Otitis media is an inflammatory condition of the middle ear space, the part of the ear between the eardrum at the end of the ear canal and the inner ear structures. It may be associated with a middle ear infection which can cause pain, inflammation, fever and hearing difficulty. This condition can occur at any age; however, it is very common in children around the time they enter day care or school.
Otitis media with middle ear infection may be due to a bacterial or viral infection such as a cold or flu, causing the nasal passages and throat to become congested and inflamed. The middle ear communicates with the back of the nasal passage through the Eustachian tube, which helps equalize pressure and drain fluids from the ear. Infection and inflammation can block the Eustachian tube causing fluid to accumulate in the middle ear. Eustachian tubes in children are more prone to blockage due to their size and shape.
Infection can lead to enlarged adenoid glands at the back of the nasal passages which can also compress and block the Eustachian tube.
Ear infections are common in children as their immune systems are not fully developed. They occur more frequently in fall and winter. Infants who are bottle fed while lying flat can have fluid enter the middle ear leading to infection. Exposure to tobacco smoke can also lead to an ear infection.
Most ear infections with fluid build-up will resolve on their own. If they are persistent or frequent, complications such as hearing loss, delayed speech, perforation of the eardrum, drainage or fluid such as blood or pus from the ear, and spread of infection to the surrounding tissues such as the mastoid bone behind the ear, can occur.
Signs and Symptoms
Otitis media with middle ear infection is associated with ear pain. Infants tend to be fussy and may pull or tug at the ears. They usually have a fever, loss of appetite and sleeping difficulty. There may be hearing loss and fluid drainage from the ear. Adults with this condition complain of ear pain and may have fluid drainage and reduced hearing.
Untreated and persistent middle ear infection could lead to complications such as deafness, difficulty with balance, facial nerve palsy, or an abscess behind the ear. More serious complications include an intracranial abscess, meningitis and increased pressure within the skull.
You should visit a doctor if the symptoms are severe and persistent, your child is younger than six months or there is any drainage from the ear.
Your doctor will review your child’s symptoms and medical history. A physical examination is performed of the ears, nose, throat and lungs. A lighted viewing instrument called an otoscope is used to examine the ear canal and tympanic membrane. Additional tests such as a tympanometry may be performed to assess middle ear function and movement of the eardrum and can determine whether fluid is present in the middle ear. A hearing test may be performed in case of repeat infections to check if hearing is intact.
Otitis media with middle ear infection usually resolves on its own in 1-2 weeks without any treatment. In some cases, antibiotics are prescribed.
If otitis media is persistent with repeat ear infections that do not respond well to conservative treatment, your physician may recommend a surgical procedure.
Myringotomy is a procedure where a small incision is made on the eardrum to release fluid or pus from the middle ear. This procedure is indicated in the early stages before perforation of the eardrum has occurred.
An adenoidectomy or removal of the adenoid glands may be performed if they are enlarged and blocking the Eustachian tube.
A perforated eardrum may be repaired through a procedure called myringoplasty or tympanoplasty using a graft of cartilage tissue.
A mastoidectomy may be performed to remove an infected mastoid bone.