Otitis Media (Middle Ear Infection): Causes, Symptoms, and Treatment

• Acute - This is the most common form, characterised by a rapid onset of symptoms such as ear pain, fever, and irritability. Acute otitis media often occurs as a cold or respiratory infection complication, where bacteria or viruses enter the middle ear, causing inflammation and fluid buildup.

• Chronic - When ear infections persist or recur frequently, they may lead to chronic otitis media. This condition can result in continuous fluid discharge, ear pain, and even permanent damage to the ear structures, potentially causing hearing loss.

• Otitis Media with Effusion - In this form, fluid accumulates in the middle ear without signs of an active infection. While it may resolve independently, otitis media with effusion can affect hearing and may require medical attention if it persists.

1. Infections

Bacterial Infections

According to research, the most common bacteria causing acute otitis media is Streptococcus pneumoniae. They are also responsible for bronchitis and sinusitis. Hence, why people occasionally experience ear pain and nasal pain due to the same bacteria and connecting eustachian tube. Studies also show that these bacteria often follow upper respiratory tract infections, like colds or sinusitis, and can lead to middle ear infections due to their ability to invade the middle ear space through the Eustachian tube.

Common Cold

The common cold, caused by various viruses, is a well-established risk factor for otitis media. Research demonstrates that colds often lead to nasal congestion and Eustachian tube dysfunction, which increases the risk of middle ear infections.

Sinusitis

Chronic or acute sinusitis can also affect the Eustachian tube and lead to otitis media. Evidence shows that sinusitis often precedes otitis media and contributes to middle ear fluid accumulation.

Viral Infections

Viral pathogens such as respiratory syncytial virus (RSV), influenza, and rhinoviruses are also known contributors. Research indicates that viral infections can cause inflammation in the Eustachian tube, leading to fluid accumulation and secondary bacterial infection.

2. Eustachian tube dysfunction

Inflammation and Swelling

The Eustachian tube’s role in regulating middle ear pressure and draining fluid is critical. Inflammation or swelling of the Eustachian tube, often due to respiratory infections or allergies, can impair its function and lead to fluid accumulation in the middle ear. Evidence shows that Eustachian tube dysfunction is a significant risk factor for otitis media, particularly in children.

Allergic Reactions

Allergies can cause the lining of the Eustachian tube to become inflamed, disrupting normal fluid drainage. Studies have documented that allergic rhinitis is associated with an increased incidence of otitis media.

3. Exposure to environmental irritants

Smoke

Exposure to secondhand smoke is a well-documented risk factor for otitis media. Studies have shown that tobacco smoke irritates the respiratory tract and Eustachian tube, increasing the risk of middle ear infections.

Pollutants

Air pollutants and environmental irritants can exacerbate respiratory conditions and contribute to the development of otitis media. Research indicates that exposure to such irritants increases susceptibility to ear infections.

4. Immune system factors

Weakened immune system

Individuals with compromised immune systems, such as those with diabetes or undergoing immunosuppressive treatments, are more prone to infections, including otitis media. Evidence suggests that a weakened immune response can lead to increased frequency and severity of ear infections.

Chronic conditions

Conditions like cystic fibrosis, which affects the respiratory and immune systems, are associated with recurrent otitis media. Studies show that chronic conditions can predispose individuals to persistent middle ear infections.

5. Anatomical factors

Eustachian tube anatomy

In children, the Eustachian tube’s horizontal orientation makes it easier for pathogens to reach the middle ear. Research confirms that this anatomical difference contributes to the higher incidence of otitis media in younger populations.

Cleft palate

Congenital abnormalities such as a cleft palate can impact Eustachian tube function and increase the risk of otitis media. Evidence shows that children with a cleft palate have a higher incidence of ear infections.

Otitis media presents a range of symptoms, some of which may vary depending on the severity and type of the infection. Common symptoms include:

• Ear pain. This is the most prominent symptom, often described as a sharp, stabbing pain in the affected ear(s). Infants and young children may express discomfort by pulling at their ears.

• Fever. A high temperature is a common symptom, particularly in cases of acute otitis media.

• Hearing loss. Temporary hearing impairment can occur due to fluid buildup in the middle ear, which prevents the eardrum from vibrating correctly.

• Irritability and restlessness. Children with otitis media may become unusually fussy or have difficulty sleeping due to the discomfort.

• Fluid drainage. In some cases, especially with chronic otitis media or when the eardrum perforates, a yellow, precise, or bloody discharge may be seen coming from the ear.

• Balance problems. Since the ear plays a crucial role in maintaining balance, inflammation and fluid accumulation can cause dizziness or unsteadiness.

• Loss of appetite. Particularly in young children, ear pain and discomfort can lead to reduced interest in eating or drinking.

• Headache. Some children and adults may experience a general headache or a feeling of pressure in the head.

