Ear Aches

What is otitis media?

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis in children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children, it also occasionally affects adults. It occurs most commonly in the Winter and early Spring.

Is it serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss in children can impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms of otitis media and get immediate attention from your doctor.

How does the ear work?

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates the bones which transmits sound to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

What causes otitis media?

Blockage of the eustachian tube from a cold, allergies, or upper respiratory infection can lead to the accumulation of fluid behind the eardrum. If this fluid becomes infected by bacteria or viruses, the resulting infection is called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, hearing problems may occur.

Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty hearing.

What will happen at the doctor’s office?

During an examination, the doctor will use an instrument called an otoscope to assess the ear’s condition. With it, the doctor will perform an examination to check for redness in the ear and fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn’t move or is red, an ear infection is probably present.
Two other tests may also be performed:

  • Audiogram – This tests if hearing loss has occurred by presenting tones at various pitches.
  • Tympanogram – This measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The importance of medication

The doctor may prescribe medication. It is important that the medication be taken as directed and that follow-up visits are kept. Antibiotics may fight the infection and make the earache go away more rapidly, but the fluid may need weeks or months to resolve completely. So be sure that the medication is taken for the full time your doctor has indicated. Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear.

What other treatment may be necessary?

Most of the time, otitis media clears up with proper medication and time. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy and ventilation tube (also known as “ear tubes”) can be performed to prevent fluid accumulation and thus improving hearing. The ventilation tube remains in place for several months in hopes that by the time it “falls out” the eustachian tube functions normally again. During this time, you must keep water out of the ears by using ear plugs because this could cause an infection. Otherwise, the tubes cause no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.
Allergies may also require treatment.

So, remember…

Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, your child can feel and hear better very soon. Be sure to follow the treatment plan, and see your physician until he tells you that the condition is fully cured.

What are the symptoms?

In infants and toddlers look for:

  • pulling or scratching at the ear, especially if accompanied by other symptoms
  • hearing problems
  • crying, irritability
  • fever
  • vomiting
  • ear drainage

In young children, adolescents, and adults look for:

  • earache
  • feeling of fullness or pressure
  • hearing problems
  • dizziness, loss of balance
  • nausea, vomiting
  • ear drainage
  • fever

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.