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Inflammation of the middle ear is a relatively widespread disease of the middle ear and is mostly bacterial in nature. Young children are increasingly affected, but adults can also suffer from this unpleasant illness. The extremely painful inflammation of the middle ear or otitis media occurs in both acute and chronic forms: otitis media acuta and otitis media chronica.
The anatomy of the middle ear
The middle ear is formed from the so-called tympanic cavity (bone cavity filled with air, which occupies the space between the eardrum up to a bony wall of the inner ear), the eardrum and a connection to the upper pharynx. This connection between the tympanic cavity and the pharynx is known as the ear trumpet, tuba auditiva or Eustachian tube. It is primarily responsible for the air pressure equalization between the two rooms. It opens automatically when swallowed. Therefore, for example, repeated pressure swallowing or forced yawning helps if there is pressure on the ears.
Symptoms of acute otitis media
The first symptoms of acute otitis media are relatively sudden, stinging, pulsating ear pain, often in connection with ringing in the ears or ringing in the ears and impaired hearing. At the same time, unspecific complaints such as fever and headache can occur.
The clinical picture is often difficult to interpret in infants. They are more likely to suffer from symptoms such as diarrhea or vomiting. Repeated touching of the affected ear and agitation can be indications of an existing ear infection. Larger children may also complain of abdominal pain. The earache is sometimes so severe that even gentle touching of the sick ear is not tolerated.
In the further course of the disease, untreated otitis media acuta often leads to a breakthrough of the eardrum (eardrum perforation) with subsequent discharge of purulent secretions. In this case, the pain usually abruptly subsides, but suddenly there is also a severe hearing loss. As a rule, severe acute otitis media heals after a maximum of four weeks with adequate medical care.
Symptoms of chronic disease
The chronic forms are usually characterized less by pain, but rather by persistent hearing impairment in the form of a sound conduction disorder. Those affected also often complain about persistent ear running, in which secretions come out of the middle ear. This is usually odorless in the case of chronic mucosal dilation, while in the case of chronic bone dilation, the secretion can have an extremely unpleasant smell.
In general, chronic inflammation is often accompanied by a dull feeling of pressure on the affected ear. However, pain usually only occurs when the chronic form briefly develops acute otitis media. Without medical care, there is usually no prospect of a cure for otitis media chronica, even if temporary symptom-free periods are not uncommon.
Causes of acute middle ear inflammation
Otitis media acuta often arises as a result of an existing infection in the nasopharynx or in the upper airways. As already mentioned, the ear trumpet is located between the pharynx and the middle ear. Through this connection pathogens can get from the throat into the middle ear and then multiply here. The result is an inflammation, which often also affects the tuba auditiva (so-called tube catarrh).
An infection via the blood path or even from the outside is rather rare. In general, an infection is almost always present when the acute form of the disease occurs. Bacteria such as streptococci, staphylococci or pneumococci are mostly responsible, but viruses can also cause a corresponding infection.
Since the tuba auditiva is still very short in infants and children up to the age of eight, germs can rise to the middle ear more quickly, which means that corresponding complaints can be observed at this age. In general, ventilation disorders of the Eustachian tube can promote the occurrence of otitis media.
If the entrance to the ear trumpet, which is lined with mucous membrane, is moved, for example, by a runny nose, mucous fluid may collect in the ear, which forms a good breeding ground for pathogens. In addition, the pressure compensation due to the blockage of the tuba auditiva is no longer guaranteed to the required extent, which can lead to a negative pressure in the tympanic cavity and a related so-called tympanic effusion.
The combination of runny nose and air travel is generally considered a risk factor. Because the entrance to the tube is blocked by the runny nose and the ventilation is not working properly, which is not only uncomfortable with the necessary pressure compensation, but can also have unfavorable consequences. The germs may migrate towards the middle ear, where they then cause inflammation.
