Otitis Media is the Latin for “middle ear inflammation” or also know as ear infection or inflammation of the middle ear. Otitis media occurs in the tympanic membrane area located at the end of the outer ear and the inner ear including the Eustachian tube. Otitis media can be severely painful but it is not life threatening. It usually subsides on its own in two to four weeks.
Otitis media have various classifications depending on the degree of severity.
· Acute Otitis Media (AOM)
AOM is the most common which is self-limiting, often purely viral and sometimes accompanied by viral upper respiratory tract infection. The ear gets congested with mild popping and discomfort. The symptoms resolve together with the upper respiratory tract infection. The middle ear is normally sterile and if this is contaminated with bacteria it results to middle ear pressure and pus. This is called as acute bacterial otitis media. The symptoms is earache which is more severely painful and continuous and often accompanied with fever. This can lead to mastoid infection or mastoiditis, ear drum perforation and in rare cases, meningitis.
· Serous Otitis Media (SOM)
SOM is a fluid collection occurring in the space of the middle ear because of negative pressure due to the malfunctioning of the Eustacian tube. It occurs from viral upper respiratory tract infection characterized by no bacterial infection and pain but it can also proceed to bacterial otitis media. The fluid in the ear may cause hearing impairment if it interferes with the vibrations of the ear drum. In weeks to months, this fluid thickens like glue, known as “glue ear” which increases the possibility of developing into conductive hearing impairment.
· Chronic Suppurative
Chronic suppurative otitis media is the perforation of the tympanic membrane and a bacterial infection is present in the middle ear which last for weeks or more. Ottorhea or pus draining outside the ear may occur or it can be as minimal which is only seen by a binocular microscope. This is common to people with poor Eustacian tube function. Hearing impairment usually happens in the long run.
Otitis media is commonly caused by bacterial, viral and fungal pathogens causing infection. Streptococcus pneumonia is the common bacterial pathogen. Haemophilus influenza, Pseudomonas aeruginosa and moraxella catarrhalis are some of the bacteria causing otitis media. Haemophilus influenzae is the common causative agent mostly in young adults and older adolescents.
The pain in otitis media is treated with oral or topical analgesics. Oral agents include acetaminophen, ibuprofen, and narcotics. Topical agents include benzocaine ear drops and antipyrine.
It is suggested to defer antibiotics in acute bacterial otitis media if pain is still manageable in 1 to 3 days with the mentioned pain measures. No adverse effects have been found in withholding treatments. Recurrence of otitis media has been found with the use of amoxicillin antibiotics in children. If warranted, the first line antibiotic is amoxicillin. Amoxicillin-clavulanate or other penicillins and beta lactamase inhibitor may be used as a second line if bacteria is resistant to amoxicillin.
In chronic cases or effusions, the otologist inserts a tympanostomy tube in the ear drum to enable the air to pass through in the middle ear releasing the pressure build up or any excess fluid.