Otitis media

Forms, symptoms and treatment

An acute middle ear disease often starts with a runny nose or a flu. When you have a middle ear disease or otitis media, as the name suggests, the middle ear, the area between the eardrum and the inner ear, is inflamed. Apart from being very painful, an otitis media can also lead to a hearing loss. To counter this, we inform about the various forms of otitis media, the symptoms and treatment methods.

Otitis media typically follows an upper respiratory infection, such as a cold. After a few days of a stuffy or runny nose the ears can become affected. The mucous membrane lining the middle ear becomes inflamed and the Eustachian tube closes up. A blocked Eustachian tube affects the air circulation in the middle ear causing a buildup of negative pressure in the middle ear. This sets up a vacuum and in some cases if the vacuum does not resolve the inflamed mucous membrane begins to secrete fluid.

Types of Otitis media

Acute otitis media (AOM)

When the term “ear infection” is used it usually refers to acute otitis media. AOM is characterized by the rapid onset and relatively short duration. AOM is generally viral in nature but can also be bacterial (acute bacterial otitis media).

Serous otitis media (SOM) or Otitis media with effusion (OME)

SOM typically follows an episode of AOM. The buildup of fluid that is secreted from the inflamed mucous membrane can be temporary with no signs of infection. Serous otitis media is a common childhood condition that is often known as “glue ear”.

Chronic otitis media with effusion

Occasionally serous otitis media can become chronic (present for 6 weeks or longer). Although there is no infection present, the fluid remains in the middle ear for prolonged period of time or returns repeatedly. The longer the fluid remains in the middle ear the more viscous the fluid becomes.

Children are particularly affected

Signs and symptoms

The signs and symptoms of otitis media range from very mild to severe. In its most mild form, acute otitis media is associated with a cold and symptoms include the feeling of congestion in the ears, discomfort or a “popping” sensation. These symptoms usually resolve once the cold is gone. In more severe cases the symptoms include hearing loss, earache or pain, dizziness, high fever, ear discharge, nausea and tinnitus. In some cases the eardrum cannot withstand the increasing pressure from the buildup of fluid and tears. This is commonly known as a perforated eardrum. Although this sounds dangerous, it actually has the positive effect that the fluid can flow out through the outer ear. This usually brings relief from the pain plus the general symptoms of illness.

With children the signs can be more subtle especially if they are not old enough to express themselves. The typical signs to watch for include:

  • Tugging or pulling at the ear(s)
  • Loss of appetite
  • Unsettledness and crying
  • Trouble sleeping
  • High fever
  • Discharge from the ears
  • Problems with balance
  • Trouble hearing, especially soft sounds or when being spoken to from behind

Otitis media in children

Otitis media is one of the most common illnesses among children (Bluestone & Klein, 2000). It afflicts 75 to 90 percent of all children, aged between six months and six years (Bluestone & Klein, 2000). Children are more susceptible to otitis media because their ears and immune systems are not yet fully developed. The Eustachian tubes and adenoids of children put them at risk for ear infections. A child’s Eustachian tubes are shorter and horizontal in orientation making it difficult for fluid to drain out of the ear. The adenoids, located in the back of the upper throat near the Eustachian tubes, are large in children and can therefore easily interfere with the opening of the Eustachian tubes. A child’s immune system is not fully developed making them more susceptible to infections compared to adults. Children generally “grow out” of ear infections by the time they are 7–10yrs old.

The impact of otitis media or “glue ear” on a child can be underestimated because parents are often unaware that their child is suffering from it. Fluid buildup in the middle ear blocks sound which can result in a temporary hearing loss. A child with “glue ear” may not respond to soft sounds, like to turn up the television or radio, may talk loud, and appear to be distracted or inattentive. Often glue ear has no symptoms and if present for long enough can have a negative effect on a child’s language development and schooling.

Be attentive to a runny nose and prevent otitis media

Prevention and treatment

There is little scientific evidence that any specific measures are able to prevent otitis media. Otitis media is considered a complication of upper respiratory infections and therefore prevention of otitis media is to reduce the risk factors associated with these infections. Several studies have found that limiting exposure to other sick children and cigarette smoke, frequent washing of hands, avoiding bottle feeding while lying down, diet and allergies can have an impact on the incidence of otitis media in children.

In many cases the incidence of acute otitis media will resolve on its own accord within three to four days with the help of prescribed ear drops, over the counter decongestants and analgesics. To prevent acute otitis media from becoming chronic as well as serious complications, antibiotics are sometimes required. Following a suitable course of antibiotics, otitis media normally clears up after two to three weeks.

The outcome – should I be concerned?

Otitis media is a very common medical condition. The majority of cases are mild and either resolve on their own or are easily treated. Generally speaking the middle ear has a strong self-healing ability and complications are very rare. Even perforated eardrums are able to heal on their own accord. Even so, the “slient” nature of otitis media which results in a hearing loss in children can have long term effects. So parents keep in mind that a runny nose may also lead to an ear with the sniffles.

Shin-Shin Hobi

References

Bluestone CD and Klein JO (2000)
“Otitis media in Infants and Children Saunders"
Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson Dl, Howie VM (1993)
“Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life” J. Pediatr, 123 (5): 702-11