What are The Symptoms of Otitis Media?
Most people with otitis media (OM) have ear pain, but some do not. Other symptoms may include fever; tugging or pulling at the ears; difficulty sleeping; clumsiness due to poor balance (ataxia); irritability; hearing loss (which may be temporary or permanent); fluid draining from the ear; and decreased appetite. Symptoms of OM can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
How does my child get otitis media?
Both bacteria and viruses can cause OM in children younger than 2 years old, although it is more often caused by a bacterial infection in this age group. By age 3, OM is slightly more common in boys, probably because they are more likely to have tubes put into their ears. Infection is most common in the winter and spring months
Otitis media is caused by inflammation of the middle ear behind the eardrum due to fluid trapped in there.
This can be because of a build-up of mucus from nearby inflamed sinuses or because of repeated infections (such as colds). Bacteria or viruses can infect this blocked area, which causes infection and inflammation.
The trapped fluid may then become infected and lead to even more swelling and irritation of surrounding tissues, increasing pain and discomfort. This vicious cycle continues until the cause of the blockage (for example, an ear infection) goes away or becomes less serious.
What causes otitis media?
The most common cause of OM is a bacterial infection. It may also be caused by a viral infection (especially in young children) but this type of OM usually resolves on its own without treatment within 7–10 days. Other causes include trauma, barotrauma (such as from airplane travel), and foreign objects in the ear canal.
Rarely is chronic suppurative OM (those occurring for more than 3 months per year) due to cholesteatoma or tympanosclerosis. Both are conditions that occur with middle ear inflammation and require further evaluation and surgical repair if needed.
Otitis media may also develop secondarily with allergic rhinitides, such as with nasal polyps. Allergic rhinitis from food allergies is another known cause.
What is the difference between a middle ear infection and otitis media?
Ear infections are acute inflammation of the middle ear caused by either viruses or bacteria. Otitis media, on the other hand, has similar symptoms but with no infectious component. It can be associated with chronic fluid in the middle ear that does not go away after an ear infection.
If there is no inflammatory component, then it is considered to be otitis media without effusion (OME). This type of OM usually resolves within 2 months if proper measures are taken for treatment. OME may lead to further complications such as hearing loss if left untreated.
How is otitis media diagnosed?
OM is usually diagnosed by a thorough history and physical examination. A doctor will look for signs of middle ear infection, including redness of the eardrum, bulging of the eardrum, fluid or pus in the middle ear, and sometimes decreased movement of the tympanic membrane that vibrates when sound waves pass through it (called pneumatic otoscopy).
Other tests may be helpful to determine if there has been damage to the bones in the hearing pathway inside the skull (ossicles) and whether there is any evidence of nerve damage as well as obstacles such as allergy, foreign body, or tumor.
Treatment of otitis media in adults:
1. painkillers and antihistamines for the first few days to reduce pain and swelling.
2. decongestants- topically or orally; glucocorticoids (eg budesonide) -topically, intranasally or orally; antibiotics (eg amoxycillin+clavulanic acid)+/− nasal steroids (e.g., fluticasone propionate); antipyretics; mucolytics; analgesics; eardrops containing vasoconstrictors such as epinephrine .neomycin and hydrocortisone).
3. alternative: oral analgesia with paracetamol and nonsteroidal antiinflammatory, systemic corticosteroids, aminoglycosides, cephalosporins, or macrolides.
4. watchful waiting with symptomatic treatment of pain and fever for 7–10 days if the symptoms are mild to moderate.
5. surgery- only in cases where there is ossicular chain obstruction or tympanomastoidectomy is required for ventilation tubes.
Treatment of otitis media in children:
1. painkillers and antihistamines to reduce pain and swelling.
2. decongestants-topically or oral; glucocorticoids (eg budesonide) -topically, intranasally, or orally; antibiotics (penicillinase-resistant penicillins, cephalosporins, amphotericin B).
3. watchful waiting with symptomatic treatment of pain and fever for 7–10 days if the symptoms are mild to moderate.
4. alternative: oral analgesia with paracetamol and nonsteroidal antiinflammatory, systemic corticosteroids, aminoglycosides, cephalosporins, or macrolides.
5. tympanocentesis to aspirate fluid from the middle ear for bacterial or viral culture, if treatment is not instituted within 48 hours of the onset of symptoms or there are recurrences (usually after 5–7 days) refractory to initial therapy.
6. surgery- only in cases where there is ossicular chain obstruction or tympanomastoidectomy is required for ventilation tubes.
otitis media symptoms in adults:
1. earache, feeling of fullness in the affected ear with reduced hearing and mild
fever may be present.
2. in severe cases, a vesicular rash on the auricle or in the mouth may indicate herpes
simplex virus infection.
3. otorrhoea- if not purulent it is usually serous or mucoid but in some cases, there is a purulent discharge from the external auditory meatus (this may be more objectionable than the pain).
otitis media symptoms in children:
1. fever (with or without otalgia) and irritability are common.