The use of a nasal spray before and during the flight can clear the entrance to the tuba auditiva and counteract the rise of the germs. But not only a cold, but also infectious diseases in the throat can form the basis for an infection of the middle ear. In addition, systemic diseases such as measles, the flu or scarlet fever are known as possible causes of otitis media acuta.
If the ear is already damaged in the form of a perforated eardrum (such as after several middle ear infections), the ingress of water alone when bathing or diving easily leads to renewed infection. The pathogens are entered from the outside.
Causes of chronic otitis media
Otitis media chronica usually arises on the basis of a persistent tube ventilation disorder (malfunction of the tuba auditiva) - especially in patients who have often suffered from acute otitis media. A disturbed physiology in the middle ear area can also lead to the chronic form developing. In addition, genetic factors are also discussed as a possible cause of the disease.
In general, two forms of otitis media chronica can be distinguished; A so-called chronic bone dilation caused by a cholesteatoma and a chronic mucosal dilation.
Both forms are associated with perforation of the eardrum and are associated with recurrent purulent secretion. With cholesteatoma, there is a risk that the causative ingrowth of multi-layer keratinized squamous epithelial cells into the middle ear can also damage the surrounding bone structures. In the worst case, complications range from destruction of the ossicles to life-threatening diseases such as inflammation of the brain (meningitis), a brain abscess or blood poisoning.
Complications of the course of the disease
If acute inflammation of the middle ear is inadequate, too late or not given medical care, there are various, at worst, life-threatening complications. For example, this can pass to the area of the inner ear and cause complete hearing loss.
In the case of severe forms of the acute variant, the so-called mastoid process (the tympanic cavity goes back into the mastoid process) is also increasingly affected. A corresponding inflammation of the mastoid process is called mastoiditis. It is the most common complication of otitis media and usually only shows up a few weeks after the onset of the original disease.
In addition to the inflammatory processes, mastoiditis also includes so-called bone melts as part of the symptoms. In this way, the disease can expand significantly in the further course and initially breaks out in most patients. There is a larger abscess and clearly visible swelling and redness behind the ear.
In the worst case, the inflammation of the mastoid process then breaks through into the interior of the skull, which can be associated with life-threatening events such as a brain abscess, meningitis or a so-called sinus thrombosis. Breakthroughs in the area of the zygomatic arch and the neck muscles are also possible, which in turn can trigger a variety of complaints. In the case of mastoiditis, there is usually a further increase in fever and a painful swelling above the mastoid behind the ear. The affected ear also stands out conspicuously.
With the chronic form of mucosal dilation, the overall risk of serious complications is relatively low, while bone dilation can lead to the destruction of the surrounding bone structures and, in the worst case, to life-threatening widening of the inflammation.
If the description of the symptoms suggests an infection of the middle ear, a so-called otoscopy is usually carried out (optical examination of the ear canal and eardrum using an otoscope). Redness and, if necessary, structural changes in the eardrum, such as perforation of the eardrum or blisters on the eardrum, can be identified.
In the case of chronic forms of the disease and complications (e.g. mastoiditis), other examination methods such as X-rays or computed tomography (CT) are often used to determine the extent of the damage. A hearing test, a so-called audio audiogram or tympanometry, can be used to determine hearing impairments and sound conduction disorders.
Treatment for acute otitis media
Since acute inflammation often heals on its own without further therapeutic measures, you can wait a few days. However, a medical check is urgently required during this time. The patients should take care of themselves and avoid the cold. At the same time, decongestant nasal sprays are often prescribed to keep the entrance to the ear trumpet free and to achieve adequate ventilation of the middle ear again.
If the symptoms do not improve after around three days, antibiotics are usually used, since a large part of the acute otitis media is bacterial and there is also a risk of secondary bacterial infection if the middle ear is infected with a virus. Pain-relieving and anti-inflammatory preparations can also be used.
If there is warping of the eardrum or complications such as mastoiditis, this requires surgery to avoid further health risks for those affected. The elimination of mastoiditis is a more comprehensive procedure in which the skull is opened behind the ear and the damaged material is cleared out.
