Symptoms of acute middle ear infection

Synonyms in the broader sense

Medical: Otitis media

Acute otitis media, haemorrhagic otitis media, myringitis bullosa

English: acute otitis media


Acute otitis media is a common disease, especially in childhood. This is caused in about two-thirds of the cases by bacteria (such as streptococci or staphylococci ) and in about one-third by viruses.
An acute middle ear infection often occurs after an upper respiratory tract infection, as a result of which germs from the pharynx reach the middle ear via the tube ( tuba auditiva ).
There they cause characteristic symptoms, which are caused by inflammation of the middle ear mucosa with concomitant swelling and consequent aeration disturbance of the middle ear.

Although this condition can be extremely painful, it usually proceeds harmlessly and without complications.

The doctor can usually diagnose the disease based on the symptoms as well as by looking into the affected ear.


Symptoms such as strong, stinging or throbbing pain in the area of ​​the affected ear are the leading symptoms of acute otitis media.

The inflammation often begins during or shortly after a cold with violent or pulsating earache.

Especially in toddlers acute middle ear infection is also manifested by non-specific general symptoms such as nausea, vomiting, diarrhea, headache, loss of appetite, abdominal pain and increased irritability.

In addition, the common cold usually causes cold symptoms such as a sore throat, cough or runny nose.
In addition, a pain may occur when pressure is exerted on the so-called mastoid bone (mastoid).

Furthermore, this disease often causes fever, which persists especially in the first 24 hours and can be associated with a strong sense of sickness.

A hearing loss on the affected ear is also typical of acute middle ear infection. This can be accompanied by a feeling of fullness of the ear, dizziness and throbbing, often pulse synchronous ear noises. Likewise, the feeling can occur that sounds and also your own voice reverberate in the head.

In most cases, this hearing loss is due to an inflammation in the middle ear, which affects the vibratory capacity of the eardrum.
This effusion may persist for several weeks after the inflammation subsides and thus there is the possibility of slight hearing loss for up to 3 or 4 weeks. After 3 to 4 weeks then a medical follow-up should take place.

Another symptom, which is usually recognized only by the family doctor or ENT specialist, is a protrusion and changes in the color of the eardrum.
This is caused by the massive accumulation of purulent secrets in the tympanic cavity and gives the attending physician a clear indication of the presence of an acute otitis media.

What are the symptoms of the baby?

A baby suffering from an acute otitis media can only express its pain through its behavior.
By shouting too often, it can alert you that something hurts. It can be very restless and throw his head from one side to the other. Here, at least at the beginning of the disease, the ear symptoms are usually not in the foreground.

Other babies often rub their ears, for example on their pillows or on their parents' shoulders.

Some babies often show a so-called ear compulsion at the beginning of the illness. This means that they are more likely to listen to their ears.
In the course of acute middle ear infection, instead, they may be able to ward off any touching of the ear immensely due to the pain, and to respond with crying and screaming.

In addition, a drinking weakness may be an expression of side effects such as difficulty swallowing, pain during swallowing and abdominal pain.
Also, the baby overall may look inactive, tired and chipped off. Some parents notice a changed skin color.

Furthermore, there may be temperature increases, chills and fever.
The younger the child is, the more general complaints and also sometimes high fever can be in the foreground.

In addition, purulent-bloody secretions can leak from the ears.

In some cases, a hearing loss may be noticed. This shows in toddlers, for example, by a reduced head turn to an acoustic stimulus.

Toothache in a middle ear infection

As part of acute middle ear infection, the ear pain can radiate to the teeth. This pain is then often perceived as a diffuse toothache.
Often the pain is described as dull pressure or as a pull.
Mostly the upper jaw area is affected by the radiating pain.

The trilling nerve, the so-called Nervus trigeminus, also supplies a large part of the ears and the tooth area with its various branches. If the facial nerve is compressed or irritated due to inflammation such as acute otitis media, toothache can also result, even with a completely healthy set of teeth.

When the symptoms of acute middle ear inflammation subsided, the radiating toothache will usually also diminish. If these persist, a dentist should be consulted.

It is also possible that the actual cause is actually in the tooth area and radiate the pain in the ear. By mistake, this may be subjectively interpreted as an acute otitis media.

Also, a viral inflammation, a so-called herpes zoster irritate the facial nerve and cause ear and tooth pain and lead to misinterpretation.

In addition, in acute middle ear infection due to the changed pressure conditions in the ear, a sudden and severe toothache may occur. The altered pressure can lead to cavitation, for example, due to caries under the fillings. A dental check would be advisable in these cases.

Jaw pain in a middle ear infection

Anatomically, there is a close neighborhood relationship between the middle ear and the temporomandibular joint. Consequently, this can lead to jaw pain in the course of an acute otitis media.
The nerves and the surrounding muscles in the surrounding area can be irritated by the inflammatory processes.
This means that the jaw musculature, ie the masticatory muscles and the muscles of the mouth, can be limited.

