Therapy 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 more precisely an inflammation of the mucous membrane of the middle ear. This is usually caused by pathogens that rise from the nose / throat via the tube, a kind of ventilation tube from the pharynx to the middle ear, into the middle ear. Typically, acute middle ear infection develops after an upper respiratory tract infection. The symptoms are caused by the inflammatory reaction of the middle ear mucosa and are associated with pain and swelling, which moves the tube, which leads to a ventilation disorder, among other things with negative pressure on the ear in question. In addition, an effusion often forms, which can cause a hearing impairment by impairing the vibratory ability of the eardrum.

lower fever

The therapy is also based on these symptoms. So it is with every inflammation in the human body, especially when it comes with fever and sickness, advisable and healing, to give the organism the rest to the regeneration that he needs. Accordingly, in the acute stage of the disease, one should not overexert and, depending on the severity of the disease, also observe bed rest. In addition, care must be taken to ensure adequate hydration, especially in the case of fever.

The drug therapy is usually symptomatic in the form of a pain therapy. Ibuprofen and paracetamol are the most commonly used systemic pain relievers and especially in the first 3 days for relief of discomfort very useful. In contrast, pain-relieving ear drops are very controversial in their effect and are not considered in disease-specific guidelines.
The effect of decongestant nose drops is also not proven, but can provide relief with simultaneous or previous cold by supporting the patency or function of the tube by a free nasal breathing and promote secretion from the middle ear.


The use of antibiotics should be restrained because of potential side effects and possible development of resistance. For example, about 80% of all acute middle ear infections in children heal without any complications. Thus, if the symptoms are not particularly severe, no complications have occurred and no tympanic membrane breakthrough has occurred, an antibiotic can be used to wait for 2 to 3 days (in children under 2 years approximately 24 hours), if the inflammation does not develop lays back very quickly. If this is not the case, as long as the symptoms persist, an antibiotic may be given, usually administered for 5 to 10 days. If there is no improvement in the middle ear infection within 48 hours after administration of the antibiotic, then a doctor should be consulted again and a change of the antibiotic should be considered ( see also: fever despite antibiotics - what to do?). As the first choice antibiotic is amoxicillin from the group of penicillins. In the case of a penicillin allergy, one resorts to the so-called macrolides, here, above all, azithromycin or erythromycin.

Antibacterial antibiotic therapy is considered the treatment of choice in acute otitis media and is considered to be the only therapy that can effectively treat the cause of acute middle ear infection with bacterial cause. The disease is one of the most common causes why antibiotics are prescribed in Germany. This is especially true for children or infants who are more often affected by the inflammation than adults.

The bacteria most responsible for the inflammation use the Eustachian tube to penetrate from the pharynx to the middle ear. Typically, pathogens such as streptococci, hemophilus influenzae or morraxella catarrhalis are responsible for the disease. These pathogens can be treated with common antibiotics. The standard antibiotic, which is recommended for the treatment of acute otitis media and is often prescribed, is the so-called amoxicillin . Since this antibiotic is a type of penicillin, existing penicillin allergy must be resorted to using another antibiotic to prevent the severe allergic reaction that may occur. In these cases, usually a so-called macrolide is prescribed.

The guideline for acute otitis media provides that only certain groups of people should be given immediate antibiotic therapy.

For example, children under the age of 6 months belong to this group of persons. Even children under 2 years should get antibiotics immediately, provided the inflammation affects both ears. Although the inflammation causes moderate pain and fever, antibiotic therapy is recommended for all ages.

If a purulent discharge from the ear is perceived, it is advisable to consult a doctor immediately, which then initiates a therapy with the appropriate antibiotic.

Individuals presenting individual risk factors should be advised that inflammation in the middle ear may be more common in them than in those who do not have these factors. Immediate antibiotic therapy is recommended, for example, in individuals with a cochlear implant, immunodeficiency, those with trisomy 21 or severe underlying conditions.


The duration of the therapy depends on the treatment method, the individual immune system as well as the pathogen responsible for the acute middle ear infection.

If the person is not part of the group that recommends immediate antibiotic treatment, antibacterial therapy will usually be avoided for the first two days. In most cases, acute middle ear infection can heal itself without antibiotic. However, if there is no improvement in the symptoms after two to three days, or the affected person has risk factors, antibiotic therapy can be started. The antibiotic should always be taken strictly as directed by the doctor. In no case should the antibiotic be discontinued before the date agreed with the doctor. Even if the symptoms go back a few days after starting the therapy, an antibiotic should always be taken to avoid resistant strains of bacteria!

The symptomatic therapy with antipyretic and analgesic medications on the other side should only take place as long as the fever and the pain occur and can be safely discontinued after the symptoms disappear.

Home remedy for a middle ear infection

There are a number of different home remedies that are often used for the treatment of acute otitis media and that have healing effects. For none of these home remedies there is scientific evidence that these help against the cause of the inflammation. This is made more difficult by the fact that the inflammation is in the middle ear, which is sealed to the outside by the eardrum.

The usual home remedies focus on the substances contained, which should have antibacterial effects, put on the ear or to fill in the external auditory canal. However, since the eardrum, if it is intact, does not let any of these substances through, these home remedies can not be effective in acute middle ear infections. If the eardrum is damaged due to the inflammation, it is not advisable to use substances in the external auditory canal, as this may lead to a germ transmission, which could significantly worsen the course of the disease.

