Otitis media

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Otitis media is inflammation of the middle ear. There is build-up of fluid in the middle ear, which is the space between the inner ear and the eardrum.

85% of otitis media cases is caused by bacteria such as Streptococcus pneumoniae (pneumococcus), nontypable Hemophilus influenzae, and Moraxella catarrhalis. Fifteen percent of the cases is caused by viruses.

Otitis media is most common in children because the Eustachian tube, the canal that connects the middle ear to the nose and throat, is shorter and more horizontal in position. Microorganisms can easily enter the middle ear which may result to an infection.

Contents

Main types and symptoms

  • Acute otitis media (AOM) is a short-term ear infection. Fluid accumulates in the middle ear and the eardrum may be swollen. There is earache, or pain in the ear. Fever may be present.
  • Otitis media with effusion (OME), also known as glue ear, is the accumulation of fluid in the middle ear after an episode of acute otitis media. Patient may exhibit no signs and symptoms.
  • Chronic otitis media with effusion (COME) is a persistent middle ear infection that lasts for at least a month, or keeps returning. It is more difficult to diagnose than acute otitis media as there are usually no obvious symptoms. The most common symptom is ear pressure, or a feeling “fullness” in the ear. It may cause damage to the middle ear and the eardrum and may lead to hearing loss.

Causes

  • Upper respiratory viral infection, such as colds and flu. It can cause the cells lining the Eustachian tube to swell, secreting thick mucus that may lead to clogging.
  • Allergies from food and/or airborne allergens produce the same effect as colds and flu.
  • Blockage of the Eustachian tube which may be a result of swollen tonsils, or problems with the bones of the cranium, the temporomandibular joint which is located at the jaw, or the cervical spine.
  • Deficiencies in Vitamin A, zinc, and iron may make children susceptible to ear infections.
  • Bottle-feeding has been linked with otitis media. When an infant sucks on the bottle, a vacuum, or a negative pressure, is formed which may affect the ear’s inner auditory tube and then the middle ear.

Diagnosis

The doctor examines the eardrum with an auriscope or otoscope, which is a medical instrument that has a light and a magnifying glass.

A doctor may conduct a tympanometry, where a tympanometer probe is inserted into the ear canal which measures the eardrums’ responses to changes in pressure. It will also reveal if there is fluid in the middle ear, a perforated eardrum, impacted ear wax, scarring of the eardrum, lack of contact between the bones of the middle ear, or a tumor.

A hearing test may also be recommended by the doctor.

Treatment

In the case of otitis media with effusion, doctors recommend a wait-and-see approach before administering medication. The fluid usually clears on its own after an adjustment in environmental factors, such as breastfeeding, and avoiding secondary smoke and other allergens

  • AntibioticsAmoxicillin is the most prescribed antibiotic to children and it is usually taken for seven to ten days. However, the use of antibiotics in treating otitis media has become a controversial issue among medical practitioners, as it may lead to high antimicrobial resistance.
  • Over-the-counter medicationParacatemol or Ibuprofen may be prescribed to control the symptoms of otitis media.
  • Myringotomy – An otolaryngologist, who is an ear, nose and throat specialist, insert tympanostomy tubes or grommets through the eardrum to drain the fluid. This surgical procedure is usually administered to children with recurring bouts of otitis media.
  • Adenoidectomy - The doctor may recommend the surgical removal of adenoids as a last resort. However, this procedure will only apply to patients aged four years or older, if otitis media is serious and has lasted for over three months, and the adenoids are inflamed.

Possible complications

If untreated, otitis media may lead to permanent hearing loss. Other possible complications include perforated eardrum, chronic and recurrent ear infections, enlarged adenoids, or [[[mastoiditis]], which is an inflammation of the bone of the skull behind the ear. Meningitis, which is an infection of the brain, and cholesteatoma, which is the formation of cyst in the middle ear, are uncommon but may occur and are life-threatening.

Prevention

A child’s risk of contracting otitis media may be reduced by observing the following:

  • Breastfeed the baby for at least four months. Breastfeeding immunizes the child from acute otitis media and the breastfeeding position allows for better Eustachian tube function. If the baby has to be bottle-fed, hold the baby in an upright, seated position. Do not allow the child to lie down with the bottle.
  • Keep the child away from secondhand smoke.
  • Ensure that the child receives vaccination. Pneumococcal vaccines reduces the risk of otitis media occurrence in children.

Philippine scenario

  • The cost of treating one otitis media episode in the Philippines is estimated at US$ 4.
  • Gretchen Navarro-Locsin of St. Luke’s Medical Center’s Department of Otolaryntology lobbies the need for vaccination to avoid the spread of otitis media in Asia in a symposium organized by Glaxo-Smithkline Philippines.

References