Otitis Media

Infection/Inflammation of the middle ear

Overview

Otitis media is usually caused by bacteria entering the middle ear through the eustachian (auditory) tube. The eustachian tube equalizes pressure on the eardrum and allows drainage of the middle ear into the throat. The auditory tube can swell and not function properly due to food allergies, especially an allergy to dairy products. Allergies are the most common cause of recurrent ear infections in children. Abnormal function of the tube is the most important cause of ear disease.

Otitis media is characterised by a feeling of fullness in the ear and stabbing pains which may disturb sleep. Pressure can even cause the eardrum to rupture.

Introduction

Otitis media is one of the most frequent causes for a consultation for Otolaryngologists. This disease is more common in young children due to the more horizontal position of the Eustachian tube (the tube that connects the middle ear to the nose), compared to in an adult.

The function of the Eustachian tube is to drain the fluid produced in the middle ear to the nasopharynx. If for any reason, it is blocked, the liquid will tend to accumulate and may cause an infection.

The frequent occurrence of ear infections among children is due to the short and narrow size of their undeveloped Eustachian tubes, which run from the middle ear to the back of the throat.

Despite its commonality among children, it can be a painful experience with serious consequences if left untreated.

Causes

There are several reasons why the Eustachian tube can clog, such as allergies, infections of the upper airway, including sinus infections (sinusitis), excess mucous and saliva produced during teething, adenoititis (growth of the adenoids), exposure to tobacco smoke and other irritants, gastro-esophagal reflux disease and even feeding in a bad position (lying face up) while feeding from a bottle.

There are certain risk factors increasing the likelihood of a child suffering from acute otitis media such as attending day care, changes in altitude, cold climate, exposure to smoke, not being breastfed, and frequent upper airwy infections.

Recurring or Chronic Otitis Media

If your child has several long-lasting middle ear infections, there's a strong likelyhood they have chronic Otitis Media; often caused by allergies. Cases of this severity occur when an infection behind the eardrum or fluid build-up in the Eustachian tube fails to subside. Chronic Otitis Media left untreated could result in hearing loss, formation of a hole in the eardrum or tissue damage and bone hardening in the middle ear.

Symptoms

In a young child, the most common manifestations are inconsolable crying, fever (greater than orr equal to 38 C) or have trouble with sleeping. In older children or adults otalgia (earr pain) may occur, sensation of a clogged ear, malaise, hypoacusia (diminished hearing) of the affected ear.

We can also find a variant to otitis media which is otitis media with effusion, which is the sudden discharge of a yellowish or greenish liquid, thick, sometimes with blood, accompanied by an improvement in ear pain that can signify the rupture of the tympanic membrane.

Diagnosis

The diagnosis is made when the doctor examines the ear with a otoscope or an ear endoscope. What is seen in these cases is known as "doming" of tho tympanic membrane which includes fluid or bubbles behind the tympanic membrane, blood or puss and in some cases, a tympanic membrane perforation may be seen.

Treatment

In Otitis Media, one of the most important things in treatment is to relieve the pain. Depending on the cause of Otitis Media, antibiotics and pain killers (paracetamol, ibuprofen, etc) may be given and antihistamines and analgesics if caused by and allergy.

In general, all children under 6 months, with fever or symptoms as described above (and especially if there is no improvement thereof), shhuld be seen by their physician to determine the best treatment for them.

The trend now is to try to determine if the cause of an ear infection is due to a virus, an allergy or a bacterial infection since antibiotics have no effect on virus infections. For this reason, you should not prescribe antibiotics for every ear infection.

If a treatment does not seem te be taking effect within the first 48 to 72 hours of starting the medication, consult your doctor again as he/she may have to change treatment or add other medications.

When to consider surgical treatment

If an infection does not go away with the usual medical treatment, or if a child presents with repeated infections over a short period of time, thoughts should be considered for inserting ventilation tubes.

This procedure consists of introducing into the tympanic membrane, a very minute tube, which allows entry of air into the middle ear so the liquid which accumulates in it can drain through the eustachian tube easily.

These ventilation tubes usually fall out by themselves. If this does not happen within 6 months after placement, they should be removed by the physician.

If the cause of otitis media is adenoid hyperplasia (growth of the adenoids) then, an adenoidectomy (surgical removal of the adenoids) should be considered.

Usually ear infections are a minor medical problem, which improves without any complications, however, it should be noted that during infection, that children may have a minor and temporary hearing loss. This is due to the presence of fluid in the middle ear.

Complications if not treated properly

Sometimes otitis media can worsen and may evolve into serious infections such as mastoiditis (infection of bone found behind the ear) or meningitis (inflammation of the coverings of the brain).

Other complications include a perforated tympanic membrane, chronic and recurrent ear infections, adenoid hyperplasia and of the tonsils, otitis media with effusion, formation of a cholesteatoma (secondary to a chronic infection), delayedd language development (as they do not understand the words properly when there is fluid in their ears).

Conclusion

The major problem connected with otitis media with effusion is hearing loss. When hearing loss occurs in a very young child the result can be a delay in speech and language development. If a child which is taking antibiotics has fluid in both ears for three months, it is recommended that ventilation tubes are inserted. This should also be done for a child which has fluid in one ear for six months. Not only are ear infections common in children but they are also the most common cause of hearing loss, therefore they need prompt treatment and a test for allergies.

As always, the most important thing is prevention. If you think your child may be having this disease, avoid dairy products, look for a consultation with your doctor and check for allergies.