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Otitis Media

What is Otitis Media?


An infection of the middle ear is called as Otitis Media. The middle ear is the air-filled, membrane-lined space behind the eardrum (medically known as the tympanic membrane).

Multiple factors like infections, allergies, and environmental factors can cause Otitis Media. This infection can lead to:

• Inflammation

• Redness

• Swelling

• Fluid build-up behind the eardrum

It is a global problem that is more common in children than in adults – about 80% of all children get affected by it atleast once in their lifetime. While anyone can get infected, men are more likely to develop Otitis Media than women.

What are the symptoms of Otitis Media?

Symptoms of acute otitis media develop rapidly, and these include:

• Fever and a high body temperature

• Earache – because of the fluid build-up.

• Fatigue

• Hearing loss

• Ear drainage – if the eardrum perforates, the fluid may flow out. At this point, the earache decreases

Note: if the fluid fills up the middle ear, hearing loss may become severe- otitis media with effusion.

Signs and symptoms of otitis media in children include:

• Unsteadiness or loss of balance

• Cough

• Excess nasal discharge

• If the child is rubbing and tugging the ear

• Diarrhea

• Restlessness

• Lack of appetite

• Difficulty in hearing the quiet sounds

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What is the main cause of Otitis Media?

Typically you are more prone to otitis media or middle infection if you have infections like cold. These infections can lead to the formation of mucus in the middle ear thereby leading to swelling and blockage in the Eustachian tube

Note: the Eustachian tube is present between the middle ear and the back of the nose

The eustachian tube can also get blocked if there is the enlargement of adenoid – soft tissue at the back of the throat. Children have a higher risk of Middle ear infections because their:

• Eustachian tubes are smaller

• Adenoids are bigger

Note: If it is found that the adenoids are consistently causing middle ear infection, then your health care provider may recommend removing it.

When should you see a doctor in case of Otitis Media?

If you notice the symptoms of otitis media and they don’t resolve even after 2 to 3 days, you should see a doctor. Some signs and symptoms that show that infection is not going away include:

• Severe persistent pain

• Ear discharge of pus

If you suffer from the following diseases, you should consult your doctor about the possible risk f Otitis Media:

• Cystic fibrosis – an inherent disease of the lungs and the digestive system

• Congenital heart disease – a congenital disability in which there are problems associated with the heart’s structure

How is Otitis Media diagnosed?

• Physical examination and the use of an otoscope– instrument used for the visual examination of the ear canal and the eardrum. Fluid build-up can be suspected if the following is observed in the eardrum:

o Bulging

o Cloudy appearance

o Unusual color – typically red or yellow

• Laboratory studies– Recommended diagnosing underlying factors like systemic or inherent diseases that may be causing otitis media. These are rarely recommended

• Imaging studies– recommended in the case your doctor suspects complications in the skull and temple. These studies include:

o Computed tomography– for identifying underlying causes like brain abscess, mastoiditis, meningitis, the formation of a blood clot in the brain’s venous sinuses,etc

o Magnetic resonance imaging– for diagnosing fluid collections

• Tympanocentesis followed by culture: To identify if middle ear fluid is present or not and does it contain pathogens

Note: Besides the tests mentioned above, your doctor may recommend other tests to diagnose a possible case of middle ear effusion:

• Tympanometry- to test the mobility of eardrum, and

• Acoustic reflectometry- to test the reflected sound from the eardrum using an acoustic otoscope.

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What is the best doctor to see for otitis media?

In case you are noticing the symptoms of Otitis media,one or more of the following doctors and specialists will be involved in your treatment:

• Primary care physicians

• Otolaryngologist

• Pediatrician

• Audiologist

• Speech therapist

What is the best treatment for Otitis Media?

Typically most of the cases of Otitis media should resolve by themselves within 3 to 5 days without any medication or treatment.
The treatments for managing acute Otitis Media include:

• For pain control: Non-steroidal anti-inflammatory drugs (NSAIDs) like acetaminophen

• Watchful waiting– during this time, your healthcare provider may recommend paracetamol or ibuprofen for pain management.

Antibiotics are not recommended on a routine basis because its usage in early cases of middle ear infections is highly controversial.

However, after despite waiting for sometime if the complications don’t resolve, your doctor may recommend the following:

For the treatment of bacterial infection:

• Oral antibiotics

• High-dose amoxicillin

• Second-generation cephalosporin

For managing perforated eardrums:

• Ototopical antibiotics like ofloxacin

Note: If despite a high dose of amoxicillin, the symptoms do not show any signs of improvement then your doctor may recommend high-dose amoxicillin-clavulanate

Alert: Some of the common side-effects of amoxicillin are:

• Rashes

• Diarrhea

• Sickness

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Who is most at risk of Middle ear infection or Otitis Media?

Certain situations can considerably increase the risk of developing Otitis Media or Middle ear infection:

• Passive smoking exposure

• Lack of breastfeeding

• Allergies

• Viral pathogens like influenza or rhinovirus

• Cleft palate

• Down’s syndrome

• Genetic predisposition

• Deficiency of vitamin A

• Ciliary dysfunction – chronic respiratory tract infections

• Cochlear implant- a surgical device implanted to improve hearing

What are the common complications of Otitis Media:

Two types of complications could result from an overlooked case of Otitis Media:

Intratemporal complications– complications within the temple

• Intracranial complications– complications within the skull


Intratemporal complicationsIntracranial complications
• Hearing loss

• Eardrum perforation (acute and chronic)

• Petrositis– infection of the temporal bone

• Mastoiditis– infection of the bone behind and under the ear

• Cholesteatoma– non-cancerous skin growth in the ear

• Chronic suppurative Otitis Media (cholesteatoma could be present or absent)

• Facial paralysis

• Infectious eczematoid dermatitis

• Cholesterol granuloma– non-cancerous cysts develop in the skull near the middle ear

• Tympanosclerosis- scarring of the eardrum

• Labyrinthitis- inflammation of inner ear or the nerves

• Meningitis- inflammation membranes that cover the brain and spinal cord

• Lateral sinus thrombosis- inflammation of the inner wall of the area beneath the brain

• Subdural empyema- pus build-up between the membranes that cover and protect the brain and spinal cord

• Otitic hydrocephalus– due to overproduction or under absorption of cerebral spinal fluid causing increased pressure in the skull

• Extradural abscess– abscess formation on the outer membrane covering the brain and the spinal cord

• Brain abscess


Note: A temporal bone is a bone that surrounds the ear

Can Otitis Media be prevented?

Complete prevention of Otitis media is rare; however,specific proactive steps can help you reduce the risk of a middle ear infection in children:

• Avoid passive smoking

• Avoid feeding while lying on the back

• Avoid missing the routine vaccines

• Avoid formula milk and prefer breast milk

Can you permanently cure Otitis Media?

Yes, Otitis Media can be cured if treated properly. However, if overlooked, it can lead to severe long-term complications.

Dr sumit

Dr. Sumit Sharma

MBBS (ENT- Honours) (KGMC-Lucknow),
M.S. (KGMC- Lucknow), FAOI (AIIMS), FAOI (U.K.)


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