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Otitis media the ear infection of the middle ear – Otitis Media

Otitis media is an illness that causes stress to people and doctors, because of their recurrent displays. Find out here symptoms and therapy.

What is the division of the ear?

The ear is divided into three sections the external, middle, and inner portion. The diseases occurring in each one of them, vary in symptoms, treatment, and complications. Therefore this classification is core for knowing in depth what befalls in each illness.

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(IMAGE 1) BruceBlaus / CC BY-SA (

In this article, we are going to focus on the middle ear. The explanation of the external ear is in another article about the Otitis Externa. However, I will first give a brief introduction of the outer ear for then submerge into the middle ear.

The external ear has three structures, the auricle, the ear canal or ear tube, and the outer portion of the tympanic membrane. The eardrum (or tympanic membrane they are the same) is the boundary between the external and middle ear.

Please, imagine the middle ear space as a box with four walls. The lateral wall connects to the external ear by the eardrum, and the internal wall connects to the inner ear. The superior wall is contiguous to the mastoid bone and the inferior to the eustachian tube.

The Eustachian tube directly connects the middle ear to the pharynx, which is in the throat right behind your mouth and nose. This structure plays a vital role in producing otitis media. I would explain this further in the causes of the disease.

What is otitis media?

Otitis media is a condition that mostly affects children. In fact, it is not the first disease affecting children in the United States because the upper respiratory tract infections lead that race, with infections as the common cold or the flu. Those characteristics yielded the name of the “child’s ear” to this condition.

The exact definition for otitis media comprises a swelling of the tissue in that box explained earlier. That inflammation can originate from multiple sources, including infections or allergies, and vary extensively in length and complications.

What are the different types of otitis media?

There is a classification of otitis media, that foresees which may be the trigger, possible difficulties, and therapy for the patient. There is acute otitis media, otitis media with effusion, chronic suppurative otitis media, and adhesive otitis media. Each one of them has distinct causes and symptoms. Therefore, the differentiation between them is core for understanding this disease.

Acute otitis media characteristically have a rapid onset of symptoms. The symptoms include ear symptoms and general body manifestations as fever, with less than three weeks of duration. Sadly, this condition can recur many times over the children’s lifetime. It also has a significant association with the middle ear infection, despite that others could similarly prompt it.

Otitis media with effusion is the term when there is evidence of effusion or liquid in the middle ear. This condition is also known as glue ear, because of the yellow aspect of the viscous middle ear fluid. But there is no proof of acute and bothering symptoms like ear pain or fever that are the focus of acute otitis media, for example. Certainly, the middle ear effusion is usually a consequence of a previous event of acute otitis media.

Chronic suppurative otitis media or just chronic otitis media is when the swelling persists over six weeks and is in association with a ruptured eardrum. This perforation means that there is an external presence of liquid continually coming from the ear. This disease is also in a relationship with ear surgeries; therefore, it requires a careful assessment from your doctor.

What causes it?

The eustachian tube dysfunction is the leading cause of the middle ear’s ailment. The essential connection of the middle ear to the pharynx causes that any affection of the regular system for clearing and cleaning the ear through this necessary tube results in ear inflammation.

The children’s predisposition to get otitis media is due to structural alterations of the eustachian tube, immature immune system, and frequent upper respiratory tract infections. The vulnerability induced by viruses is because most of the virus that generates the common cold, or the flu, allows that more bacteria settle and grow in the throat. Hence, further migration to the middle ear is more likely. Not only that, but the involvement of viruses in overall is in connection with worse outcomes of infections.

There is a complex interaction between multiple determinants as human conditions, infectious diseases, allergies, and environmental. The absence of a specific and leading factor talks about what we still don’t know about the disease, and that would need further thorough studies.

The human condition factors

Among the human factors, some of them lead more than others as causes of otitis media. A decrease in the immune system function, even if it is foreseen and transient as the children of low age or diseases as diabetes or cancer. The immune system is the most valuable arm the body has to protect itself from foreign and harmful germs. It is one of the significant determinants for acquiring more and severer infections.

Besides the impairment of the immune system, many other humans factors, despite existing, are rare or need further study, such as a family history of otitis, structural abnormalities of necessary throat muscles, carrying ear implants, obesity, and vitamin A deficiency.

The allergies factors

The allergy factor is conflictive, with evidence supporting and opposing this theory. For now, it is a fact that many patients with otitis media also have an allergic disease. Nevertheless, the antiallergic treatment that shows significant improvements in the allergy symptoms fails to alleviate the ear condition and its symptoms.

