Otitis media (Latin for "Infection of the Middle Ear") is inflammation of the middle ear, or middle ear infection.
Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the eustachian tube.
It is one of the two categories of ear inflammation that can underlie what is commonly called an earache, the other being otitis externa.
Diseases other than ear infections can also cause ear pain, including cancers of any structure that shares nerve supply with the ear and shingles which can lead to herpes zoster oticus.
Otitis media has many degrees of severity, and various names are used to describe each. The terminology is sometimes confusing because of multiple terms being used to describe the same condition.
A common misconception with ear infection is that sufferers think that a symptom is itchy ear. Although sufferers may feel discomfort, an itchy ear is not a symptom of ear infection.
Acute bacterial otitis media can cause pain that leads to sleepless nights for both children and parents, can cause eardrum perforations, not all of which heal, and can spread to cause mastoiditis and/or meningitis, brain abscess, and even death if a severe infection goes untreated long enough. High fever can occur and can cause febrile seizures. Appropriate antibiotic administration prevents most such complications.
Otitis media is very common in childhood, with the average toddler having two to three episodes a year, almost always accompanied by a viral upper respiratory infection (URI), mostly the common cold.
The rhinoviruses (nose viruses) that cause the common cold infect the Eustachian tube that goes from the back of the nose to the middle ear, causing swelling and compromise of pressure equalization, which is one of the normal functions of the tube.
The other main function is the lateral drainage of fluids from tissues on either side of the skull. It has to be remembered that the Eustachian Tube is only the width of three to four hairs in places along its length. It also changes its anatomical and physiological appearance during the early growth period of the child.
In the newborn the tube is horizontal making it more difficult to drain naturally, and the surface of the tube is 100% cartilage, with a lining of Lymphatic tissue which is an extension of the Adenoidal tissue from the back of the nose.
As the early years pass by the superior (upper) part of the tube ossifies to bone but the lower remains the same.
The angle of the tubes changes and descends to roughly a 45 degree angle increasing the downward flow of fluids. It should be noted that individuals with Downs Syndrome anatomically have more severe curves to their tubes, hence why D.S children tend to have more grommet operations than other children.
In general, the more severe and prolonged the compromise of Eustachian tube function, the more severe the consequences are to the middle ear and its delicate structures.
If a person is born with poor Eustachian tube function, this greatly increases the likelihood of more frequent and severe episodes of otitis media.
Progression to chronic otitis media is much more common in this group of people, who often have a family history of middle ear disease.
Acute otitis media
Acute otitis media (AOM) is most often purely viral and self-limited, as is its usual accompanying viral URI (upper respiratory infection).
There is congestion of the ears and perhaps mild discomfort and popping, but the symptoms resolve with the underlying URI.
If the middle ear, which is normally sterile, becomes contaminated with bacteria, pus and pressure in the middle ear can result, and this is called acute bacterial otitis media.
Viral acute otitis media can lead to bacterial otitis media in a very short time, especially in children, but it usually does not.
The individual with bacterial acute otitis media has the classic "earache", pain that is more severe and continuous and is often accompanied by fever of 102 °F (39 °C) or more.needed.
Bacterial cases may result in perforation of the ear drum, infection of the mastoid space (mastoiditis) and in very rare cases further spread to cause meningitis.
''1st phase'' - exudative inflammation lasting 1-2 days, fever, rigors, meningism (occasionally in children), severe pain (worse at night), muffled noise in ear, deafness, sensitive mastoid process.
''2nd phase'' - resistance and demarcation lasting 3-8 days. Pus and middle ear exudate discharge spontaneously and afterwards pain and fever begin to decrease. This phase can be shortened with topical therapy.
''3rd phase'' - healing phase lasting 2-4 weeks. Aural discharge dries up and hearing becomes normal.
Otitis media with effusion
Otitis media with effusion (OME), also called serous or secretory otitis media (SOM), is simply a collection of fluid that occurs within the middle ear space as a result of the negative pressure produced by altered Eustachian tube function.
This can occur purely from a viral URI, with no pain or bacterial infection, or it can precede and/or follow acute bacterial otitis media.
Fluid in the middle ear sometimes causes conductive hearing impairment, but only when it interferes with the normal vibration of the eardrum by sound waves.
Over weeks and months, middle ear fluid can become very thick and glue-like (thus the name glue ear), which increases the likelihood of its causing conductive hearing impairment.
Early-onset OME is associated with feeding while lying down and early entry into group child care, while parental smoking, too short a period of breastfeeding and greater amounts of time spent in group child care increased the duration of OME in the first two years of life.
Prior to the invention of antibiotics, severe acute otits media was mainly remedied surgically by myringotomy. An outpatient procedure, it consists of making a small incision in the tympanic membrane to relieve pressure build-up.
Chronic suppurative otitis media
Chronic suppurative otitis media involves a perforation (hole) in the tympanic membrane and active bacterial infection within the middle ear space for several weeks or more.
There may be enough pus that it drains to the outside of the ear (otorrhea), or the purulence may be minimal enough to only be seen on examination using a binocular microscope.
This disease is much more common in persons with poor Eustachian tube function. Hearing impairment often accompanies this disease.
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Last Updated: Sep 15, 2014