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Otitis Media

Overview

Otitis Media refers to inflammation of the middle ear. It can occur due to infectious or non-infectious causes. Middle air space is linked to your nasopharynx region, and any infection or distress in the upper respiratory tract can also spread up to the middle ear. It typically affects children, although adults may also suffer from this condition. It results in pain and fullness in the affected ear. The majority of the cases of otitis media are treatable with medications. A few cases may lead to severe complications, including hearing loss if the disease is left unaddressed.

Causes

Viral or bacterial infections that occur first in the nasopharynx and then progress towards the middle ear are the common cause of otitis media. Viral infections are caused by adenovirus, influenza virus, respiratory syncytial virus, cytomegalovirus, etc. Bacterial infections are caused by group-A streptococci, streptococcus pneumoniae, Haemophilus influenzae, staphylococcus aureus, Moraxella catarrhalis, etc. Non-infectious causes associated with otitis media include certain allergies, external foreign body or irritants, trauma or injury of the ear, rupture of the tympanic membrane, and extreme air pressure changes.

Types

Otitis media is divided into three types based on its cause and duration. These three types are acute otitis media, otitis media with effusion, and chronic otitis media.
Acute otitis media is the frequently occurring type, and it occurs after a preceding infection of the nasopharynx. The condition can be viral or bacterial. It presents with sudden onset and usually resolves in a short amount of time.

Otitis media with effusion is usually associated with non-infectious causes. Acute otitis media may precede it. There is a buildup of fluid within the middle ear cavity which results in the fullness of the ear. It resolves with or without medication in a short period.

Chronic suppurative otitis media refers to a long-standing middle ear infection accompanied by pus discharge. The tympanic membrane may get ruptured in this condition due to a persistent infection. This condition may take certain weeks or months to resolve completely.

Risk Factors And Epidemiology

Age is a major risk factor in the case of otitis media. Middle ear inflammation is more prevalent among children below five years of age than adults. All risk factors associated with infections of the upper respiratory tract are similar for otitis media as well. Active or passive smoking or air pollution can irritate the external ear, leading to middle ear inflammation. Individuals with a compromised immune system due to systemic diseases, genetic diseases, treatments, or medications are also at high risk. Other risk factors include cold weather, nutritional deficiency, lack of breastfeeding, seasonal allergies, etc.

Almost 51% of otitis media cases have been seen to develop in children below five years of age. Males below 20 months of age have a higher chance of developing otitis media than females. Research also shows that African, Caucasian, or Greenlandic individuals are at a higher risk.

Signs And Symptoms

Signs and symptoms of otitis media depend on the causative agent. If a preceding infection of the nasopharynx is present, the patient may have a history of coughing, runny nose, fever, or nasopharynx irritation. Once it leads to pressure buildup in the tube that connects it with the middle ear, it causes pain and fullness in the ear. Pus discharge is a presenting symptom of chronic suppurative otitis media. In some cases, you may also experience irritability, tenderness of the external ear, and partial hearing loss.

Diagnosis

The first step towards diagnosing otitis media is general history and clinical examination. If you had a viral or bacterial infection of the upper respiratory tract, in that case, it is more likely that the cause of otitis media is similar to that infection. An otoscope primarily does clinical examination to visualize the middle ear and tympanic membrane. Tympanometry is a test done to reveal partial hearing loss in some patients with otitis media. A CT scan or MRI may be performed to visualize the underlying structures for any abnormalities linked with this disease in patients with a risk of complications associated with otitis media.

Differential Diagnosis

Other conditions that may present with similar symptoms as otitis media include otitis externa (inflammation of the outer ear), sinusitis, myringitis, and Meniere’s disease.

Treatment

Viral causes of otitis media do not require any particular treatment and usually resolve by themselves within one or two weeks. Symptomatic care may be needed in case of fever or severe pain. Bacterial infections require the intake of oral antibiotics to relieve the symptoms. Chronic or recurrent patients of otitis media may require the placement of ear tubes. The function of these tubes is to ease the pressure in the middle ear and provide a way for fluid to drain outside. The surgical procedure for this purpose is known as myringotomy with placement of the tube. The tube is kept within the affected ear for six to twelve months.

Medication

Bacterial infections causing otitis media need antibiotic therapy for a full recovery. Antibiotics such as amoxicillin, ceftriaxone, etc., are prescribed in dosages decided by your doctor depending on your age, severity, and duration of infection. Other medicines include antipyretics or analgesics such as ibuprofen, acetaminophen, etc., for symptomatic care.

Prognosis

All types of otitis media have a good prognosis with medications and symptomatic care. Only untreated chronic suppurative otitis may lead to certain brain complications. This may affect the hearing sense along with the development of other neurological symptoms.

Prevention

Primary prevention methods for otitis media are similar to those used to prevent upper respiratory tract infections. These include avoiding close contact with infected individuals, wearing a face mask in crowded areas, washing hands frequently, and using alcohol-based sanitizers. If vaccination is available for possible otitis media pathogens, it is beneficial to get vaccinated in advance. Places with too much smoke or air pollutants should be avoided. Prophylactic antibiotics may only be prescribed in a few cases at high risk.