Otitis Media

Definition

Otitis media is the infection of the middle ear, the part of the ear behind the tympanic membrane (eardrum). Infections of the middle ear are common especially in children. Middle ear infection tends to follow the seasonal flu (influenza) and is usually self limiting. Untreated or inadequately treated otitis media can lead to chronic otitis media which in some cases can complicate to the point where there is permanent damage of parts of the hearing apparatus.

Symptoms

InĀ  mild cases, the symptoms may be barely noticeable. Symptoms of otitis media includes :

  • Feeling of fullness in the ear.
  • Ear pain of varying intensity.
  • Hearing loss usually on one side only.
  • Tinnitus – ringing or roaring sound in the ear despite environmental stimulus.
  • Autophony – spoken words of the patient echoes in their ears.
  • Fever and malaise may be present.
  • In children, irritability accompanied with pulling of the ear is noticed.
  • In chronic conditions, discharge from ear may be present along with dizziness.

Causes

Microbes can gain entry into the middle ear either through a perforated eardrum or through the tube running from the back of the throat – the eustachian tube. The latter is one of the more common ways in which otitis media develops. Eustachian tube factors related to causing otitis media:

  • Collection of fluids in the middle ear due to obstructed eustachian tube.
  • Spread of infection from the adenoids, tonsils, sinuses or throat.
  • Forcible blowing of the nose causes spread of infection to the middle ear through the eustachian tube.
  • Water entering the nose under pressure during swimming can spread infection to the middle ear.
  • Bottle feeding to children in the lying position causes infection of the middle ear through the eustachian tube.

Other factors include :

  • Trauma to the eardrum while cleaning the external ear canal.
  • Fractures of the bones related to the middle ear due to head injury.
  • Blood borne infection which is rare.
  • Changes of pressure of the ear during diving or flying can spread the infection to the middle ear.

Chronic infection can spread to the adjacent regions of the middle ear. Infection could cause destruction of the surrounding skull bone and lead to abscess formation. The abscess can even spread to the brain causing severe complications and in rare instances even progressing to life threatening states.

Treatment

Chronic otitis media should be treated by an otorhinolaryngologist (ENT specialist).

  • Antibiotics should be administered as early as possible in otitis media. A culture is necessary if there is no response to an antibiotic in 48 hours. Antibiotic ear drops are given only if there is discharge from the ear. Fomentation may help relieve the pain.
  • Nasal decongestants help in the drainage of the middle ear through the eustachian tube.
  • Analgesics are given to relieve the pain.

Surgically, eardrum may need to be incised to promote drainage of the middle ear cavity. A drainage tube may be inserted in the eardrum if middle ear fluid collection is recurrent. The patient needs to be assessed on a regular basis to identify any continuation of the condition that may not be overtly evident in the chronic stages.

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