The environmental factors

The environmental factors include lack of breastfeeding in critical ages (from the first three to six months of life), exposure to tobacco smoke, attending to crowded daycare settings, these are critical for developing this condition.

Each one of those risk factors acts in different ways in promoting otitis. Early breastfeeding is core for the development of a healthy immune system, which I already told that it is essential to fight germs. The tobacco smoke inhalation promotes chronic inflammation of the airways and could also trigger allergic reactions in patients. And assisting in daycare environments increase the interchange of viral and bacterial germs between children, which ultimately leads to more ear infection.

The infectious factors

The infection can be by a wide range of microorganisms, including bacteria and viruses. When the infection happens, in seven of every ten patients comes from a previous viral infection of the nose and/or throat, which settles the environment for bacteria to grow. It can occur as an acute or chronic middle ear infection.

When there is a bacterial infection (mostly in acute otitis media), the most common bacteria are Streptococcus pneumoniae, non-typable Haemophilus influenzae, and Moraxella catarrhalis. In fact, these three bacteria account for nearly all bacterial infections in the middle ear. In children below six weeks of life, other bacteria can overcome these, causing almost 20% of the cases, but the former three keep their prevalence.

All the data that I just told you is true for acute otitis media, but for the others, classifications of the disease are different. Otitis media with effusion till recently studies was an illness without bacteria, but this concept has changed due to newer studies finding bacteria in them. In chronic otitis media, the bacteria found in the ear are different from the ones in its acute phase; this is a highlight because it must receive other therapy.

What is the relationship between acute otitis media and otitis media with effusion?

Acute otitis media is in a close relationship with otitis media with effusion. When the patient receives specific treatment and resolves its infection (treatment description is further in this article), more than half of the children would remain with effusion as sequelae. This complication could last as short as two weeks to two months and would require close monitoring by the medical doctor.

This condition’s previous name was “serous otitis media” and it is a children’s disease with less than 1% of the cases in adults. Otitis media with effusion is the presence of secretion in the middle ear in the absence of an infection. Effusion is a medical term, it means that liquid is within a body cavity that was dry in the first place, in this case, the middle ear.

Interestingly, otitis media with effusion is also a risk factor for developing acute otitis media. We need to have in mind that the acute disease is transient, while the effusion condition is chronic, taking days or weeks to resolve. During the time that it can affect, the prompting of new acute otitis infections is very likely.

What are the symptoms of acute otitis?

Acute otitis media has the most high-pitched symptoms from all the conditions. The symptoms could impact in three spheres of the body like the ear, intestinal, and general body. This form of the disease, above all, is the most important to early identify because it is the one needing antibiotic treatment, so to know its symptoms is a must.

The ear symptoms of acute otitis media are ear pain and secretion coming out of the ear. Other symptoms are also important as headache, cough, runny nose, and nasal congestion, typical from a cold. The intestinal symptoms include loss of appetite, nausea, vomiting, and diarrhea. The body symptoms are core for identifying this condition, a mild fever (high fever happens mostly in the complications), and apathy.

The usual presentation comprises three scenarios, severe or moderate swelling of the eardrum at the otoscopic exam, new-onset of secretion through the ear, or mild swelling of the tympanic membrane, with ear pain and intense redness of the eardrum.

The symptoms are severe when intolerable ear pain or fever greater than 102,2 F° appears. The presence of secretion coming out from the ear usually means rupture of the eardrum, which is a complication. The secretion tends to be yellow in appearance which tells about the implication of pus in the disease

What are the symptoms for otitis media with effusion?

Otitis media with effusion scarcely display symptoms, for that most of the detections occur on routine screenings. If symptoms appear, a perception by the parents would depend on their alertness, in concern of their child.

The confusing symptoms that can appear are all in relation to a halt in the normal development of the child with hearing loss, speech development delay or no advancement at all, deterioration in school performance, a tendency to fall, or having mouth breathing due to nasal obstruction.

I already told that otitis with effusion could appear after an acute episode of otitis. Therefore, all the patients that after an acute otitis media have any of these symptoms should raise the alarms about effusion in the middle ear. The list includes ear pain or tingling in the ear, or any of those, as mentioned earlier.

Could it have complications?

A lot of complications could exist due to otitis media. But not in all of them with the same frequency, the worst scenario is for the child that accumulates most of the risk factors. Also, by this time, you should know that acute otitis media is more harmful than the others.

