Otitis media acuta H66.0; H66.1;H66.2; H66.3; H66.4

Frequent bacterial or viral inflammation of the middle ear that occurs mainly in children, but also in adolescents and adults. Up to the age of 3, about ⅔ of all children have experienced a disease.

The most common pathogens include pneumococci, Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, Moraxella catarrhalis and occasionally enterobacteriales (e.g. Klebsiella pneumoniae). Anaerobic bacteria can also cause otitis media (including Peptostreptococcus, Fusobacterium, Prevotella and Porphyromonas). More rarely, viruses are directly responsible for inflammation of the middle ear (e.g. measles virus, enteroviruses, RSV, rhinoviruses, influenza and parainfluenza viruses and adenoviruses).

Acute otitis media usually develops as a result of a viral infection of the upper respiratory tract (rhinitis) involving the mucosa of the auditory tuba eustachii, rarely as a result of a tympanic membrane defect. In children in whom the tuba is more horizontally placed, swelling of the mucosa leads to obstruction, which is favored by enlarged pharyngeal tonsils. As a result, the ventilation of the middle ear and the drainage of secretions are significantly impaired. This favors bacterial infection. In newborns, a sexually transmitted infection (STI) of the mother can also be a possible source of infection ("intra partum"). Chlamydia is considered a possible trigger.

Classic symptoms of acute otitis media are severe earache, a feeling of pressure, fever and general complaints (headache and aching limbs), possibly also hearing loss. Another characteristic feature is a so-called tragus pain when pressure is applied to this ear cartilage. Particularly in small children, it is often not the ear complaints but rather unspecific symptoms such as loss of appetite and abdominal pain that are the main focus.

In case of spontaneous perforation with discharge of pus, microbial examination of the smear material. Paracentesis is only necessary in severe cases in order to obtain specific material for microbiological examination. The hearing loss can be quantified if necessary within the scope of a hearing examination

If the purulent infection is passed on to neighbouring structures, mastoiditis, labyrinthitis (involvement of the inner ear with dizziness, nausea, balance disorders) can occur less frequently, leading to life-threatening endocranial complications (meningitis, brain abscess, sinus vein thrombosis).

If an acute inflammation of the middle ear does not heal completely, chronic otitis media can develop.

The spontaneous healing rate is relatively high, especially in children.

In cases of minor impairment, measures such as bed rest, analgesic/anti-inflammatory therapy (NSAIDs), decongestant nasal drops or moist ear compresses are often sufficient.

If the cause is primarily bacterial, antibiotic therapy should be administered to prevent chronicity and/or permanent damage such as hearing loss.

Recommended are e.g. ampicillin (possibly combined with a beta-lactamase inhibitor, 2nd generation cephalosporins or macrolides). In the case of atypical bacteria, e.g., chlamydia in the newborn, an alternative antibiotic with a different spectrum of activity may then have to be selected. The serous effusion cannot be drained naturally as long as the outflow obstruction persists. In this case, a relieving tympanic membrane perforation (incision, paracentesis) must be performed. This acutely reduces pain and the feeling of pressure.

Vaccinations against pneumococcus and Haemophilus influenzae can prevent most infections in children.

Compared to the acute form, chronic otitis media is due to a permanent defect of the eardrum. The pathogen spectrum is altered in otitis media acuta (mostly Pseudomonas aeruginosa, also Staphylococcus aureus, Enterobacteriaceae). Clinically, the main focus is on hearing loss.

1. Cornely O et al (2019) Ear infections. In: Hof H, Schlüter D, Dörries R, ed. Duale Reihe Medizinische Mikrobiologie. 7th, completely revised and extended edition. Stuttgart: Thieme.