Otitis media (OM) is a common term for inflammation of the middle ear mucosa.

This is the second most common disease in childhood, after inflammation of the upper respiratory tract. According to various authors, 20% to 90% of children under the age of 10 at least once had inflammation of the middle ear.

Inflamed eardrum
Pressure on the eardrum and present fluid reduce the mobility of the middle ear bones
The eardrum is initially pulled inwards, which causes a feeling of pain
Eustachian tube becomes inflamed and clogged
As the infection progresses, internal fluid pressure can cause the eardrum to bulge outward.

Acute middle ear inflammation – Otitis media acuta (OMA)

OMA is a sudden inflammation of the mucosa of the middle ear with duration of the inflammatory process up to 3 weeks. As a rule, it is caused by the rhinopharyngeal route, and the causes are viruses, bacteria or it is a viral/bacterial coinfection. In 50% of cases, the virus is present, while bacteria are less common.

The clinical picture is dominated by local symptoms, while the general symptoms are mostly mild (the patient is not a sick person, but a person with a sick ear). The main symptom is ear pain. Younger children will cry, feel sick or have trouble sleeping due to pain. About 50% of children with an ear infection will have a fever.

The most common signs and symptoms of acute otitis media are ear pain (otalgia), ear leakage (otorrhea), impaired hearing, irritability and fever.

Frequent middle ear inflammations
Child at the doctor's check-up

The diagnosis is most often established by an otolaryngologist on the basis of the clinical findings, i.e. if the examination shows poor mobility of the eardrum, due to the typical presence of fluid in the middle ear.

50% of cases of acute otitis media are caused by virus, while bacterial/viral coinfection was demonstrated in half of these middle ear samples, which explains the lack of success of antibiotic therapy in these children.

The advice is not to administer antibiotics in the treatment of acute otitis media in the first 48 to 72 hours of the disease.

Therapy of acute otitis media

1. Primarily, in the treatment of pain, an application of local dry warm compresses on the affected ear is recommended.

2. Paracetamol is also recommended for pain relief purposes, in the appropriate dose for the age, and according to the child’s body weight.

3. Antibiotics

The advice is not to administer antibiotics in the treatment of acute otitis media in the first 48 to 72 hours of the disease, but only to observe the child’s condition, because:

  • in 70%-90% spontaneous healing occurs within 7-14 days for first-time OMA and sporadic OMA
  • early use of antibiotics provides relief of symptoms after 24 hours, when they disappear spontaneously, and the incidence of diarrhea in children increases by 10%.

After monitoring the child, if there is no improvement, there are signs of fever and/or increased ear pain, ear leakage or the doctor decides to start antibiotic therapy immediately, the antibiotic of choice is amoxicillin at a dose of 80-90 mg/kg TM divided into three doses.

The optimal duration of antibiotic therapy is not precisely determined and ranges according to the author’s recommendations from 5 to 10 days.

Source: OTITIS MEDIA National Guide for Physicians in Primary Health Care, November, 2004

Complications of acute otitis media are fortunately not so common, but they include mastoiditis (inflammation of the mastoid air cavities, which are an integral part of the temporal bone), meningitis, damage to the hearing apparatus and other.