Otitis Media
Group 2 Presentation – Emily, Isabella,
Deborah, Sheila
Why may hearing be affected by
cold or congestion?
• The middle ear communicates with the
nasopharynx via the Eustachian tube.
• An upper respiratory infection causes inflammation
and swelling of the tissues surrounding the
Eustachian tube, resulting in difficulty hearing as
sound does not travel efficiently from the outer ear
to the inner ear.
• Infection that is spread via the Eustachian tube from
the nasal cavity and pharynx (throat) to the middle
ear, can cause otitis media.
What is otitis media?
Definition: Otitis media is inflammation of the
middle ear, or middle ear infection.
• Infection causes pressure to build up behind
the tympanic membrane, causing intense pain. In
severe cases, the membrane may rupture, leading
to chronic conditions.
• Location: in the area between the tympanic
membrane and the inner ear, including the
Eustachian tube
• Cause: most commonly caused by infection with
viral, bacterial, or fungal pathogens. Most common
bacterial pathogen is Streptococcus pneumoniae
•
Acute Otitis Media
Risk Factors:
• Developmental alterations of the auditory tube
• Immature immune system
• Frequent infections of the upper respiratory mucosa
Acute Otitis Media:
Signs and Symptoms
• One or more of the following symptoms:
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o
o
o
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Otalgia (earache)
Fever
Otorrhea (discharge from the external ear)
Recent onset of anorexia
Irritability
Vomiting
Diarrhoea
• Signs  Abnormal otoscopic findings of the
tympanic membrane including:
o
o
o
o
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Opacity
Bulging
Erythema
Middle ear effusion
Decreased mobility with pneumatic otoscopy
Acute Otitis Media:
Treatment Options
• Pain present  treatment to reduce pain
o E.g., ibuprofen
• Medical treatment
o Concern of antimicrobial resistance due to aggressive antibiotic use
o Observation without antibiotic use in children with mild acute Otis media
o Treatment with antibacterial agent  amoxicillin (80-90 mg/kg/day)
• ENT referral if history of recurrent acute Otis media
o Surgical intervention
Chronic Otitis Media
Chronic otitis media (COM)
Chronic suppurative
otitis media (CSOM)
Perforated tympanic membrane with
persistent drainage from the middle ear
(i.e. persistent otorrhea)
• major cause of acquired hearing
impairment in children esp. in
developing countries
• WHO’s definition: >2 weeks of
otorrhea
• Otolaryngologists: >3 months of
active disease
Other forms of COM (nonCSOM group)
• Recurrent or persistent effusions
in middle ear behind an intact
tympanic membrane in which
principal symptom (if present at
all) is deafness and not ear
discharge
• i.e. chronic non-suppurative/
secretory / seromucous / serous
/ mucoid OM (glue ear)
Chronic Otitis Media:
Contributing Risk Factors
• Young age (children)
• (Developing nations) Overcrowding, malnutrition
• Being a member of a large family
• History of multiple episodes of acute OM
• Nasopharyngeal colonisation by bacteria implicated in
OM
• Chronic sinus infection & allergies
• Upper respiratory infections (certain viruses like RSV,
influenza, adenovirus)
• Altered eustachian tube anatomy and function
o Abnormalities in shape of the face, palate or eustachian tube
o Down syndrome
Chronic Otitis Media:
Signs and Symptoms
Warning signs of chronic otitis media include:
Hearing loss (most common)
Facial weakness
Persistent blockage of fullness of the ear
Persistent deep
ear pain or
headache
Chronic ear drainage (can range from a watery
consistency to a yellow-green, foul-smelling
discharge)
Fever
Drainage or swelling behind the ear
Development of
balance problems
Confusion or sleepiness
•
•
COM occurs gradually over many years in patients with longstanding or
frequent ear trouble. But it can (rarely) develop over several months in a
patient with no previous history of ear disease.
Any of the above symptoms should prompt an evaluation by an ENT or
otologist/neurotologist.
