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
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
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
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
''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
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
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
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
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Last Updated: Feb 15, 2014