Middle Ear Infection (otitis media)
Otitis is the medical term for different types of ear infections or inflammations. What they have in common is a severe aching pain in the ear.
The different forms are classified by:
- the affected area of the ear (outer ear or middle ear)
- the course (acute or chronic)
- the type of infection (viral or non-viral)
- the cause of the illness (e.g., a cold, swollen tonsils or measles)
Outer ear infection vs middle ear infection
With outer ear infection or otitis externa, the outer ear is affected. More precisely, the outer ear canal and the visible part of the ear, also known as the auricle. It often occurs after swimming, after a draughty ride, or from changes in air pressure on a flight.
The term otitis media or middle ear infection, on the other hand, refers to the middle ear. This form of earache is most common in children and babies. But it can also affect adults.
When sudden, stabbing ear pain occurs, you may wonder, “why are my ears aching”? Often, a middle ear infection is the trigger.
The causes of otitis media are usually
- upper respiratory tract infections
- a cold
- a sinus infection
- tonsillitis
In particular, a severe and long-term cold that impairs the ventilation of the ear trumpet (eustachian tubes) can promote acute middle ear infection. This is mainly because the ear trumpet connects the ear to the nose and throat. That means pathogens can easily rise. If liquid and mucus can no longer drain through the ear trumpet, viruses and bacteria can collect and grow.
Other risk factors include:
- Age (young children are affected more often than adults)
- Smoking (also passive)
- enlarged tonsils
- a weakened immune system
- allergies, such as hay fever
Problems in the tooth and jaw area can also cause secondary or so-called referred pain in the ear. Both the nerve fibers from the ear and those from the facial region run together to the pain centers in the brain. This makes it sometimes hard to distinguish the exact origin of the pain.
It often begins with a sudden onset of ear pain. The severe, stabbing, pulsating or throbbing pain can worsen when lying down and recur at night. Other symptoms of an ear infection include:
- uncomfortable feeling of pressure in the ears
- increased body temperature or fever
- difficulty hearing
- sometimes dizziness
- feeling sick
- a cold with runny nose and cough
Earache in kids and babies happens particularly often since their immune system is still developing. In addition, the ear trumpet in children is shorter and lies flatter than in adults. This makes it easier for pathogens to travel from the upper respiratory tract to the ear. That is why a middle ear infection is often associated with a cold.
In the first three years of life, on average, children have respiratory infections three to four times as often as adults. By the age of four, over two thirds of all children have experienced at least one middle ear infection. About half of them have suffered three or more ear infections during the same period.
Parents should know that children often show other signs before touching their painful ears. A common sign is restless sleep at night with tossing and turning. Young children may cry more than usual because they cannot yet articulate well what is wrong with them.
Other signs can also include:
- irritability or fatigue
- abdominal pain
- loss of appetite and refusal to drink
- nausea or vomiting
- swollen lymph nodes
The duration of a middle ear infection depends on various factors. This includes the severity of the infection, the pathogen type, and whether it is uncomplicated or complicated otitis media.
Mild or “uncomplicated” otitis media
A mild case of infection lasts about a week. At first the symptoms increase for two to three days until they reach their peak on day 4. They then need about the same time to slowly subside.
The infection always begins with the inflammatory phase, regardless of whether the earache is viral or bacterial.
1. Inflammatory phase
The inflammation leads to severe swelling of the mucous membranes in the ear trumpet. This hinders the ventilation of the middle ear. The secretion that has collected there can no longer flow away.
As the disease progresses, the pressure in the middle ear increases and the eardrum stretches painfully. The inflammation can also cause fluid to leak from the tissue.
2. Defense phase - for bacterial infections
A middle ear infection can also be caused by bacteria, e.g., when bacteria join a viral infection. Here, the inflammatory phase transitions into the defense phase.
Swollen mucous membranes may hinder secretion from the inflammation to flow into the mouth and throat. This creates high pressure in the eardrum, causing a rupture and fluid draining from the ear.
After this pressure relief, the symptoms such as pain and fever subside. The hole in the eardrum usually heals on its own within 2-4 weeks. In most cases, hearing in the affected ear is impaired during this period.
In most cases, acute, uncomplicated middle ear infections are caused by viruses or at least start virally. Antibiotics do not help against virus-related infections. For this reason, along with increasing antibiotic resistance, your doctor may choose a watchful waiting approach.
The “watch and wait” strategy
This approach means cautious waiting under medical supervision of a healthcare practitioner. Changes in the patient's condition are closely monitored over a period of 24, 48 and 72 hours. In patients without any particular risk factors, this strategy has proven to be effective for mild infections.
What you can do in the meantime:
- Alleviate symptoms with oral remedies so you don’t have to touch the sore ear
- Relieve ear pain with oral over the counter pain relievers
- Improve ventilation of the middle ear with nasal sprays
Can middle ear infection be prevented?
Many parents ask themselves, what can I do to prevent otitis media?
Unfortunately, it is not possible to completely prevent middle ear infections. The immune system of little kids is not yet fully developed and must first learn to defend itself against pathogens. Colds and middle ear infections are therefore part of the child's natural development.
Even if you can't prevent a middle ear infection in most cases, there are still things you can do to make it less likely. The following applies to children and adults:
- Strengthen your immune system.
- Get regular exercise in the fresh air.
- Eat a balanced, vitamin-rich diet.
- Drink plenty of fluids.
- Avoid cigarette smoke and overheated rooms.
- Don’t use cotton swabs to remove any water after swimming or showering. Instead, dab the outer area of the ears with a cloth or use a hairdryer on the lowest setting.
The symptoms of a middle ear infection usually begin suddenly and can be accompanied by severe pain. Small children in particular are sensitive to this. They often touch the affected ear or turn their head back and forth restlessly.
Do not try to get rid of ear aches yourself by using local, pain-relieving ear drops. This is mainly because in otitis media the ear drops do not reach the middle ear. The ear drops can only reach the middle ear if the eardrum is already damaged, which can lead to further injuries.
If ear pain does not improve within two days, it should always be checked by a doctor. Only they can properly view the eardrum with their equipment and make an appropriate diagnosis.
When should you see a doctor immediately? Here is our checklist:
- with children under the age of 2 years
- if you have a persistent or high fever
- if there is no significant improvement after 48 hours
- with bilateral ear pain, discharge from the ear
- if you have swelling and ache behind the ear
(this might be a sign that the infection spread to the mastoid bone)
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