Otitis media

Otitis media is inflammation of the middle ear. It can be acute or chronic and is a common condition, believed to affect 80% of all children less than 10 years at least once in their lifetime.

Acute otitis media (AOM) is an infection of sudden onset. It is very common in children under 5 years and usually caused by viruses and bacteria. A common cold or sinus infection often precedes it. Risk factors for the development include exposure to smoking, attendance of day care centers, use of pacifiers and Down syndrome.

Symptoms of AOM include pain, fever, fullness in the ear, hearing loss, vomiting and poor appetite. Small children may have a tendency to pull on their ears. When the pressure of the fluid that builds up in the middle ear behind the eardrum reaches a certain point the eardrum may rupture. Pus may then drain from the ear, often with relief of the pain.

AOM may resolve spontaneously but in most cases pain medication and antibiotics are required. Patients with recurrent attacks may benefit from the placement of ventilation tubes (grommets).

Chronic supporative otitis media (CSOM) lasts longer than two weeks. It is characterized by discharge from the ear (otorrhea), often in episodes. It may be a complication of grommets, especially if water is not kept from the ear. The discharge may have an offensive smell. It may be painful and lead to hearing loss.

Otitis media with effusion (OME) or glue ear is the condition where there is accumulation of fluid in the middle ear for a period of three months or longer. “Glue” refers to the tenacious appearance of the fluid. It is also referred to as chronic serous otitis media.

OME is usually not very painful. A child may have problems sleeping, be irritable and develop a delay in speech development. In older children it may lead to learning and behavioral problems. Examination of the tympanic membranes will confirm the diagnosis. If the fluid persists after antibiotics, drainage and grommet placement may be necessary.

Complications of otitis media include permanent hearing loss, tympanic membrane perforation, adhesion and scarring in the middle ear and cholesteatoma formation. Serious complications include brain abscess, meningitis and sigmoid sinus thrombosis.

Vaccination and breastfeeding are likely to reduce the incidence of otitis media.

Further reading

Diseases of the middle ear in childhood.

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