Acute otitis media in adults

What is it about ?

Acute otitis media, often called ‘acute otitis,’ is an infection of the middle ear that comes on suddenly and lasts a short time.

For the doctor, the most visible sign is the bulging of the eardrum due to the presence of fluid behind the eardrum in the middle ear.

The cause of otitis media is usually an obstruction of the eustachian tube. The Eustachian tube connects the middle ear to the upper part of the pharynx, at the level of the nose (nasopharynx). Its obstruction is most often the consequence of a viral or bacterial infection of the upper respiratory tract. The bacteria usually involved are Streptococcus pneumoniae (also called pneumococcus), Haemophilus influenzae and Moraxella catarrhalis. In rare cases, the causative germ is group A streptococcus. The inflammation is usually more severe and can cause hearing loss.

Irradiation (radiation therapy) to the neck area can also damage the eustachian tube and lead to middle ear infections.

How to recognize it?

Adults who develop otitis media complain of ear pain and the feeling of having a stuffy ear. They may also have other pain and fever.

How is the diagnosis made?

The doctor diagnoses acute otitis media using an otoscope (a medical device he uses to examine the inside of the ear). The otoscope allows her to see if the eardrum is yellowish, cloudy, bulging and red.

What can you do ?

Acute otitis media lasts about a week and usually resolves on its own. An improvement is already present after 3 days. You can therefore wait for healing by relieving the pain with painkillers such as paracetamol or an anti-inflammatory (eg ibuprofen).

If your immune system is weakened (immunodeficiency), see your doctor.

What can the pharmacist do?

The pharmacist can advise you on a paracetamol-based pain reliever. If this is not effective enough, you can switch to an anti-inflammatory (eg ibuprofen), unless you have asthma, have a kidney problem, or are at risk of dehydration. Anti-inflammatory drugs can cause gastrointestinal symptoms: take them with or after a meal, and stop immediately if you have an upset stomach. Respect the dose and the minimum interval between two doses. If you are taking other medicines such as blood thinners, tell your pharmacist.

If the ear infection was triggered by an upper respiratory infection (eg a cold), you can use a nasal decongestant spray or drops for a short time (for a maximum of 5 days). You can also rinse the nose with physiological saline.

Pain relieving ear drops are not recommended. Some are contraindicated if the eardrum is perforated.

If, after 3 days of painkiller treatment, the pain and fever have not gone away, you should see a doctor.

What can the doctor do?

In adults, otitis usually resolves spontaneously. It is therefore rarely necessary to take antibiotics.

Complications of acute otitis media are rare in adults. In severe or prolonged otitis media with discharge, a sample of pus may be needed to determine which bacteria is causing the infection.

If you don’t suspect an infection, but think, for example, of a problem with the eustachian tube, you can use a nasal decongestant spray. Aeration or ventilation of the middle ear is also provided. This can be done, for example, by the Valsalva maneuver. This maneuver involves pinching your nose and, while keeping your mouth closed, carefully trying to blow air (as if you are blowing your nose). Simple exercises like swallowing, yawning, or chewing (gum) can also help open the eustachian tube.

The doctor will refer you to an ENT (otolaryngologist, doctor specializing in the ears, nose and throat) in case of dizziness ortinnitus severe, if your general condition is deteriorating, if the pain is very severe or if you suspectinfection of the bony protrusion behind the ear (mastoiditis) due to bacteria. In case of persistent infection of the middle ear, the doctor, for safety, will refer you to an ENT for a more thorough examination of the nose and throat (pharynx).

Fluid in the middle ear may persist for several weeks after infection. A blocked ear and hearing loss can be very annoying. It is advisable to continue ventilating the ear using the Valsalva maneuver (see above). After about a month, a follow-up visit is indicated to check that there is no longer too much fluid in the middle ear and that hearing has improved.

Want to know more?

• Ear (image) – Larousse
• Orifice of the eustachian tube in the nose (image) – Larousse
• Otitis (video) – Larousse

• Painkillers and self-medication – Federal Agency for Medicines and Health Products
• Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
• Non-steroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
• Nasal vasoconstrictors (decongestants) – CBIP – Belgian Center for Pharmacotherapeutic Information
• Antibiotics – BAPCOC – Belgian Commission for the coordination of antibiotic policy

Sources

• Foreign clinical practice guide ‘Acute otitis media in adults’ (2000), updated on 24.04.2016 and adapted to the Belgian context on 20.05.2018 – ebpracticenet

• www.cbip.be
• Zelfzorgadvies in de apotheek, Praktijkgids 2. S. Cornwell, V. Foulon. Publisher Acco. 2018 edition.