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.

Alternative Names of Otitis Media are: Middle ear infection - chronic; Ear infection - chronic; chronic otitis media; chronic ear infection.

Complications of Otitis Media

• Cyst of the middle ear cyst (cholesteatoma)
• Facial paralysis
• Infection of one of the skull bones (mastoiditis)
• Inflammation around the brain (epidural abscess)
• Permanent damage to the ear with partial or complete deafness

Most children will have temporary and minor hearing loss during and right after an ear infection, because fluid can linger in the ear. Although this fluid can go unnoticed, it can cause significant hearing problems in children. Any fluid in the ear that lasts longer than 8-12 weeks is cause for concern. In children, hearing problems may cause speech to develop slowly.

Permanent hearing loss is rare, but the risk increases with the number and length of infections.

Causes of Otitis Media

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 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.
• Additionally, in infants, otitis media has been associated with bottle feeding. Breast feeding provides two protective mechanisms. One is the suction created by sucking on the breast helps close the ear canal and prevents reflux of particles and bacteria into the middle ear. Second is the general protection from infections provided by the mother’s antibodies crossing over to the baby in the mother’s milk.

Signs & Symptoms of Otitis Media

• Ear pain or discomfort, earache
  1. Usually mild
  2. May feel like pressure in the ear
• Pus-like drainage from the ear
• Hearing loss

Note: Symptoms may be continuous or intermittent, and may occur in one or both ears.

Diagnosis of Otitis Media

• Otitis media can only be detected by examining the ear with an otoscope. Only by directly looking in the ear and seeing how the eardrum responds to gentle pressure can the diagnosis be confirmed. 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.
• In recurrent cases or when an acute case does not respond to treatment, it may be necessary to obtain a culture from the middle ear, through the eardrum. This is usually done by an otolaryngologist.

Treatments of Otitis Media

• Antibiotics may be prescribed if the doctor thinks the infection is due to bacteria. Antibiotics may need to be taken for a long time, either by mouth or in the form of antibiotic ear drops if there is a hole in the eardrum.
• Surgery to remove the adenoids may be needed to allow the Eustachian tube to work properly. The surgeon may make an opening in the eardrum to allow fluid to drain. This is called a myringotomy. The procedure may or may not involve placing tubes in the ear.
• Surgery to repair a ruptured eardrum may prevent further chronic ear infections.
• Keep the ears clean and dry to prevent reinfection. This is particularly important if myringotomy has been performed.

Prevention of Otitis Media

Prompt treatment of acute ear infections may reduce the risk of development of chronic otitis media. Follow-up examination after treatment of an ear infection will ensure that it is completely cured.

When to seek Medical Advice

• Call for an appointment with your health care provider if you or your child has signs of chronic otitis media, including an episode of acute otitis media that does not respond to treatment.
• Call your health care provider if chronic otitis media does not respond to treatment, or if new symptoms develop during or after treatment.