Chronic Otitis Media:
Treatment Options
• Appropriate topical antibiotic drops (remove small
granulations in middle ear resulting from
inflammation) AND
• Aural toilet (thoroughly cleansing of the ear; reduce
quantity of infected material/discharge and
facilitate antibiotic action)
• Sometimes surgery may be necessary
o Mastoidectomy removes mastoid air cells, granulations & debris
o Tympanoplasty repairs eardrum; closes perforation of tympanic
membrane
Otitis Media with
Effusion (Glue Ear)
• Not an ear infection
• Thick/sticky fluid behind the eardrum
• Usually occurs after treatment for OM, when fluid
(effusion) can remain in the middle ear for a few
days or weeks.
• Can lead to OM – when the tube is partially
blocked, fluid builds up in middle ear  bacteria
already inside become trapped and begin to
grow  infection.
Otitis Media with Effusion:
Contributing Risk Factors
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Oedema of the lining of the Eustachian tube (creates negative
pressure in middle ear that sucks fluid from mucous lining) 
increased fluid. Due to:
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Allergies – most common in spring
Irritants
Respiratory infections
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Drinking while lying on back
Sudden air pressure increases e.g. airplane, mountain road
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Shorter tube, more horizontal, straighter – easy for bacterial entry
Tube floppier, with opening that is small and easily blocked.
Immune system not as developed  get more colds.
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Congenital abnormalities e.g. Cleft palate, immune deficiencies
Genetic factors e.g. Down’s Syndrome
Repeated ear infections, especially <6m, and close succession.
Attendance at day care
Passive smoking
Blockage/closure of the tube, due to:
Children get more OME than adults (and younger more than
older), due to:
Other risk factors include:
Signs and Symptoms
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Often children with OME don’t act sick – no obvious symptoms, as no
infection.
Muffled hearing (transient) – usually 15-40dB hearing threshold (mildmoderate); loss of >35dB in about 20% of cases; fluctuating hearing loss
(with varied fluid volume).
Sense of ‘fullness’ in the ear
Children might have obvious difficulty hearing e.g. turn the tv up louder,
as ‘What?’ often.
Can have behavioural impact:
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Distractibility
Overactivity
Social withdrawal
Irritability
Inattention
Inappropriate response behaviours
Specific ‘ear’ symptoms e.g. pulling on ear, head banging, rolling head from side to side
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Acute ear infection
Cyst in middle ear
Permanent damage to the ear with partial/complete hearing loss
Scarring of the eardrum (tympanosclerosis)
Speech or language delay (rare)
Complications:
Otitis Media with
Effusion: Tests
• Examine the eardrum for:
o
o
o
o
Air bubbles on the surface
Dullness when light is used
No movement when little puffs of air are blown at it
Fluid behind it
• Tympanometry – shows amount and thickness of
fluid.
• Acoustic otoscope/reflectometer – detects
presence of fluid.
• Audiometer – to determine what treatment.
Otitis Media with Effusion:
Treatment Options
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Watchful waiting – 2-3 months (unless there are signs of infection).
Smaller, daily dose of antibiotics to prevent new infections, if child has
had repeat ear infections (with/without oral steroids)
Changes:
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o
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Avoid cigarette smoke
Encourage breastfeeding of infants
Treat allergies, stay away from triggers.
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o
o
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Further observation
Hearing test
Single trial of antibiotics (if not given earlier) – not always helpful.
A significant hearing loss (>20dB)  antibiotics or ear tubes.
At 4-6m, tubes probably needed, even where there is no significant hearing loss.
Adenoids might need to be removed to restore proper functioning of the Eustachian tube.
o
o
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Antihistamine-decongestant combinations
Oral mucolytics
Eustachian tube autoinflation
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o
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Myringotomy (pressure release)
Tympanostomy tubes (grommets)
Adenoidectomy (only when concurrent adenoid issues)
If fluid still present after 6 weeks:
Insubstantial evidence for:
Surgical:
Why do children get more middle
ear infections than adults?
• Children < 7 years old are more prone to otitis
media due to shorter, narrower and more horizontal
Eustachian tubes than in the adult ear
• They also have not developed the same resistance
to viruses and bacteria as adults.
• Breastfeeding for the first 12 months of life is
associated with decrease in number of otitis media
infections in children.