Ear Pain-associated symptoms

Diagnosis of Otitis Media

Clinical examination

Diagnosing otitis media typically involves a physical examination by a healthcare professional. The doctor will use an otoscope, a specialised tool that allows them to look inside the ear canal and examine the eardrum for signs of infection, such as redness, swelling, or fluid behind it.

Otoscopy

This is a more detailed examination where the doctor gently puffs air into the ear using a pneumatic otoscope. This test assesses the movement of the eardrum. Limited or no movement indicates fluid in the middle ear, confirming the presence of otitis media.

Tympanometry

In some cases, especially when fluid presence is suspected but not visually confirmed, a tympanometry test might be performed. This test measures the eardrum's movement in response to changes in air pressure and can help determine if there is fluid in the middle ear.

Hearing tests

If hearing loss is suspected, especially in cases of chronic otitis media, the doctor may recommend a hearing test (audiometry) to assess the extent of hearing impairment.

Pain relief

The initial treatment for otitis media often involves managing pain and discomfort. Over-the-counter pain relievers such as paracetamol or ibuprofen can reduce pain and fever. Always follow dosage guidelines, especially when treating children.

Antibiotic therapy

Antibiotics may be prescribed if bacteria cause the infection and symptoms are severe or persist beyond a few days without improvement. The choice of antibiotic, such as amoxicillin, and the duration of treatment depend on the patient’s age, severity of symptoms, and medical history. It is essential to complete the entire course of antibiotics, even if symptoms improve, to prevent resistance and recurrence.

Watchful waiting

For mild cases of acute otitis media, especially in children over two years old, doctors might recommend a "watchful waiting" approach. This involves monitoring symptoms for 48 to 72 hours before starting antibiotics, as many ear infections resolve independently.

Home care and prevention

Parents can help alleviate their child’s symptoms with home care measures such as applying a warm compress to the ear, ensuring the child stays hydrated, and keeping the child in an upright position to reduce pressure in the ear. Preventive measures include breastfeeding, avoiding exposure to tobacco smoke, and keeping vaccinations up to date, particularly the pneumococcal and influenza vaccines, which can reduce the risk of ear infections.

Complications of Otitis Media

While most otitis media cases resolve without significant issues, there are potential complications, mainly if the infection is severe, recurrent, or left untreated. Some of the complications include:

1. Hearing loss - One of the most common complications is temporary hearing loss due to fluid buildup in the middle ear. Chronic cases, or if left untreated, can become permanent, especially if the eardrum or middle ear structures are damaged.

2. Perforated eardrum - Pressure from fluid buildup or severe infection can cause the eardrum to rupture. While this can relieve pain by releasing pressure, it may lead to chronic ear infections and hearing loss. Most perforated eardrums heal independently, but some may require surgical repair.

3. Chronic Sppurative Otitis Media - This is a persistent ear infection that results in continuous or recurrent discharge through a perforated eardrum. It often requires more intensive treatment and can lead to permanent hearing damage.

4. Mastoiditis - An untreated or severe middle ear infection can spread to the mastoid bone behind the ear, leading to mastoiditis. This condition is severe and can cause swelling, pain, and redness behind the ear, as well as fever. Mastoiditis requires urgent medical treatment and often antibiotics or surgery to prevent further complications.

When to see a doctor for Otitis Media

It’s essential to know when to seek medical advice for otitis media to prevent complications and ensure proper treatment:

1. Persistent symptoms. If ear pain, fever, or other symptoms of otitis media persist for more than 48 hours despite home care or over-the-counter medications, it’s time to consult a doctor. Persistent symptoms may indicate a more severe infection that requires medical treatment.

2. Severe pain or high fever. Severe ear pain or a fever higher than 39°C (102°F) in children or adults warrants immediate medical attention. These symptoms could indicate a significant infection or complication that needs prompt treatment.

3. Hearing loss. If you or your child experiences hearing loss or a noticeable decrease in hearing, it’s important to see a healthcare provider. Hearing loss can be a sign of fluid buildup, a perforated eardrum, or another underlying issue that needs to be addressed.

4. Discharge from the ear. If there is pus, blood, or a foul-smelling discharge coming from the ear, it may indicate a perforated eardrum or a chronic ear infection. A doctor’s evaluation is necessary to determine the appropriate treatment.

5. Balance problems or dizziness. Experiencing dizziness, balance issues, or vertigo along with ear symptoms could indicate that the infection has spread or that there is another issue affecting the inner ear. This requires a medical assessment.

6. Recurrent infections. If you or your child frequently suffer from ear infections, it’s important to seek medical advice. Recurrent otitis media may require preventive measures or further investigation to determine the underlying cause.

Seeing a healthcare professional for persistent or severe symptoms helps ensure that otitis media is treated appropriately, reducing the risk of complications and promoting a full recovery.