Helpful home remedies that can treat the often-elevated temperature are calf rolls. Applying moist wipes to the calves of the affected area can effectively lower body temperature.

In general, a doctor should be consulted in any case so that the treatment options can be discussed with him. In consultation with the attending physician, the safety of the home remedies can also be inquired.


Homeopathic substances are often used in diseases where antibacterial drugs are normally used. There is currently no scientific evidence that could prove a significant effectiveness of homeopathic substances.

From a medical point of view, however, there is nothing wrong with taking the available homeopathic remedies in addition to conventional medicine. The important thing is that the disease is not played down and complications are accepted. For this reason, a doctor should always be consulted if it comes to the symptoms of acute otitis media.

In a detailed doctor-patient interview therapy options can be discussed and the possibilities to take homeopathic remedies in addition to conventional medical methods.

in children / babies

Acute otitis media is a disease that is more common in children and infants. The symptoms of this inflammation can be detected by a pediatrician, who looks at the affected child's ear canal and examines the eardrum. In addition, children typically attack the ears in the presence of middle ear inflammation, which is why such behavior combined with severe pain can be an indication of acute otitis media.

Therapy in children, or infants, is similar to the therapy recommended for adults. For babies under 6 months of age, immediate antibiotic use is recommended. The same applies to children under the age of two, when the middle ear infection occurs simultaneously on both ears. Immediate treatment should also be initiated if it is unlikely that a doctor's control of the course of the disease can be maintained.

All children over the age of two may wait up to two days, depending on the individual assessment of the treating physician, before beginning antibiotic therapy. If the inflammation goes down, it may be possible to dispense with antibiotics.

The standard antibiotic of choice is amoxicillin, as in adults. The duration of antibiotic therapy in children depends on their individual age. For example, in children up to the age of two years, as well as in children with severe illnesses, antibiotic therapy lasting 10 days is recommended. For children between the ages of two and six, a 7-day course of treatment is taken. From the age of 6, antibiotics usually last for 5-7 days.

Even in children, should be despite the administration of antibiotics, no improvement in the symptoms occur, a so-called paracentesis, ie an opening of the eardrum, carried out.

In any case, if you suspect that an acute otitis media is present in an infant or child, you should consult a doctor who can examine the affected child and confirm the diagnosis and initiate adequate therapy. The individual disease situation of the ill child or baby must be considered in each case before a therapy can be initiated. In addition, in order to avoid complications and to assess individual risk factors, self-care should be avoided using home remedies without consultation with the treating physician.


Should no satisfactory improvement occur even after a change of the antibiotic, any complications should be excluded and a so-called paracentesis with a protrusion of the eardrum, which can be determined by the doctor, with a microbiological examination of the effluent secretion. Under local anesthesia - in children under general anesthesia - a small incision is made in one part of the eardrum so that the secretion or the pus can run out of the middle ear. This is then further investigated and adequate therapy is sought. This procedure also leads to pressure relief, which should be accompanied by an improvement in pain.

It can also come spontaneously by the pressure in the middle ear to a tearing of the eardrum (eardrum perforation). This manifests itself usually by a sharp, short pain, as a result of which the symptoms decrease. The "ear run", so the emergence of middle ear secretions from the outer ear is a sign of this. Acute otitis media should be treated with antibiotics following a perforation of the eardrum, because from the outside further germs can penetrate, which can aggravate the inflammation. In addition, if the ear is in the ear, flush the ear canal with body-warm water, but only by the doctor to avoid the spread of germs, and carefully wipe the ear canal with cotton swabs. An eardrum perforation or a small incision into the eardrum usually heals on its own within 2 weeks without complications.

After the acute inflammation subsides, the so-called Valsalva maneuver can bring relief for a short time. In this case, an overpressure in the pharynx is created by firmly pressing the air in the mouth with the mouth closed and closed nose, which can cause an opening of the most closed and eingeschwollenen tube and thus ventilation of the inner ear and a lifting of the meanwhile resulting negative pressure. A similar effect may also be chewing gum or the like, as the chewing motion allows opening of the tube.


A heat treatment of the ear can also improve the pain in acute middle ear infection, for example by a hot water bottle, a heating pad or the irradiation with red light. However, this should not be done with already occurring complications. However, a scientific study proving its effectiveness does not yet exist. The application of onion or chamomile bags brings alleviation, according to experience, even if there is also no study-based evidence.

For recurring acute middle ear infections, a specific clarification by a doctor is recommended. In addition, vaccination against certain bacteria, such as pneumococci, can be successful. Removal of enlarged tonsils or antibiotic prophylaxis, which however is controversial because of the formation of possible resistances, can also prevent further middle ear infections.

Follow-up should be performed approximately 3 to 4 weeks after the diagnosis of acute otitis media, unless a prior visit to the doctor for persistent symptoms was necessary to assess the eardrum and hearing and determine if the otitis media has healed. It is also to be considered that after a severe otitis media, the inflammation after the symptoms have resolved is not necessarily completely healed. So you should still be gentle - even if you feel better already - and take the time to get properly healthy. Even swimming pool visits in the days after an acute otitis media is strongly discouraged, so as not to promote a renewed inflammation.

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