Accordingly, in acute middle ear inflammation, opening the mouth and chewing can be difficult and painful.

Conversely, it can also be that jaw problems lead to radiating earache.
The cause may be dentition and temporomandibular joint deformities or signs of wear and tear. In addition, jaw joint pain, jaw and jaw pain, nocturnal teeth grinding, neck tension, jaw opening problems in combination with diffuse aching ears, ear noises, and headaches may indicate a TMJ problem.

As with toothache, it is often difficult to make a subjective assessment, whether it is an acute otitis media or TMJ disorder.

Headache with middle ear inflammation

In the course of an acute otitis media, headaches can also appear as a concomitant. These are usually harmless and improve as soon as the acute middle ear infection heals.
The cause of pain in the head can also be irritation of the facial nerve.
In addition, due to the inflammatory processes in acute otitis media, altered circulation conditions can lead to headaches.

If, in addition to severe tiredness, fever, diminished consciousness, confusion and severe headaches, severe neck stiffness and overstretching of the body (so-called Opisthostonus ) occur, a doctor should be consulted immediately. Even if only a few of the listed symptoms show, a meningitis should definitely be ruled out in this case.

However, this complication is relatively rare in acute otitis media. However, it is possible that the pathogens of acute otitis media invade the brain and cause a serious inflammation there. One speaks of a so-called passed on meningitis. This is an absolute emergency and requires emergency medical treatment.

Furthermore, an acute middle ear infection can also be erroneously assumed to be suspected, even though there is a disease in the head area. For example, the pain of a migraine can radiate into the ears and sometimes manifest as severe earache.

Dysphagia in case of middle ear infection

Due to the proximity to the oral cavity and the pharynx, swallowing symptoms may occur as part of an acute middle ear infection. The structure that connects these areas is called the Eustachian tube ( tuba auditivia) .
Usually the Eustachian tube is equipped with a so-called respiratory ciliated epithelium, which ensures that germs are transported in the direction of the throat. However, pathogens in the throat area may migrate up to the ears if this protective mechanism is disturbed.

An inflammation of the tonsils with dysphagia could possibly continue in a middle ear infection.

The dysphagia may vary greatly. In some cases, they impede food intake.

In addition, difficulty swallowing may occur due to the altered pressure conditions associated with the functionality of the Eustachian tube.
In a healthy state, the Eustachian opens at each swallow. In addition, a small opening, the so-called safety tube of the Eustachian tube, ensures continuous ventilation of the middle ear.

As part of an acute otitis media, this opening or the Eustachian tube may be closed. This can be expressed in addition to hearing problems in swallowing. Often, a crack in the ear when swallowing can be heard.

If swallowing persists after the acute otitis media has healed, medical attention should be sought.

How long do the symptoms last?

The severity and duration of the complaints can vary a lot.
In most cases, the course of the disease is shorter in the case of a viral middle ear infection than in the case of a bacterial otitis media.
Severe earache often disappears after one to three days with uncomplicated acute otitis media.
Ear pain and radiating toothache, jaw and headache usually disappear completely after an uncomplicated course of one week.
Similarly, any symptoms of swallowing that may be associated with the symptoms will improve.

Viral inflammation can cause blisters on the eardrum. These blisters are filled with a watery-yellowish secretion and blood. The blisters can burst after a few hours after the onset of inflammation and the secretion flows out of the ear.

With bacterial otitis media, purulent discharge may also be possible. This usually happens after 3-8 days.

In both cases, the acute earache after withdrawal of the secretion is decreasing.

Often an accompanying hearing loss occurs, which also recedes in the course of a week.
However, if tympanic effusion has developed as part of acute otitis media, hearing loss and pressure pain may persist for another two to three weeks. If these exist longer, a medical examination is required.

If fever has occurred, it usually goes back after three days. General body aches usually resolve with fever. Infants often complain of abdominal pain and diarrhea at the beginning of an acute middle ear infection, which normalize with possible other symptoms at about the same time.

In case of bacterial acute otitis media, the duration of the complaints can be shortened in some cases by targeted antibiotics usually by a few days.


Complications, which can occur in the course of an acute otitis media, are usually to recognize specific symptoms.
Thus, the inflammation in addition to the middle ear also affect the inner ear, which in addition to the transmission of the sound information is responsible for the balance.
Thus, an inflammation of the inner ear can be felt mainly by dizziness and a total hearing loss on one side.

Another complication is meningitis, which is caused by an infection of the meninges.

An infection of the middle ear can also cause a so-called brain abscess. This can lead to nonspecific neurological-psychological failures, which require a neurological diagnosis and should be recognized quickly.

