ear inflammation in the toddler

Acute middle ear infection heals completely in most children within 7-14 days. In the vast majority of cases the symptoms decrease after 2-3 days. If this is not the case, the treating pediatrician usually starts antibiotic therapy.

When can my child swim again after a middle ear infection?

During an acute otitis media, the child should not go swimming because more germs can enter the already inflamed ear via the water. The child should not go back into the water until the symptoms of the inflammation have completely resolved, ie usually not earlier than after one to two weeks. For the individual case, the treating pediatrician should be asked when the child is allowed to swim safely again.

Is a middle ear infection contagious in the child?

No, a middle ear infection is not contagious. Often, however, the cause of otitis media is an infection of the respiratory tract. This is contagious. However, it does not automatically lead to middle ear infection in another child. A child with otitis usually needs to stay home for a few days because of the discomfort. However, there is no risk of infection, so this is no reason for sick leave if the child is otherwise well again.

Consequences and complications

In most cases, the eardrum remains undamaged and the inflammation is fully restored. However, it may happen that an effusion remains in the middle ear, which then gives the child a permanent feeling of pressure and in rare cases can also lead to hearing loss and earache. If a child is frequently affected by a middle ear infection, it may happen that the tympanic membrane tears and becomes stiff. As a result, incoming sound waves can not be conducted completely to the inner ear and the children hear in the episode worse. Rarely, there are also complications during a middle ear infection. You should therefore always watch your child well, pay attention to possible warning signs and, if necessary, go to the doctor early.

On the one hand it can come to a so-called mastoiditis. This is a bacterial infection of the air-filled cavities of the mastoid in the temporal bone of the skull. These are lined with mucous membrane and can be felt by pressure pain, swelling and redness in the area behind the earlobe, fever, ear beating or ear discharge. The mastoiditis must be treated with antibiotics so that the inflammation does not spread to the bone. If the pathogens spread further, it can also lead to meningitis, meningitis. This is a very serious illness that can be life-threatening and requires immediate treatment. Symptoms of meningitis include fever, headache, nausea, neck stiffness, impaired consciousness and photophobia.

In small children younger than 2 years, the symptoms can be very different. For example, they may have a general weakness and be touch-sensitive, and shrill cries or whimpers are common. In addition, there may be circulatory problems, for example an increased respiratory and heart rate or even a shortness of breath. The child should be taken to a hospital emergency room immediately for treatment to begin as soon as possible and for no permanent damage. Rarely, a middle ear infection can also lead to damage to the inner ear.

Invading bacteria release their toxins, which spread from the middle ear to the inner ear, causing "toxic labyrinthitis". Here, the sensory cells of the inner ear are damaged and the patients report a hearing loss to deafness and ear noises, tinnitus. Partial dizziness and balance disorders may also occur because the organ of equilibrium is located in the inner ear. If you notice any of these symptoms in your child, visit your doctor early to prevent chronic damage.

Complication: eardrum ruptured in a middle ear infection in the toddler

The eardrum perforation, so the tearing of the eardrum is not uncommon in a middle ear infection. The secretions and pus accumulate in the middle ear and accumulate there because they can not drain sufficiently on the Eustachian tube due to mucosal swelling. If the pressure from this fluid in the middle ear becomes too strong, the eardrum may no longer be able to withstand and tear it. As a result, the severe ear pain suddenly abates significantly. As a rule, the crack heals without any external intervention. However, eardrum controls should be performed to assess the healing process. Incidentally, in children with very severe pain that does not respond adequately to analgesics, sometimes even deliberately cut a small hole in the eardrum, so that the secretion can drain and thus reduce the pain. This is called a paracentesis .

Can my child fly with a middle ear infection?

Theoretically yes. In practice, however, a flight with middle ear inflammation should be avoided as far as possible. Although flying does not cause any additional damage to the ear in the case of pure middle ear inflammation. Due to the increased pressure on the ears, however, the pain in a child with acute middle ear infection can still increase significantly in intensity. Even for adults, a flight with acute otitis media can be very painful. If a flight is absolutely unavoidable, shortly before decongestant nose drops and, if necessary, analgesics should be used. For this, the treating pediatrician should be interviewed. Also, this should necessarily examine the ear before starting the flight by ear mirroring. If there is evidence of damage in the eardrum or middle ear, a flight may be contraindicated.


For the above symptoms, parents should consult a doctor. He will ask them in detail about the current symptoms and the history of their child. This is followed by a physical examination, in which above all the ear is thoroughly examined and, if necessary, the measurement of body temperature. At the ear examination, the doctor looks at the eardrum with an otoscope. This is an instrument equipped with a magnifying glass and a small lamp, which makes it possible to closely inspect the ear canal. In addition, the hearing is checked in further steps and examined whether the eardrum is free to move.

In addition to the symptoms described by the parents, there are other diagnostic indications for inflammation of the middle ear in toddlers. These include a reddened eardrum and an outwardly arched, immobile and non-transparent eardrum, suggesting a buildup of fluid behind the eardrum. If the eardrum tears due to excessive pressure, secretion may occur. It then runs a yellowish, purulent, sometimes bloody fluid (through the tear in the eardrum) from the ear and the child's complaints abruptly.


Often, middle ear infections occur in infants accompanied by an infection, such as a flu infection, influenza or strep throat. Viruses reach the pharynx and there is a swelling of the mucous membranes, also in the ear trumpet. This causes a secretion in the ear and the small pathogens can work their way into the ear, settle there and multiply. This situation then causes inflammation of the middle ear, and the child feels the symptoms mentioned above. As already mentioned, the polyps may also be responsible for the genesis, in addition, allergic reactions or inflammation of the paranasal sinuses favor the development of otitis media.

Other risk factors include using a pacifier, visiting day care or similar care and passive inhalation of tobacco smoke, which is the biggest risk factor as it weakens the immune system of children and thus promotes respiratory infections. Protective effect has the diet with breast milk instead of milk from the bottle.

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