Consultant ENT Surgeon, Sitaram Bhartia Institute of Science and Research, New Delhi
What is Otitis Media?
The ear consists of various parts – outer ear, ear canal, ear drum, middle ear, inner ear, the hearing nerve and the Eustachian tubes. Air in the middle ear must be at the same atmospheric pressure as that outside the ear for healthy ear functioning.
Otitis media, or middle ear infection is a condition which occurs when the eustachian tube becomes swollen as a result of cold, a throat infection, or an allergic reaction causing fluid to accumulate in the middle ear. If this gets infected, it may lead to an inflamed eardrum and a build up of pus and mucous behind the ear drum. At times, the pressure in the middle ear becomes so high that the eardrum bursts, resulting in pus and blood drainage from the ear.
What are the symptoms?
Severe ear pain.
Pus and/or blood from the ear.
High fever especially in small children (sometimes, if there is a complication viz. intracranial spread) and muffled hearing.
Nausea and dizziness.(if there is involvement of the internal ear).
Who are the people at risk?
People having persistent cough and cold or other upper respiratory tract infections that have not been treated for long are at risk of developing this infection. Infants that are bottle-fed (in supine position) are more at risk than breastfed babies. That is why the infants being bottle-fed (if unavoidable) should be put with the head end raised so that no milk can enter the wide and straight Eustachian tube. People living in cold climates at high altitudes are also prone to this infection.
What are the causes?
Otitis media occurs when fluid accumulates behind the eardrum, failing to drain from the Eustachian tubes, the tiny passageway that connects the ear to the nose. In children the Eustachian tube often functions poorly because it is not mature or large enough and is unable to drain the middle ear very well. Bacteria from the nasal passages invade this fluid and cause an ear infection.
How is it detected?
If otitis media is suspected the doctor examines the patient’s ear with an otoscope to check for redness or fluid behind the eardrum. He may also perform additional tests to determine the severity of the infection.
He may use an audiogram to measure the extent of hearing loss. Samples of the ear discharge help in detecting the micro-organisms that are causing the infection so that the right antibiotic is given for effective treatment.
What is the treatment?
The infection is treated with antibiotics that are prescribed for eight to ten days. Amoxicillin is commonly used but other choices include ampicillin, cefaclor, erythromycin, clarithromycin or bactrim. The infection usually begins to clear within 48-72 hrs. but the antibiotics should be taken for the prescribed period to avoid a relapse. Acetaminophen may be given for relief of pain or fever. If the symptoms last for more than 48 hours after the treatment has been started, the doctor would examine to see if the drugs needs to be changed. The doctor may also prescribe drugs to aid drainage viz. decongestants or suggest some pain-relieving ear drops.
What are the complications associated with the infection?
Recurrence or persistence of ear infections.
Blocked or unclear hearing.
Delayed language development, especially in younger children.
Extension of the infection to the brain.
Involvement of veins in the neck.
Abscess formation in the throat causing difficulty in swallowing.