CEN Otitis Media

CEN Otitis Media Overview

Otitis media is a group of inflammatory diseases of the middle ear.  The two main types are acute otitis media (AOM) and otitis media with effusion (OME).  AOM is an infection of abrupt onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. OME is typically not associated with symptoms.  Occasionally a feeling of fullness is described. It is defined as the presence of non-infectious fluid in the middle ear for more than three months.

Chronic suppurative otitis media (CSOM) is middle ear inflammation of greater than two weeks that results in episodes of discharge from the ear. It may be a complication of acute otitis media. Pain is rarely present.  All three may be associated with hearing loss.  The hearing loss in OME, due to its chronic nature, may affect a child’s ability to learn.

Signs and Symptoms

• An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there often are accompanying symptoms like cough and nasal discharge.

• Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).

Causes

• The common cause of all forms of otitis media is dysfunction of the Eustachian tube.  This is usually due to inflammation of the mucous membranes in the nasopharynx, which can be caused by a viral URI, strep throat, or possibly by allergies. 

• Because of the dysfunction of the Eustachian tube, the gas volume in the middle ear is trapped and parts of it are slowly absorbed by the surrounding tissues, leading to negative pressure in the middle ear.

• Eventually the negative middle-ear pressure can reach a point where fluid from the surrounding tissues is sucked in to the middle ear’s cavity (tympanic cavity), causing a middle-ear effusion.

• By reflux or aspiration of unwanted secretions from the nasopharynx into the normally sterile middle-ear space, the fluid may then become infected — usually with bacteria. The virus that caused the initial URI can itself be identified as the pathogen causing the infection.

Risk Factors

Risk factors for otitis media include:

• Age. Children between 6 to 36 months are most likely to get ear infections.
• Attending daycare
• Recent illness, such as a cold or sinus infection.
• History of allergies, like hay fever, also called allergic rhinitis, or sinusitis.
• Exposure to secondhand smoke
• Having family members who are prone to ear infections; studies show a clear genetic component for recurrent otitis media.
• Using a pacifier
• Having a history of gastroesophageal reflux disease (GERD).

Treatment

• Treat infections with antibiotics
• Pain meds for pain management
• Prevent future infections