Otitis media
Otitis media is inflammation of the middle ear. "Otitis" means inflammation of the ear, and "media" means middle. This inflammation often begins with infections that cause sore throats, colds or other respiratory problems, and spreads to the middle ear. These can be caused by viruses or bacteria, and can be acute or chronic.

Acute otitis media is usually of rapid onset and short duration. Acute otitis media is typically associated with fluid accumulation in the middle ear together with signs or symptoms of ear infection; a bulging eardrum usually accompanied by pain, or a perforated eardrum, often with drainage of purulent material (pus). Fever can be present.

Chronic otitis media is a persistent inflammation of the middle ear, typically for a minimum of a month. This is in distinction to an acute ear infection (acute otitis media) that usually lasts only several weeks. Following an acute infection, fluid (an effusion) may remain behind the ear drum (tympanic membrane) for up to three months before resolving. Chronic otitis media may develop after a prolonged period of time with fluid (effusion) or negative pressure behind the eardrum (tympanic membrane). Chronic otitis media can cause ongoing damage to the middle ear and eardrum and there may be continuing drainage through a hole in the eardrum. Chronic otitis media often starts painlessly without fever. Ear pressure or popping can be persistent for months. Sometimes a subtle loss of hearing can be due to chronic otitis media.

Otitis media is more frequent in certain racial groups (eg, Inuit and American Indians); this is likely due to anatomic differences in the eustachian tube.

Boys are affected more commonly than girls, but no specific causative factors have been found. Male sex is a minor determinant of infection.

·         Ear infections occur in all age groups, but they are considerably more common in children, particularly those between ages 6 months to 3 years than in adults. This age distribution is presumably due to immunologic factors (eg, lack of pneumococcal antibodies) and anatomic factors (eg, a low angle of the eustachian tube with relation to the nasopharynx).

·         Children with significant predisposing factors (eg, cleft palate, Down syndrome) acquire infections so frequently that some authors advocate the routine placement of polyethylene tubes in their tympanic membranes to maintain aeration of the middle ear.

How is chronic otitis media treated?
Initially, antibiotics may resolve the infection. If a tympanic membrane perforation is also present, topical antibiotic drops may be used. If eardrum or ossicle scarring has occurred, that will not be reversed with antibiotics alone. Surgery is often indicated to repair the tympanic membrane (eardrum), remove the infected tissue and scar from the middle ear and the mastoid bone.

What are the symptoms of acute otitis media?
Young children with otitis media may be irritable, fussy, or have problems feeding or sleeping. Older children may complain about pain and fullness in the ear (earache). Fever may be present in a child of any age. These symptoms are often associated with signs of upper respiratory infection such as a runny or stuffy nose, or a cough.

The buildup of pus within the middle ear causes pain and dampens the vibrations of the eardrum (so there is usually temporary hearing loss during the infection).

Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal. The hole in the eardrum from the rupture usually heals with medical treatment.




 

Serous Otitis Media