Middle Ear Infection

A middle ear infection or otitis media is a painful disease in the area of ​​the middle ear. It can occur both acutely and chronically. The triggers are mostly bacteria and viruses. Middle ear infections are common in young children. Typical signs are earache, hearing loss, fever and exhaustion. A middle ear infection is to be distinguished from an inner ear infection .

Middle Ear Infection

What is a middle ear infection?

A middle ear infection is also referred to in medicine as otitis media. It can occur both acutely and chronically. Typical signs of a middle ear infection are earaches that usually occur on both sides. In addition, pounding in the ear, headache, fever and dizziness are also acute symptoms. See nonprofitdictionary for Crimean-Congo Fever (abbreviated as CCHF).

A middle ear infection is usually caused by bacteria and viruses are only known to be the cause in rare cases. In Germany, mostly babies and children suffer from this disease.

The middle ear itself is a cavity in the ear that is filled with air. It is separated from the eardrum and thus also from the external auditory canal. The middle ear also contains the well-known auditory ossicles incus, hammer and stirrup. You can find out more about hearing here: Hearing.


Middle ear infections can be caused by a variety of reasons. Bacteria are almost always responsible. Viruses are also less common. The viruses are often influenza viruses, which can trigger a middle ear infection as part of a cold. The bacteria already mentioned include the well-known streptococci, pneumococci and Haemophilus influenzae. In small children and babies, the disease is often triggered by the bacterium Staphylococcus aureus.

As already mentioned, an acute middle ear infection often develops in the course of a simple cold. The pathogens then penetrate through the nasopharynx into the middle ear. Sometimes, however, germs can also trigger the disease in the event of an eardrum injury. Another cause can be a delayed infectious disease, such as scarlet fever, which then carries the pathogen to the ear via the blood.

The last cause to be mentioned is a connection with sore throats. This can lead to a disruption in the ventilation of the middle ear and the pharynx. Fluid builds up, which can lead to a middle ear infection caused by pathogens.

A chronic otitis media is rather rare, but can occur as part of a congenital disorder in the pharynx, such as cleft palate. Polyps are also considered to be triggers for chronic middle ear infections.

Symptoms, Ailments & Signs

The main symptom of a middle ear infection is severe ear pain. In the case of an acute middle ear infection, there is a general feeling of illness with fever, nausea and weakness. The earache can be unilateral or bilateral. Touching or squeezing the ear also causes pain in most cases. The pain may be throbbing and may increase with movement.

The eardrum may bulge and be very red. The areas in and around the ear may also be red and tender. The pressure conditions in the middle ear change due to the inflammation, restricting sound transmission. A middle ear infection also causes headaches in some people.

A middle ear infection that has become chronic shows up with additional symptoms, all of which affect hearing. Chronic otitis media can lead to tinnitus. There is often a watery or purulent discharge from the ear. Inflammatory tissue can begin to proliferate and narrow the middle ear.

At the latest, a chronic middle ear infection is associated with hearing difficulties. The hearing loss consists of a feeling of a duller speaking environment and a persistent noise in the ear. Both ears or just one ear can be affected.

Course of the disease

Schematic representation of the anatomy of the ear in otitis media. Click to enlarge.

The course of an acute middle ear infection is characterized as follows. If left untreated, the disease usually heals on its own within 14 days. If this is not the case and the disease persists, there is a suspicion of a mastoid process, which can later develop into mastoiditis. This then leads to the formation of pus in the middle ear or bone process.

If this circumstance is not treated by a doctor, meningitis (meningitis) can develop. Typical signs are then additional severe dizziness and vomiting. It is not uncommon for tears in the eardrum (perforation) to occur with a middle ear infection. Accumulated pus then runs out of the ear and the ear pain subsides .

A middle ear infection should be examined and treated by a doctor in order to prevent complications in good time. In addition, measures can be taken to relieve symptoms such as earaches and headaches. In addition, medical treatment should also be used to prevent chronic middle ear infections.


Because an acute middle ear infection usually heals after about two weeks, complications are rare. In some cases, however, there is a risk of serious consequences. One of the most common complications of otitis media is mastoiditis.

It is mainly seen in babies and young children. Mastoiditis is a purulent inflammation of the bony mastoid (mastoid). The inflammation becomes noticeable through a reddened and painful swelling of the skin behind the auricle, which is also protruding. In the case of mastoiditis, medical treatment is absolutely necessary, because otherwise there is a risk of further complications such as meningitis (inflammation of the meninges) or a brain abscess, which in the worst case can become life-threatening.

