Hearinginfo.org   © Copyright. No copying without prior written permission	Diseases and Disorders of the Ear
Otitis Media (Middle Ear Infection)

Definition of otitis media

Otitis media is an infection or inflammation of the middle ear usually caused by a viral or bacterial infection.

Symptoms of otitis media

Some of the symptoms of middle ear infection include:

• Earache
• Headache
• Fever
• Discharge from the ear
• Mild deafness
• Difficulties in sleeping
• Loss of appetite.

Causes  of Otitis media

The causes of middle ear infection can be:

• A progressive head cold
• A viral sinus infection that spreads
• An otitis externa infection (infection of the outer ear) left too long that spreads to the middle/inner ear
• Blowing your nose too hard, forcing sinal or Eustachion material into the middle ear.
• An opportunistic infection entering through a perforated eardrum

Mild infections clear up by themselves in a matter of hours. Over-the-counter painkillers can help alleviate the pain. Warm olive oil dripped in the ear can also soothe the pain. Repeat every few hours.

In more severe cases, antibiotics might be needed which usually includes an initial antibiotic shot, and antibiotic pills and antibiotic ear drops.

In many cases of middle ear infection, the Eustachion tube is blocked and can cause or at least contributes to a middle ear infection. (See also Glue Ear, below). The Eustachion tube can become blocked from any combination of the following:

• The body's inflammation reaction to an infection, swelling the Eustachion tube to where it closes completely.

• A contributing factor can be the discharge of the dead bacteria and dead lymphocytes in the lymphatic fluid from the middle ear. The lymphatic system contains the white blood cells or lymphocytes which are the body's defense against foreign objects such as bacteria. When the white blood cells kill bacteria, the lymphatic fluid becomes pus-like. Pus is made up of dead white blood cells and dead bacteria. This discharge from the middle ear can irritate the Eustachion tube causing it to close.

Pain of Middle Ear Infections

A blocked Eustachion tube is what causes the pain of a middle ear infection. Pus builds up in the inner ear cavity with no where to go, putting pressure on the inner ear and the ear drum. If left without treatment, pressure in the middle ear cavity can be so great that it bursts the ear drum. The initial excruciating pain of a burst eardrum is immediately compensated for by pain reduction from the release of pressure. Whereas, prior to the burst eardrum, sleep was impossible, the pain relief from the pressure reduction allows the sufferer to finally sleep. If the middle ear infection is cured, the ruptured ear drum usually heals on its own, although sometimes surgery (tympanoplasty) is indicated if the rupture is extremely large.

Otitis Media Complications - Glue Ear

There is a natural flow of fluids from the middle ear (the fluids keep the middle ear cavity moist) that migrate through the Eustachion tube to the back of the throat. A blocked Eustachion tube prevents air from reaching the middle ear. When this happens the middle ear can fill up with the fluid that can becomes thick, like glue over time. This problem is called glue ear or otitis media with effusion. The buildup of fluid in the middle ear reduces the movement of the eardrum and ossicles, and hearing is reduced. More information


Otitis Media Variants

Chronic Suppurative Otitis Media (CSOM)

CSOM is the name given to a condition when you get an infection of the middle ear which fails to heal and is draining all the time. There are two forms of this condition:

• Tubo-tympanic. The tubo-tympanic form usually involves a perforation of the central part of your eardrum. This can be caused by infection, injury or surgery.
  
  Symptoms of Chronic Suppurative Otitis Media (CSOM)
  
  You may have a hearing loss and a discharge, which may come and go, and will become noticeable particularly if you get a cold or your ear gets wet. You might also get tinnitus.
  
  Treatment for Chronic Suppurative Otitis Media (CSOM)
  
  If the opening is not too large, it may close and heal on its own. Failing that, an ENT (Ear, Nose, and Throat specialist) may close it with surgery or by covering it with a special material to keep the opening closed while it heals,.
  
  You can usually help your symptoms by taking simple steps - for example, by wearing an ear plug or keeping your ear dry when you are having a bath or swimming. A hearing aid can improve your hearing. However, you may need an operation to repair the hole in the eardrum. This is called a tympanoplasty or myringoplasty.
   

Attico-antral complications of Chronic Suppurative Otitis Media (CSOM)

•  The attico-antral form of CSOM might also involve a hole in your eardrum - usually in the upper part. This form of CSOM can be more of a problem than the tubo-tympanic form because your eardrum sheds dead skin which can build up and enter your middle ear. This skin can then mix with wax and other debris to form a cyst-like mass. This is known as a cholesteatoma. This type of CSOM can be quite serious, because the cholesteatoma can get bigger and cause damage to nearby parts of your ear, such as the eardrum and ossicles.

Symptoms of Attico-antral complications

The attico-antral form of the condition causes a smelly discharge to leak from the ear. You may also have a hearing loss and sometimes tinnitus. You can get vertigo - dizziness - if your semicircular canals, which form part of the balance system, are damaged. Occasionally the cholesteatoma can damage the bone covering the nerve that supplies your face, which can weaken your facial muscles. In very severe cases it may even wear through your skull, causing meningitis or brain infections.

Signs that damage is taking place include extreme pain, vertigo, weakness of the facial muscles and splitting  headaches.

Treatment for Attico-antral complications

It is important to remove the cholesteatoma and all traces of infection. For this, it is usually necessary to have a procedure known as mastoid surgery (see below), usually performed by an Ear, Nose, Throat (ENT) specialist.

Attico-antral Complications - Mastoid Infection

The mastoid is an area of bone just behind the ear. In fact the cochlea part of the inner ear is actually embedded in it. The mastoid contains lots of small air pockets like a sponge. Because it is made mainly of bone, the mastoid does not have a large blood supply going to it, thus minimizing the effect of any antibiotics - if the antibiotic can't get to the site, it can't destroy any bacteria. Surgery may be required to remove the infection.

Mastoid Surgery

An operation on the mastoid bone is done under general surgery.  It involves drilling away the infected bone. This aims to remove all the infected tissue and cholesteatoma. There are a few different types of mastoid surgery depending on how bad your condition is. Some of these leave a cavity (hole) in the mastoid bone, which may require regular cleaning. Your surgeon should discuss with you exactly which operation is suitable.