Acute otitis media in adults

Essentials

  • Eustachian tube dysfunction caused by an upper respiratory infection is the usual cause.
  • If the middle-ear infection becomes prolonged the patient should be referred to an ENT specialist for ruling out a nasopharyngeal tumour.
  • Barotrauma (e.g. during diving) (1) leads to serous otitis media where sterile secretion is found in the middle ear.
  • Radiotherapy of the pharynx region may predispose to functional disorder of the Eustachian tube and middle-ear infections.

Symptoms and clinical findings

  • Ear pain and sensation of a block in the ear
  • The eardrum is opaque or cloudy and usually also red (see Otitis media in children (Otitis media in children: definition, epidemiology and diagnosis)).
  • The mobility of the eardrum is impaired when examined with a pneumatic otoscope of sufficient size. Tympanometry (3) is helpful in the diagnostics.

Treatment

  • The most common causative bacteria in acute media are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In rare cases, group A streptococci may also be found; these may cause sensorineural hearing impairment and a more severe clinical picture.
  • The recommended first-line drug is amoxicillin 750 mg twice daily or amoxicillin-clavulanic acid 875 mg/125 mg twice daily. If the causative agent is group A streptococcus, it should be treated with penicillin V 1.5–2.0 million IU twice daily for at least 10 days.
    • Alternative drugs include trimethoprim-sulfamethoxazole or second-generation cephalosporins.
  • Complications of acute otitis media are rare in adults. Tympanocentesis is indicated in prolonged or severe otitis media, or if a sample for bacterial culture is needed (e.g immunocompromised patients). If group A streptococci are suspected to be the cause, a throat swab to detect these bacteria by either a rapid test or culture is warranted.
  • Serous otitis media caused by barotrauma can be treated with vasoconstrictor drugs and by aeration of the middle ear (4) and, if necessary, by tympanocentesis. Antibiotics are indicated only if a secondary infection is suspected.
  • An ENT specialist should be consulted if the patient has vertigo or intensive tinnitus, the general condition has deteriorated, the pain is intensive or there is a suspicion of mastoiditis (Acute mastoiditis).
  • There may be fluid in the middle ear for several weeks after the infection. An adult may experience the blocking of the ear and the hearing loss as very annoying. The block may be relieved by ventilation of the middle ear (Valsalva manoeuvre: the pressure in the nasopharynx is increased by exhaling forcefully while keeping the nostrils and the mouth closed).

Follow-up

  • A follow-up visit should be scheduled after about one month in order to check the patient’s clinical condition and nasopharyngeal status and to verify middle ear ventilation and hearing improvement.

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