The complications have a division into local-within the ear and cranial complications. Let’s begin with local, and the most common from them is the rupture of the tympanic membrane. It occurs in approximately 7 of every 100 patients. This rupture heals in about one or two weeks nearly always. However, if the crack persists, it can become a chronically perforated tympanic membrane.

Other complications are very odd, but if present are severe to the point of threatening life. The spread of the infection to the mastoid bone (see image), known as mastoiditis, is a possibility and very dangerous. Formation of an abscess which is an accumulation of pus due to bacterial infection severely affects the patient. The condition could touch the nerves that allow face movement; therefore, impossibilities such activity with the repercussion that it carries.

The assumption of intracranial complications rises when very-severe symptoms appear, such as alteration of the consciousness, vomiting, eye pain when seeing the light, and persistent headache. These complications, although treatable, are very deadly, comprises meningitis, brain abscess, lateral sinus thrombosis, and otitic hydrocephalus.

How your doctor can diagnose otitis media?

The doctor would first ask all the risk factors and perform a thorough body exam emphasizing in both your ear and whole body. The significant findings in the body exam plus a particular ear exam “pneumatic otoscopy” would tell about the condition of the patient and its eardrum. The alteration of the eardrum with whole-body symptoms is more than enough to either start therapy or watchful waiting. This decision will, of course, depend on the findings.

It is essential to highlight that pneumatic otoscopy is different from otoscopy alone, and only the former is specific enough to achieve an excellent diagnosis. When the absence of acute otitis media is a fact, then, other exams aid the doctor to define how well it is functioning the eardrum, such as tympanometry, acoustic reflectometry, and audiometry.

In children young than twelve weeks, with symptoms of an acute episode, a thorough assessment is a recommendation. Other more complex exams are an indication when any of the complications is an active suspicion. The exams are computed tomography (CT) and magnetic resonance imaging (MRI); each one has its indications depending on the complication.

The best and most accurate exam for having a diagnosis is a tympanocentesis. This procedure is invasive; it comprises the insertion of a needle through the eardrum. Even though it sounds awful, it is a standard procedure that allows the identification of secretions in the middle ear, plus a microbiological examination of that ear sample.

What is the treatment recommendation?

The focus on the article would be on this section because the two primary expressions of this condition are treated differently. Acute otitis media requires antibiotic, while the otitis media with effusion don’t. Otitis media with effusion medical treatment comprises watchful waiting, medical therapy, and as a last resource surgical intervention. However, It is now known that this condition alleviation in half of the cases, is possible after three months without any intervention. But still, many patients require treatment.

The focus of acute otitis media treatment is on the resolution of symptoms and lowering complications, with antibiotic therapy. Firstly, mitigating pain through over the counter pain killers such as paracetamol and ibuprofen have significant results. Antibiotics are the cornerstone of the treatment. The children below two years old are the ones that have had the most successful results in the resolution of symptoms. The standard treatment is with a high-dose of amoxicillin and clavulanate; if allergic, there are plenty of other options available.

Medical therapy for otitis media with effusion has not yielded any remarkable result. Many different types of treatment were tried but with conflicting results. The only treatment that produces some betterment is ten days of antibiotics, as it was an acute episode. However, the surgical treatment showed to improve hearing capacities in these patients.

The surgical procedures range from simple to complex, and both conditions can benefit. It would depend on the particular case of the patient and their risk of complications. The simplest and that can be performed early is tympanocentesis. Then, there are others more severe and with other purposes as myringotomy, adenoidectomy, and tympanostomy tube.

Can I prevent this condition?

Prevention is possible through multiples approaches. First, the elimination of the risk factors mentioned before as tobacco smoke exposure, breastfeeding less than three months. Secondly, the immunization by a vaccine is core for prevention. Most of the three main bacteria causing this infection are preventable by vaccines. Also, please remember that the viruses frequently prompt these conditions, so prevent them is also beneficial. The pneumococcal vaccine, and influenza vaccine, are given since the two and six months of life, respectively.

When repeated otitis media infection affects the child, more accurately, that had four or more episodes within a year. A low dose of antibiotics for the long term has shown relative success in preventing further episodes. So it would great to take it into account in the therapy options.

What I can do If I think I or my children have acute otitis media?

Please, make use of this acute otitis media symptoms checker, which will aid you in determining how likely it is that your symptoms indeed are an acute otitis media. It is free and would not take more than a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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