Otitis Media

Otitis Media – General Information

Otitis Media is an inflammation of the middle ear, in the space between the inner ear and the ear drum. It is one of two human earaches, in an ear inflammation category, the other one being Otitis Externa. A fact is that these diseases can provoke an ear cancer, pain or infections of any structure that are passed by a nerve that supply the ear, and these symptoms are diagnosed by a otolaryngologist, who makes a complete examination of the ear, nose and throat.

The main symptom of the disease is the inflammation of the skin of the ear canal and can be provoked by a microbial infection, when eczema appears, and can be also caused by a fungal infection. In both cases, but more often with infection, the ear canal skin swells and becomes painful and tender to touch.
Otitis Media is a childhood disorder, which is accompanied in most of the cases by an upper respiratory infection. The nose viruses, called rhinoviruses, that cause the cold, infect the Eustachian tube, the tube that goes to the middle ear, and cause swelling and disturbs the pressure equalization, the normal function of the tube. The more severe damage to this tube, the more severe malfunctions are to the middle ear and its structures. If a child is born with a poor Eustachian tube function, there are many possibilities that he will develop more frequent episodes of Otitis Media. In this group of people, the progression to a chronic stage of the disorder is common, who often have a family history of middle ear disorder.

Otitis Media – Symptoms

The main symptoms of Otitis Media include pain and pressure in the ear, and are directly related to the severity of the otitis. The pain can be greater when the patient is lying down, when creates more pressure within the ear. The acute stage of Otitis Media is usually accompanied by severe pain. The chronic stage of the ear infection is in most of the cases less painful, but can cause a persistent hole in the eardrum. When the patient swallows there’s a cracking or popping sound produced by the fluid accumulated in the ear. Otitis Media symptoms also include fever, headache, vomiting, dizziness, nausea, and temporary loss of hearing.

The ear drum can burst, because of the pressure applied on it, and making it to release a blood tinged or a yellow-green fluid out of the ear. After repeated ear infections, some parts of the middle ear can damage and this lead to hearing loss. If the infection is not treated at its time, the bacteria from the ear infection can spread, and if it spread to the mastoid bone, which is located behind the ear, it provokes mastoiditis, an infection of the mastoid bone. Another symptom, that is considered the main sign of infection, is when the ear gets swollen and itchy. This symptom is often followed by ear drainage, and at this stage the pain is already present, especially when the external ear is moved. It is recommended to the patient to seek medical attention as soon as possible, when he noticed the first symptoms of the disorder.

Otitis Media – Treatment

The treatment of Otitis Media is considered to be controversial, because of the difficulty to distinguish the viral infection from a bacterial infection, but also that the viral infection can easily progress to a bacterial infection. Most of the times pediatricians use a monocular otoscope or a tympanometer like diagnostic tools, but even with these tools it is hard to distinguish the type of the infection, because the ear canal is small with all the wax in the ear that obscures the view to the ear drum. The prescribing of antibiotics as the treatment of the disorder has been recently condemned by many doctors, because they have a tradition of inappropriate treat for viral otitis, that’s why ear specialists consider antibiotics only for bacterial infection more effective, and make extra efforts to distinguish viral and bacterial infection.

The treatment of Otitis Media usually starts with the diagnosis, and then a treatment plan is made, depending of the patient’s age, the risk factors for having resistant bacteria, also the status of their immunity system, even the hearing status. For children it is preferred the treatment that consists antibiotics, taken for 24 hours, with the rechecking the disease status. Some children have improvement of their pain, using the treatment with analgesic drops, not needing any antibiotics. If the ear infection is chronic, the hearing loss is installed, or the child’s infection fails to respond to the antibiotics, the doctor may perform surgery, and the most common type of surgery is called myringotomy. This kind of surgery provides relief to the patients, including children and some adults who suffer with Otitis Media, and who have a persistent fluid in the middle ear, which can lead to hearing loss. This surgery is a short procedure, where the otolaryngologist makes a small incision on the ear drum, and then places a small ventilation tube, which is called tympanostomy tube. This tube drains the fluid from the middle ear and keeps it from recovering, and usually depends on the severity of the ear infection. There can be made more than one myringotomies if is necessary, because the tube falls on its own in 3 to 18 months.

As a safe measure action, the doctor can suggest the removing of the adenoids, by performing an operation called adenoidectomy, and it is usually made in children older than 4 years, depending if the otitis lasted more than three months and the adenoids are repeatedly inflamed. As a last resort measure, to treat Otitis Media, the doctor will perform an operation called tonsillectomy, when he removes the tonsils. This procedure is also performed on children older than 4 years, in case of severe otitis that lasted more than three months and the tonsils were repeatedly inflamed. But if there is any damage on the ear drum, the doctor makes a tympanoplasty, which is a plastic operative procedure, in which repairs the drum, or a myringoplasty, which is a surgical procedure, in which the doctor inserts a tissue graft in the damaged ear drum. If hearing loss appears, then the doctor may perform a stapedectomy, which consists in the replacement of the stapes, or stirrup, with prosthesis.