Therapy of otitis media chronica
Chronic forms of the disease do not heal on their own without therapeutic care. Although the symptoms can be temporarily alleviated by the administration of decongestant nasal sprays, anti-inflammatory drugs and painkillers, especially in the case of mucosal dilatation, a final cure requires surgery. The tympanic membrane perforation is repaired in the course of a so-called tympanoplasty (reproduction of the tympanic membrane) in order to prevent the re-penetration of pathogens and corresponding infections.
Chronic bone dilation requires surgical removal of the causative cholesteatoma. If larger parts of the surrounding bone structures have been damaged, surgical reproduction may also be appropriate here.
Naturopathy for otitis media
Naturopathy offers various options for treating the acute form, although these cannot replace a doctor's visit in an emergency. Through the targeted naturopathic support of the self-healing powers, however, a significant improvement can often be achieved within a very short time and further therapeutic measures are not necessary.
First of all, heat treatment by means of a red light lamp should be mentioned here, which remains controversial to this day, however, since an unfavorable effect on the course of the disease is predicted under certain conditions.
Homeopathy has resources that can help. For example, in acute otitis media with massive pain, aconite is the treatment of choice. Belladonna is used when fever is added to the pain and the patient tends to blush. Chamomilla is used for small children who are very tearful due to the pain and only want to be carried around. Ferrum phophoricum is a remedy that is primarily aimed at eliminating inflammation. Furthermore, various homeopathic mixed preparations are available, which should support the decay.
If the ear infections occur unusually often, naturopathic therapy also takes a closer look at the intestine, since possible correlations are suspected here according to the holistic principle. It is not without reason that colon cleansing is often the beginning of successful therapy for recurrent middle ear diseases.
If patients are prone to increased otitis media when they have a cold, naturopathy also uses nasal drops so that the auditory tuba is kept free and no inflammation can develop in the ear. This is especially important for children. There are various preparations here that contain natural substances so that the mucous membranes are not affected.
Another option for naturopathic treatment is the so-called cantharid plaster. This special plaster is coated with a paste of powdered Spanish fly. The poison cantharidin contained in it triggers an artificial combustion. The blood circulation is promoted, wheals and smaller blisters develop at the place of the action. Metabolic waste and pain mediators come to the surface of the skin, the immune system is stimulated.
The cantharid plaster is applied to the mastoid (mastoid process) and the resulting wound is sterile after removal. This is an ancient but very effective method for otitis media. Baunscheidt therapy is a somewhat gentler treatment. This slight incision in the skin also takes place in the area of the mastoid, behind the diseased ear. The blood circulation is stimulated, the lymph flow is stimulated and the inflammation is accelerated.
Proven home remedies for inflammation of the middle ear
Often, home remedies such as the well-known onion wrap have a promising effect on middle ear infections. To do this, chop an onion and wrap it in a cloth handkerchief. This is placed on the sick ear and fixed with a hat or headband. Above this comes a heat source, for example in the form of a warmed cherry stone sachet.
Inhaling and other home remedies for earache can work against inflammation of the middle ear. However, if the naturopathic treatment approaches do not lead to a significant improvement in the state of health in the short term, treatment based on the conventional therapeutic approaches should be carried out promptly.
In general, it is important that otitis media is always completely cured. This is all the more true for children, since recurrent ear infections, which are often accompanied by hearing loss, can cause them to develop significantly. The risk of long-term damage should therefore not be underestimated.
There is also the risk of delayed, life-threatening complications such as mastoiditis. A final medical check-up should therefore be checked to see whether the disease has actually completely subsided. (sw, fp)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Susanne Waschke, Barbara Schindewolf-Lensch
- German professional association of ear, nose and throat doctors: acute otitis media - signs and course (accessed: July 30, 2019), hno-aerzte-im-netz.de
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- Harvard Health Pubishing: Middle-Ear Infection (Otitis Media) (accessed: July 30, 2019), health.harvard.edu
ICD codes for this disease: H65-H67ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.