A B C D E F G H I J K L M N O P R S T U V W

ACUTE OTITIS MEDIA

What is Acute Otitis Media ?

Acute otitis media is an infection of the middle ear. The middle ear is the small space behind the ear drum It contains three tiny bones which conduct sound to the inner ear. From the front end of the middle ear, the Eustachian tube connects the ear space with the cavity behind the nose. The purpose of the tube is to allow air to pass into the middle ear and thereby keep the pressure in the middle ear cavity normal. The main symptoms of acute otitis media are pain, deafness and discharge from the ear. In babies and very small children, there may be nothing to indicate that the ear is the cause of their illness: the child may simply be crying, looking unwell and off his or her food. The child may have a temperature and be vomitting. Deafness can develop quite rapidly. The ear drum may perforate: then there is a sudden discharge from the ear and the pain becomes less severe.

How does Acute Otitis Media occur ?

Middle ear infections are usually due to common germs such as streptococci, staphylococci and Haemophilus influenzae . These bacteria are the cause of common throat and nasal infections. They infect the middle ear by passing up or alongside the Eustachian tube. Acute otitis media often follows a cold or a flu-like illness. In children it may occur with measles or mumps or complicate tonsillitis or infection of the adenoids.

Why does Acute Otitis Media occur ?

Acute otitis media is most common in children. In children the Eustachian tube is shorter, fatter and more horizontal than in adults. This makes it easier for germs to get to the middle ear from the back of the nose. Children have to build up resistance to infection and of course they are exposed to many infections from other children.

Treatment Involved for Acute Otitis Media

The pain of acute otitis media is distressing and needs to be treated with painkillers such as paracetamol. There are flavoured liquid preparations which are suitable for children. Aspirin should not be used in children under 12 years of age but may be used for adults. Aspirin and paracetamol will also bring down any raised temperature. If the temperature is very high, other measures such as cold sponging may be necessary. Decongestants and antihistamines may also be used to help clear the nose if it is blocked. These drugs may help to restore the eustachian tube function by reducing swelling of the tubal lining. Depending on the age of the patient and any history of drug allergy, the doctor will usually prescribe a suitable antibiotic.

It is important to take the prescribed medicines for the full course. Failure to finish the antibiotic course may result in persistent middle ear problems. If the ear drum has perforated then there may be a discharge in the ear (otorrhoea). Treatment with antibiotic/steroid ear drops may be used. The discharge should be gently mopped away from the outer ear with a piece of cotton wool. The drops should be kept at room temperature and should be put into the ear with the head on the side: it should be kept in this position for a minute or so to allow the drops to reach the middle ear.

If the acute infection has not responded satisfactorily the doctor may prescribe another course of a different antibiotic. Failure to respond to treatment usually results in referral to a specialist. At this stage acute symptoms may require drainage of the middle ear. This is a minor operation like lancing a boil. It involves making a very small cut in the ear drum. This is called a myringotomy and is usually done under a general anaesthetic using an operating microscope. The myringotomy usually relieves symptoms and enables the surgeon to test the fluid in the middle ear for bacteria. These tests allow the best antibiotic to be chosen for further treatment. Sometimes the specialist will delay a decision on myringotomy and prescribe further treatment. Failure of hearing to be restored to normal may be a reason for doing a myringotomy.

During Treatment for Acute Otitis Media

Complications are rare. The most serious complication used to be spread of infection into the brain and the spaces surrounding the brain (meningitis), but this is now extremely rare. Occasionally infection may spread from the middle ear space to involve the mastoid bone. This is a condition called acute mastoiditis. Acute mastoiditis is nowadays treated with antibiotics and only rarely needs mastoid surgery. If infections are incompletely treated, the development of mastoiditis may be masked . Deafness may be the only symptom. Mastoid surgery may then be needed. The specialist may ask for x-rays and scans of the mastoid to help in making the correct decision. If mastoid surgery is needed it is usually the so-called simple mastoidectomy operation. Using an incision over the mastoid bone the infected bony material is removed under a general anaesthetic. After the operation there is only minimal discomfort and the recovery is usually rapid and uncomplicated. Hearing is usually restored to normal but sometimes there may be some residual deafness.

After Treatment for Acute Otitis Media

Repeated attacks of acute otitis media occur quite often in children. Treatment with low dose antibiotics for 6 to 8 weeks can be very successful in dealing with this. In some of these cases removal of adenoids and possibly insertion of grommets may be needed. Blood tests may be done to exclude conditions such as anaemia which can lower the body's resistance to infection. Children eventually grow out of the tendency to ear infection. Treatment aims to get them to this stage with the best possible hearing level.