Otitis media is one of the most common ear problems affecting usually the children. Usually the condition resolves with time without any treatment however, sometimes antibiotic treatment is required in severe cases.
In some serious cases without proper treatment there is high chance that several complications like hearing loss, spread of infection to other nearby structures, even the skull bone (mastoid bone can be affected leading to mastoiditis), delayed speech in children due to persistent hearing loss etc. will arise.
Causes
The most common underlying cause of otitis media is a bacterial or viral infection. In many cases there is another contributing factor other than the underlying infection. These contributing factors include cold, flu or allergy leading to selling and congestion in the nasal cavity, Eustachian tube and throat.
The Eustachian tubes are the narrow tube like structure which extends from the back of the throat to the middle ear cavity. The part of the Eustachian tube in the throat region closes or opens to maintain certain air pressure in the middle ear cavity, to change the air confined in the middle ear at regular intervals and also to drain the secretions accumulated in the middle ear cavity.
Sometimes allergy or infection in the throat may lead to closure of the throat end of the Eustachian tube leading to blockage of the tube and collection of fluid in the middle ear. The accumulated fluid in the middle ear acts as a favorable place for bacterial or viral infection. ‘
This condition is more common in children as the Eustachian tube is anatomically straight and narrow, making the process of draining through the tube difficult and also the chance of blockage is increased in children.
Adenoid glands are two small glands located near the end of the Eustachian tube. These glands are part of the immune system and are more likely to get infected, become inflamed and swollen. This infection and the consequent swelling of the adenoids are more common in children leading to further increase in the risk of getting the Eustachian tube blocked in them.
Chronic suppurative otitis media is an associated condition which may occur leading to perforation of the ear drum.
Risk factors
Common risk factors include
1. Age: usually children between 6 months to 12 years are at increased risk both because of narrow and straight Eustachian tube and increased incidence of adenoid infections
2. Children in day care are at increased risk as cold and the resulting ear infection may easily spread from one child to another
3. Bottle feeding usually in lying down posture is a common risk for otitis media.
4. Seasonal variation: cold and flu are more common during the winter and rainy seasons hence the risk of otitis media also increases
5. Prolonged exposure to noxious smoke or other kind of air pollutants also increases the risk of otitis media
Treatment
Most of the cases of otitis media resolve without any treatment. However, depending upon the child’s age, severity of the disease, presence of other associated factors decision is made regarding treatment options.
Usually without treatment the symptoms resolve within two days and infection is cleared up within 2 weeks. As per the American Academy of Paediatrics monitoring without any treatment is recommended in children between 6 and 23 months with one sided mild ear pain for 48 hours and fever less than 102.2 F and in children above 24 months with one or both sided mild ear pain and fever less than 102.2 F.
Other than the above mentioned situations, doctors usually prescribe antibiotic drugs to manage otitis media like in temperature greater than 102.2 F and with moderate to severe ear pain in one or both the ears.
Ear pain associated with otitis media is commonly managed with warm compress, pain relieving drugs, ear drops containing antipyrine benzocaine and glycerine.
Recurrent otitis media is a child as described as at least 3 attacks in 6 months or 4 attacks in 1 year, otitis media with repeated fluid collection even when the infection has been cleared or without any infection require drainage of the fluid from the middle ear by creating a small hole in the eardrum (myringotomy) and putting a tympanostomy tube to maintain aeration and prevention of any fluid accumulation in the middle ear cavity. Some of the tubes fall off on their own within 6 months and some are to be removed surgically.Regular monitoring is an essential part of treatment in children suffering from recurrent attacks of otitis media.