Acute otitis media

from Wikipedia, the free encyclopedia
Classification according to ICD-10
H65 Non-purulent otitis media
H66 Purulent and unspecified otitis media
H67 * Otitis media in diseases classified elsewhere
ICD-10 online (WHO version 2019)

The Acute otitis media ( acute otitis media ) is a painful, usually by viral or bacterial infection caused inflammation of the mucous membranes of the middle ear .

Clinically, acute otitis media with special shapes is scarlet -Otitis, measles -Otitis and flu -Otitis of chronic otitis ( otitis media chronica ) distinguished.

Cross-section of the human ear
on the left, white outer ear outer ear canal
pink the eardrum
right, knows the middle ear with the ossicles (gray) , see detailed description


The bacterial acute otitis media - by far the less common form of acute otitis media - is predominantly by pneumococci , pyogenes Streptococcus , Haemophilus influenzae , Moraxella catarrhalis , and Staphylococcus caused. The colonization of the middle ear is usually continuously through the eustachian tube from the nasopharynx ( nasopharynx ), but can also via the bloodstream ( hematogenous ) take place.

In acute viral otitis media, the infection usually occurs through the blood. A large number of viruses can cause otitis media, usually in conjunction with an upper respiratory infection. The viral infection can occur alone or it can precede a bacterial infection.

If the eardrum is perforated, pathogens can also be brought in from outside, for example through bath water.

In acute serous otitis media, swelling of the mucous membrane caused by a respiratory infection causes the auditory tuba to become blocked . As a result, the middle ear can no longer be adequately ventilated, creating a negative pressure. This can lead to an effusion in the tympanic cavity, which can be perceived as a feeling of pressure in the ear, deterioration of hearing or noise.


Acute otitis media is not a rare disease. It is one of the most frequent consultation occasions in a general medical practice. It often occurs in childhood, as the Eustachian tube is still short and wide at this age, making it easier for bacteria to ascend from the nasopharynx. Infants can also develop otitis media.

Acute otitis media, dedifferentiation, left ear


The optical examination of the auditory canal and the eardrum ( otoscopy ) with an ear funnel ( otoscope ) reveals initially a reddened, later a dedifferentiated eardrum without recognizable details. Then the eardrum bulges, after a few days pus emerges from a small perforation. Over the course of two to three weeks, the reddening disappears and the eardrum thins again and the small perforation heals.

Acute otitis media, "lumpy cloudiness" of the eardrum, left ear

In viral otitis, blisters filled with serous or bloody fluid are often found on the eardrum (myringitis bullosa), which can burst after hours and briefly cause a watery yellow or bloody discharge.

Acute otitis media viral, myringitis bullosa, left ear

Course of the disease and symptoms

The disease begins with an inflammatory phase lasting one to two days with pulsating earache, fever , throbbing noises in the ears , hearing loss and possibly a tenderness of the mastoid process of the temporal bone . Also nausea and vomiting may occur. A viral otitis media often ends with this phase. With bacterial otitis media, the following three to eight days (defense phase) often lead to a spontaneous rupture of the eardrum with leakage of pus . Then the pain and fever subside. This phase is often significantly shortened by the administration of an antibiotic and perforation of the eardrum is avoided. During this period, the hearing ability in the affected ear is significantly reduced. After another two to four weeks, the otitis media will usually heal.


The recurrence of pain , purulent discharge from the ear and painful swelling behind the auricle after two to three weeks - even earlier in children - are typical of mastoiditis. Mastoiditis is an indication for surgery .

Frequent middle ear infections can lead to scarring of the eardrum and adhesions in the area of ​​the auditory ossicles and result in permanent hearing impairment ( conductive hearing loss ).

Therapy and prophylaxis

Physical rest, decongestant nasal sprays or drops , anti-inflammatory pain relievers such as ibuprofen .

As a rule, otitis media heals without treatment. It is therefore justifiable to wait under medical supervision for the first 2-3 days. If after this time there is no improvement in symptoms, there is a risk of complications. In this case, the administration of a suitable antibiotic (e.g. amoxicillin or, in the case of penicillin allergy, azithromycin or clarithromycin ) is indicated. It should be noted, however, that antibiotics only help with otitis media caused by bacteria - unnecessary antibiotics should be avoided in the case of viral infections.

In some studies, the administration of high doses of the sugar substitute xylitol was able to achieve a prophylactic effect with regard to acute otitis media. Xylitol inhibits the growth of pneumococci and the binding of pneumococci and Haemophilus influenzae to the cells in the nasopharynx . The dose of xylitol was in the range of 10 g / day.


Vaccines are available against pneumococci and Haemophilus influenzae, which are common pathogens causing bacterial otitis media. The pneumococcal vaccination and vaccination against Haemophilus influenzae ( HIB ) are therefore recommended in children.

If the eardrum is perforated, hearing protection (swimming protection) is recommended when showering and bathing . In adults, smoking and various allergies are risk factors that can promote otitis media. A sensitization can accordingly be carried out to prevent otitis media.


At the beginning of the 20th century, otitis media was not yet defined as a bacterial infection, but the pus leaking out of the ear was recognized as a central indicator of the disease. The vernacular spoke of "ear runny ears", doctors of "middle ear catarrh". They made a strict distinction between the course of the disease in children, where usually no intervention is necessary, because their eardrums are "very delicate and thin", and adults, whose eardrums are "much coarser" and therefore often perforated by the pressure of the pus lasting hearing damage. As a last resort, the only thing that can be done is to “create the opening in the eardrum with the knife; a small, grateful and not difficult operation that would be used more often if it weren't painful ”.

See also

Web links

Individual evidence

  1. According to W. Fink, G. Haidinger: The frequency of health disorders in 10 years of general practice. In: ZFA - Journal for General Medicine. 83, 2007, pp. 102-108, doi: 10.1055 / s-2007-968157 . Quoted from What family doctors mainly deal with . In: MMW update. Med. , No. 16, 2007, 149th vol.
  2. Facts Health Check, Bertelsmann Foundation
  3. JL Danhauer, CE Johnson a. a .: Xylitol as a prophylaxis for acute otitis media: systematic review. In: International journal of audiology. Volume 49, Number 10, October 2010, pp. 754-761, ISSN  1708-8186 . doi: 10.3109 / 14992027.2010.493897 . PMID 20874048 . (Review).
  4. ^ JL Danhauer, A. Kelly, CE Johnson: Is mother-child transmission a possible vehicle for xylitol prophylaxis in acute otitis media? In: International journal of audiology. Volume 50, Number 10, October 2011, pp. 661-672, ISSN  1708-8186 . doi: 10.3109 / 14992027.2011.590824 . PMID 21812632 . (Review).
  5. M. Uhari, T. Tapiainen, T. Kontiokari: Xylitol in preventing acute otitis media. In: Vaccine. Volume 19 Suppl 1, December 2000, pp. S144-S147, ISSN  0264-410X . PMID 11163479 . (Review).
  6. The otitis media . In: Deutscher Hausschatz (Christian journal), Issue 2, 1910, p. 67, Verlag Friedrich Pustet, Regensburg / New York.