Otitis media

What is Otitis media?

Otitis media is an inflammation of the lining of the middle ear canal (mucosa), eardrum (tympanic membrane), and the associated structures such as the small bones of the ear (ossicles) and the tube that connects it to the throat (eustachian tube). It can arise from infection or physical causes.

The disease generally accompanies upper respiratory tract infections. It frequently is a complication of viral infections such as the common cold, measles, or influenza. Different forms (serous, purulent, secretory) of acute otitis media have been characterized, based on the severity of the infection and the involvement of different parts of the ear.

Otitis media of less than three weeks duration (acute) is one of the most common infections of childhood, but it is also seen in adults. Otitis media that persists for longer than three months (chronic) can also occur in different forms. It is often the result of an untreated ear infection. This disease is considered more dangerous because its slow, chronic effects can result in permanent damage. Chronic otitis media may not cause enough discomfort to warrant immediate action and may not be noticed until it is well established.

How is it diagnosed?

Signs and symptoms: In acute otitis media, the individual usually complains of severe earache, feeling of fullness in the ear, fever, chills, nausea, diarrhea and hearing loss. The individual may describe a discharge of blood and thick pus from the ear. In chronic otitis media, the individual often reports a history of previous ear infections. Symptoms of earache, seeping of pus from the ear and hearing loss are sometimes described.

Physical exam: Physical findings will vary depending on the type of infection present. An ear exam (pneumatic otoscopy) will characteristically show a thickened, inflamed and possibly scarred eardrum with decreased or absent mobility. If the eardrum has ruptured, the examination will show discharge in the external ear canal.

Tests: Tympanometry can be used to measure the mobility of the tympanic membrane. Audiometric studies may be performed to test the hearing. Laboratory testing of draining material is often done to determine if there is a bacterial infection so that appropriate antibiotic therapy can be prescribed. If chronic disease is suspected, CT scan of the head may be necessary.

How is Otitis media treated?

Treatment options for otitis media include antibiotics, decongestants, antihistamines, corticosteroids, immunizations, and allergy hyposensitization. Standard medical therapy for acute otitis media includes antibiotics given for ten to fourteen days. Treatment of chronic otitis media may require an incision into the tympanic membrane to allow drainage of middle ear secretions (myringotomy), followed by insertion of a pressure-equalizing tube through the incision. Long-term antibiotic therapy is usually prescribed.

Medications

• Use ear drops to relieve pain. You may use non-prescription drops or those prescribed for a previous infection. They will not cure the infection.
• Use non-prescription drugs, such as acetaminophen, to reduce pain and fever.
• Antibiotics may be prescribed, if the infection appears to be bacterial rather than viral. Finish the medication. The infection may remain active for several days after symptoms disappear.

Information	Brand	Generic	Label	Rating
	Zithromax	Azithromycin
	Bactrim	Co-trimoxazole
	Amoxil	Amoxicillin
	Augmentin	Amoxicillin/Clavulanate
	Principen	Ampicillin
	Levaquin	Levofloxacin

Keflex (Cephalexin), Cleocin (Clindamycin)

Activity

Rest in bed or reduce activity until fever and pain subside.

What might complicate it?

Mastoiditis, facial paralysis, central nervous system infection (meningitis), permanent hearing loss or deafness, tympanosclerosis, labyrinthitis, cholesteatoma, perforation, and fibrosis of the middle ear space are possible complications.

Predicted outcome

Most individuals with acute otitis media improve after 48 hours on antibiotic therapy. If surgery is necessary in chronic cases, recovery may take several days.

Alternatives

Otitis externa and nasopharyngeal carcinoma are possible diagnoses.

Appropriate specialists

Otolaryngologist.

Last updated 17 December 2011