The occurrence of an otogenic inflammatory facial paralysis (facial paralysis) is also conceivable. The facial nerve, whose bone canal is located in the immediate vicinity of the middle ear, is affected, which in turn can lead to unilateral paralysis. Another consequence of acute otitis media is toxic labyrinthitis.

It is caused by bacterial toxins that migrate from the middle ear towards the inner ear. As the condition progresses, tinnitus (ringing in the ears) and inner ear hearing loss can occur. Dizziness and balance disorders are also possible.

Sinus vein thrombosis is also conceivable. It is a consequence of mastoiditis. With this complication, blood clots form within the large collecting veins of the brain. In this case, immediate medical treatment is necessary.

When should you go to the doctor?

A middle ear infection can occur in many different degrees of severity, so that in some cases a visit to the doctor can be dispensed with. Children under the age of 12 are affected many times more frequently than adults. If there are symptoms of a severe middle ear infection in a child, a doctor should be consulted as soon as possible.

In many cases, such an inflammation does not occur without side effects. A runny nose, fever and other cold symptoms are also very common side effects associated with a middle ear infection. Such an inflammation can be counteracted very well with appropriate medication. However, if you do not take anti-inflammatory drugs at this point, you sometimes run a great risk.

If left untreated, pus formation may occur. This is always a sign of a significant worsening of the existing inflammation. A visit to the doctor must not be delayed any longer, as in the worst case, blood poisoning can occur.

An inflammation in the ear does not always have to be treated by a doctor or medication. However, if there is no significant improvement after two to three days, drug treatment is urgently recommended. It is imperative that the inflammation is contained and alleviated, otherwise an abscess may form.

Treatment & Therapy

A middle ear infection should be treated by a doctor. In the most favorable case, the family doctor will refer the patient to an ear, nose and throat doctor. The doctor will usually carry out the treatment with the help of antibiotics . In addition, nose drops are available, which allow the accumulated pus to drain better and ventilate the middle ear.

Ear plugs are rarely used because, for anatomical reasons, they cannot develop their effect up to the middle ear. Those affected can independently relieve some symptoms with red light and ear pain medication prescribed by the doctor.

If the eardrum has already been attacked and complications arise, an operation may have to be considered. Nevertheless, the damaged eardrum often heals on its own. Chronic middle ear infections are treated surgically if there is bone suppuration. The same applies to mastoiditis.

Outlook & Forecast

The prognosis for a middle ear infection is considered to be very good. The inflammation heals in about four fifths of all those affected within a few days without any consequences and there is no need to worry about permanent damage or other problems. The speed of healing is not influenced by symptomatic drugs. Prescribed antibiotics are relevant, however, which must continue to be taken after a symptomatic phase of otitis media, depending on the prescription. Otherwise there is a risk of a relapse.

In a few cases, a chronic otitis media develops, which is correspondingly long-lasting and painful. Therapy is also more difficult. Rapid treatment of acute otitis media is therefore a priority.

If the infection moves further, for example to the mastoid process of the cranial bone, complications can occur. In the worst case, it comes to meningitis, whereby a good prognosis here depends on the rapid prognosis and rapid treatment. Otherwise, the course can be very dangerous.

In children it is possible that repeated middle ear infections always seem to heal without consequences. However, it can happen that the middle ear in particular also affects the inner ear, which leads to damage to the structures necessary for hearing. Hearing loss is possible.

You can do that yourself

In the case of an acute middle ear infection, painkillers such as ibuprofen or paracetamol have proven effective, as have decongestant nasal sprays. These help to open the auditory tube so that the middle ear is ventilated again. It should be noted that nasal sprays should not be taken for longer than seven days due to the habituation effect and the drying out of the mucous membranes.

Onion bags are recommended as home remedies. To do this, an onion is cut into small pieces and placed on a clean cotton or linen cloth. The cloth is rolled up and placed on the painful ear and fixed with a band. Many sufferers find it beneficial if the onion bag is first heated in the microwave. The onion has an anti-inflammatory and pain-relieving effect due to its antioxidant sulfur compounds. The onion sac should remain on the diseased ear for half an hour to an hour.

In the case of a middle ear infection, heat helps to heal the disease more quickly. It makes sense to use a red light lamp or a hot-water bottle. Heat helps to liquefy secretions and reduce inflammation.

Sick people should drink as much as possible, rest and protect the painful ear from drafts. Air travel is not recommended due to the increased pressure; ear drops are also not recommended because they cannot reach the middle ear through the eardrum.