Otitis Media

Definition

Otitis media is an inflammation of the middle ear (the cavity between the eardrum and the inner ear).

Description

The eustachian tubes equalize the pressure between the middle ear cavity and the outside atmosphere and allow fluid and mucus to drain out of the middle ear cavity. Inflammation of the middle ear causes the tubes to close causing the fluid to become trapped. Bacteria from the back of the nose travel through the eustachian tube directly into the middle ear cavity and multiply in the fluid.

The inflammation can occur as a result of an infection extending up the eustachian tube. This tube may become blocked by a bacterial or viral infection or by enlarged adenoids. Fluid produced by the inflammation cannot drain off through the tube and instead collects in the middle ear.

The type of otitis media is determined by the type of fluid found in the middle ear. If the fluid is thin and watery, the condition is called serous or secretory otitis media, also known as middle ear effusion.

If serous otitis media fails to clear up after three months or more, it is called chronic otitis media.

If the fluid is sticky and thick, the condition is called mucoid otitis media, or "glue ear."

If pus is present, the condition is called purulent otitis media, also known as acute otitis media.

If purulent otitis media returns time and again once or twice every month once or twice every month, this is called recurrent otitis media.

Causes and Risk Factors

Children are more commonly affected than adults because of the small size and horizontal position of their eustachian tube (the passage that connects the back of the nose to the middle ear). Otitis media affects about 2/3 of youngsters at least once before they reach their second birthday.

The four main causes of otitis media are allergy, infection, blockage of the eustachian tube and nutritional deficiency.

Allergy. Studies have shown that food and airborne allergies can cause otitis media. The most common offending foods are milk products (from cows), wheat, egg white, peanut products, soy, corn, oranges, tomatoes and chicken. The most common airborne allergens are cigarette smoke, pollen, animal dander, house dust, mold, fungi, sulfur dioxide, bacteria and volatile organic compounds such as formaldehyde, pesticides and herbicides.

Infection. Otitis media infections are caused by viruses or bacteria that infect the cells lining the eustachian tube, throat and middle ear. When infected, these cells become swollen and secrete a thick mucus that may clog the eustachian tube and cause fluid and pressure to build behind the eardrum. Some of the most common bacteria to cause this infection are Streptococcus pneumoniae, Haemophilus influenzae and moraxella catarrhalis.

Blockage of the eustachian tube. This obstruction can be a result of swollen tonsils or adenoids or problems involving the bones of the cranium, the temporomandibular joint (located at the jaw) or the cervical spine.

Nutritional deficiency. Researchers have found that children with vitamin A, zinc and iron deficiencies are more susceptible to upper respiratory and ear infections. Additionally, large amounts of prostaglandins (fatty acids found naturally in all people) and leukotrienes may also play a part.

Symptoms

Serous otitis media may not cause any symptoms, however, fluid remaining in the middle ear for a long period of time may result in hearing loss. Although this condition can develop on its own, it most commonly occurs after being treated for acute otitis media.

Acute otitis media causes sudden, severe earache, deafness, and tinnitus (ringing or buzzing in the ear), sense of fullness in the ear, irritability, tugging or rubbing the ear, an unwillingness to lie down, fever, headache, a change in appetite or sleeping patterns, fluid leaking from the ear, nausea and difficulty in speaking and hearing. Occasionally, the eardrum can burst, which causes a discharge of pus and relief of pain.

Mucoid otitis media's symptoms include sudden and unexplained fever and hearing loss.

Complications of otitis media include otitis externa (inflammation of the outer ear), damage to the bones in the middle ear (sometimes causing total deafness) or a cholesteatoma (a matted ball of skin debris which can erode bone and cause further damage to the ear).

Rarely, infection can spread inward from an infected ear and cause a brain abscess, mastoiditis (inflammation of the mastoid bone cells), or meningitis (inflammation of the membranes covering the brain and spinal cord).

Diagnosis

Otitis media can be detected by examining the ear with an otoscope. A sample of discharge may be taken to identify the organism responsible for the infection. In addition, two tests may be performed to give the doctor information that cannot be learned through observation only.

One of these tests is an audiogram, in which tones are sounded at various pitches. An audiogram is used to measure how much hearing loss has occurred. The second test, called a tympanogram, measures the air pressure in the middle ear; this indicates how well the eustachian tube is functioning. These two tests help the doctor determine the severity of the problem and decide on a course of treatment.

Treatment

Medication

The first line of treatment for otitis media is usually medication. The most common medications used are antibiotics such as Amoxicillin, Augmentin, Bactrim, Ceftin, Ceclor, Erythromycin, Pediazole and Cedax.

In certain cases the doctor may choose to add a decongestant or steroids, as well as analgesics for pain. A physician may also remove pus and skin debris and prescribe antibiotic ear drops if necessary.

Please speak to your doctor regarding the controversy regarding treatment of otitis media with antibiotics. Recent studies have suggested that some children with otitis media do just as well without being treated with antibiotics. This depends upon the severity of the infection, prevailing causes of otitis in your community, your child's health history and other factors.

If the acute otitis media is recurrent the doctor may recommend prophylactic (preventive) treatment. This treatment involves administering low doses of antibiotics. Treatment extends for 2 to 6 months, depending on the time of year. Infections that begin during the winter require a full 6 months of treatment, because relapse in more common in winter.

Surgery

Your doctor may recommend surgery if the child's infection fails to respond to antibiotics, if the ear infections are chronic or hearing loss is indicated. The most common type of surgery is myringotomy.

Myringotomy. This kind of surgery offers relief to children and some adults who suffer recurrent ear infections or persistent fluid in the middle ear, which can lead to hearing loss. In a short and simple outpatient procedure, an otolaryngologist makes a small incision in the eardrum and inserts a tiny ventilation tube called a tympanostomy tube. The tube promotes drainage of fluid from the middle ear and keeps it from recurring. The procedure also usually results in a marked reduction in the number and severity of ear infections. The tube will fall out on its own within 3 to 18 months. Additional myringotomies may be necessary.

Other options include:

Adenoidectomy. As a last resort the doctor may suggest removing the adenoids (adenoidectomy). This procedure is only recommended for children 4 years of age or older, if the serous otitis media has lasted three months or more and the adenoids are repeatedly inflamed.

Tonsillectomy. As a last resort the doctor may suggest removing the tonsils (tonsillectomy). This procedure is only recommended for children 4 years of age or older, if the serous otitis media has lasted three months or more and the tonsils are repeatedly inflamed.

If there is damage to the eardrum the doctor may suggest tympanoplasty (a plastic operative procedure to repair a damaged eardrum) or myringoplasty (surgical closure of a perforation in the eardrum by means of a tissue graft).

If there is hearing loss the doctor may suggest a stapedectomy (replacement of the stapes (stirrup) with a prosthesis).

Questions to Ask Your Doctor

What is causing the problem?

Is there significant damage to the bones or nerves?

Can this be effectively treated with antibiotics?

Can this be effectively treated without antibiotics?

Is surgery necessary?

What is it called?

How will the procedure be performed?

What are the risks?

What benefits and degree of success can be expected?