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Otitis Media

more about Otitis Media

Middle ear infection


  • The part of the ear that we can see is called the outer ear.  It is connected to an external canal, which is then separated from the structures of the middle ear by a thin drum-like membrane called the eardrum (tympanic membrane).  The middle ear is filled with air and is connected to the back of the nose by a tube-like canal called the eustachian tube.  The other parts beyond the middle ear are the inner ear (cochlea, semicircular canal) and the auditory nerves (carries messages to the brain).
  • Otitis Media refers to an infection of the middle ear that normally follows the flu or a cold.  OM can affect people at any age, but it is more common in children under the age of 7.

  • 20-40% of the cases of bacterial infections may have fewer or no symptoms.
  • In infants, irritability, poor feeding, or loss of appetite may be the only symptoms for the first few months.
  • In cases without bacterial infection, there may be a mild decrease in hearing or a feeling of heaviness in the ear.
  • In most cases of acute OM there is:
    flu, cold, sinus, throat, allergies, and earaches.
  • The bone behind the ear (mastoid bone) may hurt if it is pressed.
  • Decreased hearing
  • Fever may or may not be present
  • If the eardrum is punctured, fluid may leak out (otorrhea)
  • Hearing loss and spread of the infection to other sites (brain, facial nerves and mastoid bone) can occur

  • Conditions such as a Common Cold (caused by a virus), sinusitis, throat infections, allergies to tree pollen, mold spores, and mites can irritate the eustachian (E) tube and weaken its normal defenses.
  • Once the defenses of the eustachian tube are compromised, it is prone to invasion by bacteria, which then climb up to the air-filled middle ear chamber and cause an infection.  This results in fluid build up, earaches, and other symptoms.
  • Bacteria responsible for OM are:
    1. Pneumococci (30-35%)
    2. Haemophilus Influenza (20-25%)
    3. Moraxella catarrhalis (10-15%)
    4. Group A streptococci and Staphylococcus species (1-3%)
    5. Up to 30% of cases of OM occur without any bacterial infections

  • Medical history and a physical examination is the first step
  • There may be facial pain (over the sinuses), nasal (nose) congestion, sore, red throat if allergies exist, or a sinus infection may be present.
  • There may be enlarged Lymph glands (pea size nodes) in the neck
  • The mastoid bone may hurt if doctor presses on it.
  • The doctor will use a special light (otoscope) to look into the ear canal, where he will see the ear drum bulging out (fluid behind it), moving poorly, or have a tear in the eardrum.  A tear on the eardrum may let fluid leak from the middle ear, through the tear, with the external canal.
  • The fluid that may have leaked out can be collected by a sterile cotton swab, and sent to the laboratory so they can identify the cause and type of bacteria (takes 24-48 hours).
  • Hearing can be tested by a specialist called an audiologist.

  • Males more than females
  • Ear trauma or previous ear surgery
  • Structural abnormalities of the ear or an E-tube present at birth
  • Previous history of OM
  • Family history of OM, especially in a sibling
  • Second hand tobacco smoke
  • Day care
  • Allergies
  • Sinus infections
  • Throat infections
  • Formula feeding

  • Usually treated on an outpatient basis except for infants under 2 years of age with high fever.
  • If not too sick, use Auralgan drops (eases the pain) and Tylenol (pain and fever) by mouth, and observe closely for the first 2-3 days.
  • If symptoms persist for more than 48-72 hours, or the patient is sick, consider antibiotics.
  • Antibiotics such as amoxicillin are given by mouth for up to 10 days (or until the bacterium is identified).
  • If there are 3 or more OM's in 6 months, or 4 or more in one year, then antibiotics may be needed for up to 6 months.
  • In cases where there is persistent fluid (Effusion) in the middle ear without bacteria (consider Allergy), antibiotics do not help, and Antihistamines (Claritin) or decongestants such as Entex can be tried.
  • In allergic OM, where medications do not help, one may consider consulting with an allergy doctor.
  • In cases where middle ear effusion is present for more than 4 months in both ears, or more than 6 months in one ear, or, if hearing is affected (greater than a 25 decibel loss), surgery may need to be done.
  • Recurrent bacterial OM (more than 2-3) while on antibiotics may also benefit from surgery.
  • An ENT (ear, nose, throat) doctor will perform all necessary surgeries.
  • Surgeries include drainage of the middle ear fluid via a tiny tube (tympanostomy tube).
  • The tube may be placed for days, weeks, months, or in some cases, permanently.
  • A good diet that is full of vegetables, fruits, fish, and low in animal products (beef, pork, etc.) and fats may help to prevent future infections.
  • Try breast-feeding your baby
  • Stop smoking, especially around your children and animals.

  • Contact your physician and see him/her as soon as possible.

  • Jaw or tooth pain can radiate to the ear
  • TMJ is the joint next to the ear that helps us with chewing
  • Arthritis and other diseases can affect it and cause pain

more about Otitis Media

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