Another dreaded complication of acute otitis media is so-called mastoiditis. This is the inflammation of the mastoid of the temporal bone.
Whether such an inflammation is present can be recognized above all by severe pressure pain in the area behind the ear.
This area is often associated with a swelling and there is an outflow of purulent secretions from the ear.

Middle ear inflammation can affect nerves that are localized near the middle ear, causing temporary paralysis.
This mainly affects the facial nerve ( Nervus Facialis ), which can paralyze areas of the face in case of a failure. This is indicated by a drooping corner of the mouth on one side and the inability to completely close an eyelid.

Probably one of the most serious complications of acute middle ear infection is sepsis (colloquially blood poisoning), which is caused by a shift of the pathogens from the middle ear to the blood.
Sepsis can be recognized by pronounced shock symptoms. This includes fast breathing, increased heart rate and increased body temperature.

Frequent middle ear infections can damage the eardrum to scar. Since the eardrum plays a major role in enhancing the perceived sound, scarring of this structure is associated with permanent hearing loss.

Frequently occurring middle ear inflammations with breaking eardrum should be prevented for this reason as far as possible.


The causes of the typical symptoms of an acute otitis media are the reaction of the body to the colonization by pathogens.

In acute middle ear infection in most cases, bacteria are the cause of the infection, and viruses may be responsible for the disease.

The typical pathogens of acute otitis media are also pathogens that typically cause respiratory infections in the human organism.
These are primarily bacterial pathogens such as streptococci, Morraxella catarrhalis, or hemophilus influenza, or viral agents such as the influenza virus or herpesviruses.

The path of infection which the pathogens take upon infection of the middle ear is the passage connecting the pharynx with the middle ear: the so-called Eustachian tube (Tuba auditiva).
If this duct is swollen as a result of the infection, the middle ear or tympanic cavity can no longer be sufficiently ventilated, which leads to an accumulation of secretion in the same.

This accumulation of inflammatory secretion can explain a number of typical symptoms of acute otitis media.


Depending on the pathogen present, ie virus or bacterium, the individual position of the immune system and the treatment of acute otitis media, the disease can take a different course.

A few days after onset of the disease there may also be a spontaneous tearing of the eardrum, as too much pus or fluid has accumulated in the ear. The resulting pressure, the eardrum can no longer withstand.
This tearing, also called eardrum perforation, is usually associated with a short, sharp and very severe ear pain, but the earache and fever soon improve.
However, a slight and after a few days to weeks reversible deafness may occur again.

Through the resulting hole in the eardrum can now flow out of the pus and it comes to discharge from the ear, which may well be a bit bloody. This leads to a pressure relief and re-ventilation of the middle ear, which may promote the healing process, as long as no germs immigrate from the outside through the perforated eardrum into the middle ear, which is why an antibiotic is usually prescribed for a tympanic membrane perforation.
The small tear in the eardrum usually heals on its own within 2 weeks.

It is usually possible to wait one to two days for antibiotic treatment of the disease since, especially in childhood, most acute middle ear infections heal on their own.

However, there are some warnings that require a doctor to visit again.
This includes:

  • very high persistent fever, feverish infants under three months with a fever over 38 degrees
  • persistent vomiting
  • no significant improvement on therapy after two to three days
  • Disturbances of consciousness
  • a seizure
  • more severe discomfort (such as increased ear pain after initial recovery)
  • Facial muscle paralysis
  • a sudden protruding ear caused by a swelling on one side, associated with a pressure pain

In addition, one should be especially vigilant if an acute middle ear infection with serious complications has already preceded in the past, in the near past again and again middle ear infections have occurred or if there are immunodeficiencies or previous operations on the middle ear.
Here an early visit to the doctor to estimate the risk of complications and timely treatment is advised.


The most effective treatment for the symptoms of an acute otitis media is the causal therapy, as the symptoms disappear with the fight against the causative agents of the inflammation.

In many cases, the immune system by itself succeeds in fighting the inflammation. However, if there is no improvement in sight after two to three days, causal treatment of the disease should be started.

A bacterial infection should be treated with antibiotics in any case, as this can prevent the breaking of the eardrum and the course of the disease can be shortened.
The therapy can also reduce the intensity and duration of the symptoms.

Earlier, the eardrum was often opened by a small incision so that the secretion can drain. Nowadays, the breakthrough is awaited on its own, as it has been observed that a ruptured eardrum heals better than one that has been cut open.

A symptomatic therapy with analgesic medication, for example, with ibuprofen makes sense, since in addition to the analgesic effect and an anti-inflammatory effect can be achieved with the drug.

Even decongestant nasal sprays can help, since with their help, the connection between the throat and tympanic cavity is ideally restored and thus a drastic improvement of the symptoms can be achieved.

As a general rule, physical protection can benefit the course of the disease and ensure a speedy recovery and improvement of the symptoms.

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