2. vomiting and diarrhea may occur;
3. otalgia;
4. mastoid tenderness;
5. conductive hearing loss;
6. bulging of the TM, especially if severe otitis media with effusion is present or there has been been been a perforation of the TM.
treatment should be based on antibiotics and painkillers according to symptoms.
otitis media complications in adults:
1. tympanic membrane perforation may cause otorrhoea and vestibular dysfunction.
2. secondary infection may spread into the mastoid or the brain via a septic thromboembolic complication (very rare).
3. diabetes insipidus
4. labyrinthine fistula-other intracranial complications are very rare (elevated
pressure, meningitis; cerebral abscess).
otitis media complications in children:
1. it may spread into the mastoid or the brain via a septic thromboembolic complication (very rare).
2. labyrinthine fistula-other intracranial complications are very rare (elevated pressure, meningitis; cerebral abscess).
Ear infection spread to brain symptoms:
1. headache;
2. vomiting, nausea, and fever are not uncommon.
3. intense ipsilateral ear pain can occur with or without discharge from the ear canal or otorrhoea.
4. acute labyrinthitis may produce mild vertigo 4–6 days after onset of symptoms, leading to balance disorder which may last for several weeks to months in some cases- this is more common in older people who have chronic inflammation of the tympanic membrane or otitis media with effusion.
5. deafness, facial paralysis (rare).
otitis media complications:-
1. mastoiditis
2. meningitis
3. brain abscess
4. cerebral arteriovenous fistula
5. labyrinthitis
6. facial paralysis
7. deafness
8. diabetes insipidus
9. indirect ossicular damage leading to conductive hearing loss
10. tympanosclerosis (calcific degeneration of the TM)
11. facial nerve injury (rare).
treatment should be based on antibiotics and painkillers according to symptoms.
Otitis media self-care:
earplugs in noisy areas, use of cotton wool in the ear canal to prevent the entry of foreign bodies, wearing glasses instead of contact lenses, avoidance of swimming when the child has acute otitis media with effusion or a perforated TM, provision of proper ventilation for home heating system, warm clothing and avoiding exposure to passive smoking.
erythromycin or cefuroxime axetil for 10–14 days is the first choice of treatment for acute otitis media with effusion and for children with mild to moderate
Otitis media with effusion:
amoxicillin, 25 mg/kg/day, in 2 divided doses (maximum 1 g daily) is the treatment of choice.
observation without antibiotic therapy may be appropriate if there is no improvement after 48 hours of initial clindamycin therapy.
cleft palate.
chronic suppurative otitis media
tympanosclerosis
serous otitis media
cholesteatoma ear infection spread to brain treatment:
1. if intracranial complications are suspected, an urgent CT scan of the brain is necessary to evaluate the disease and the patient should be hospitalized for appropriate antibiotic therapy.
2. tympanosclerosis- usually not requiring surgical management.
Otitis media complications:
1. chronic suppurative otitis media
2. cholesteatoma
3. mastoiditis
4. meningitis
5. brain abscess
6. cerebral arteriovenous fistula
7. labyrinthitis
8. facial paralysis
9 deafness
10 diabetes insipidus
11 indirect ossicular damage leading to conductive hearing loss
12 tympanosclerosis
13 facial nerve injury
14 cleft palate
15 ear deformity
16 otorrhoeas
17 tinnitus
18 vertigo
19 hearing loss.
otitis media symptoms:
1. ear pain
2. fever
3. drowsiness
4. irritability
5. nausea
6. vomiting
7. fluid draining from the ear
8. reduced movement of the jaw (in children)
9. fullness in the ear
10. purulent discharge
11. decreased hearing
12. excessive cryings
13. headaches
14. neck stiffness
15. disorientation
16. seizures
17. photophobia
18. cranial nerve deficits
19. hemipareses
20. visual changes
21. ataxia
22. ptoses
23. meningismus
24. papilledemas
25. comae
26. death
lateral semicircular canal dehiscence syndrome is a rare benign congenital anomaly by thinning or absence of the bony lateral semicircular canal near the petrotympanic fissure.
Treatment:
1. observation
2. surgical repair.
surgical repair of the dehiscent lateral semicircular canal is being performed by many surgeons but evidence-based data are lacking regarding indication, timing, conditions necessary for implantation of a shunt or cochlear implant, and complications.
Further studies are necessary to evaluate the efficacy of this procedure in comparison with hearing aid amplification adapted to emphasize low frequencies along with speech therapy for these patients with severe SSCD who have advanced age without contraindications for cochlear implantation.
self-care:
1. earplugs in noisy areas;
2 use of cotton wool in the ear canal to prevent the entry of foreign bodies;
3 wearing glasses instead of contact lenses;
4 avoiding swimming when the child has acute otitis media with effusion or perforated TM;
5 provisions of proper ventilation for home heating system, warm clothing, and avoiding exposure to passive smoking.
6. observation without antibiotic therapy may be appropriate if there is no improvement after 48 hours of initial clindamycin therapy.
7. antibiotics are recommended for infants 6 months to 2 years old with recurrent AOM because this group has the highest risk for developing chronic otitis media.