Otitis media is one of the most common ear diseases in children, most often of bacterial etiology. One of its symptoms is acute pain and it is the result of the spread of a bacterial infection from the nose or throat. Otitis shouldn’t be underestimated. Without treatment it can lead to serious complications.
There are different types of otitis such as acute, serous (otitis media with effusion) and chronic otitis media.
Acute otitis media
Acute otitis media is an inflammatory process characterized by suddenly appearing symptoms: severe and pulsating pain in the ear, fever, hearing impairment and symptoms observed in an objective examination: red and convex tympanic membrane with fluid behind the eardrum. Otitis media is more common in children. It sometimes occurs in adults, but in this group we often observe chronic otitis media, which may be the result of untreated or badly treated acute otitis media in childhood.
Predisposing factors for otitis media are Eustachian tube dysfunction, genetic factors, gastroesophageal reflux disease (GERD), environmental factors, immunological disorders, allergy, passive smoking, non-breastfed children, abnormal facial skeleton anatomy.
When should you contact a specialist?
Acute otitis media is diagnosed if the following criteria are met at the same time:
1) The sudden onset of the disease, characterized by pain in the ears, child’s anxiety, irritability or crying; high fever, purulent discharge from the external auditory canal.
2) Significant redness of the eardrum or severe pain in the ear, which disrupts the normal functioning of a child or their sleep. In addition to the symptoms typical of acute otitis media, such as severe often pulsating pain in the ear, the feeling of fullness in ears and hearing loss, general symptoms may appear: fever, sickness, loss of appetite, anxiety, vomiting, diarrhea; the smaller the child is, the more severe these symptoms are. In 50% of cases, acute otitis media occurs without pain in the ears. Ear tragus pain is not a characteristic symptom of otitis media and can only indicate external otitis.
Acute otitis media can be severe or mild. A severe course of the disease is characterized by an increase in body temperature >39 ° C and severe pain in the ear, a mild course – with the temperature of less than 39 ° C and moderate pain in the ear.
There is also reccurent acute otitis media which occurs at least 3 times in the last 6 months or at least 4 times in the last 12 months.
To treat acute otitis media in children we use medications that alleviate the symptoms of the disease, analgesics and antipyretics, which reduce the inflammatory process in the Eustachian tube, and in some cases antibiotics are prescribed. Earache, especially on the first day of illness, must be treated regardless of the decision concerning the use of antibiotics.
The main goals of treating acute otitis media are to eliminate symptoms as soon as possible, eliminate bacteria from the middle ear cavity and prevent purulent complications of the infection. Immediate use of an antibiotic for acute otitis media is usually recommended, but the final decision is made by the doctor.
You should remember that improper treatment of acute otitis media can lead to complications, such as acute mastoiditis, paresis or facial nerve paralysis, otitis interna and intracranial complications.
Otitis media with effusion
In serous otitis media there are no signs of acute or chronic otitis media. Serous otitis media can last for many months or even years. It is an inflammatory disease of the mucous membrane of the Eustachian tube, tympanic membrane and air cells of the mastoid process (presence of a yellow or amber discharge behind the intact tympanic membrane, which thickens over time).
The main symptoms are hearing loss and tinnitus. The discharge is gathered in the tympanic cavity without any perforation of the tympanic membrane. A prolonged presence of such a discharge in the ear leads to a gradual hearing impairment.
What causes serous otitis media?
One of the most common causes of this disease in children is pharyngeal tonsil hypertrophy, which blocks the Eustachian tubes in the nasopharynx, thereby causing its obstruction and impaired functioning. Other causes in children are allergies and specific nose anatomy. Very often this disease occurs in children with cleft palate and genetic syndromes, which are accompanied by an incorrect anatomical structure of the head and neck. Otits media is usually asymptomatic at the first stage, neither children nor parents notice it, and it should be emphasized that otitis shouldn’t be treated with antibiotics (with some exceptions).
Initially, the exudate in the middle ear is watery, over time, due to the presence of the so-called goblet cells producing mucus, it turns into a viscous discharge. This discharge accumulates in the tympanic cavity causing a sensation of overflow in the ear and hearing impairment. If serous inflammation is present for a long time, at least for several months, then the exudate turns into a dense discharge that blocks the middle ear. Such a discharge is much more difficult to remove, even surgically. It can lead to obstructive otitis media and then to permanent deterioration of the middle ear conduction system (auditory ossicles) which leads to hearing loss.
Among other causes of serous otitis media in children are thyroid diseases with hypothyroidism, Turner syndrome and barotrauma (for example, after a flight). An extremely rare cause in children is a nasopharyngeal tumor, while in adults, especially with unilateral serous otitis media, it might be a tumor that can block the mouth of the Eustachian tube and cause its dysfunction.
When should you contact a specialist?
The symptoms of chronic serous otitis media:
- Serous otitis media can be asymptomatic and undiagnosed for a long time, especially in small children. It is due to the fact that exudate in the middle ear usually appears gradually and the child gets used to its presence without informing parents of hearing loss.
- If there are symptoms, the child may complain about hearing loss or a feeling of fullness in the ear, the presence of water in the ear – as after the swimming pool. Sometimes children complain of earaches that are not severe in case of serous otitis media.
- Earache in serous otitis can be caused by a retracted or convex tympanic membrane when dense discharge fills the entire space in the middle ear.
- Changes in child’s behavior should also attract parents’ attention. Irritability, lack of response when a child is called, hyperactivity can be symptoms of hearing impairment, especially in the situation when the child used to behave properly.
- The characteristic symptoms of serous otitis media do not include ear discharge. If they appear it may indicate another disease: perforation in the tympanic membrane, chronic otitis media, inflammation of the external auditory canal. These diseases are associated with more serious conditions of the ear and in many cases they should be treated surgically.
- An increase in body temperature is not a symptom of serous otitis media. In case of increased body temperature and severe pain in the ears, acute otitis media should be suspected, which should be treated with antibiotics. The decision to use antibiotics is up to the doctor.
How to diagnose serous otitis media?
- A medical examination in the ENT room should be aimed at identifying the causes of serous otitis media and determining the level of hearing loss in a child.
- The doctor examines the ear using a video otoscope.
- Otoscopic examination is a basic examination due to which the doctor can assess the condition of the middle ear and the degree of damage of the tympanic membrane or middle ear elements. The doctor also evaluates the patency of the nose and throat, since serous otitis media in children is often associated with enlarged tonsils, especially the pharyngeal tonsil, which is located in the nasopharynx.
- To assess adenoids and their size a fibroscopic examination of the nasopharynx should be performed using a thin camera inserted through the nose of the child.
- After the examination additional audiometric tests are performed. The basic test performed in children is impedancemetry. This test allows us to assess the condition of the middle ear and also to control the healing process of the child. To assess hearing in children a screening test is conducted, which is called otoacoustic emission. It is also a quick and painless test. In older children a pure tone audiometry can be performed to assess the degree of hearing loss.
- After examining the child and additional tests the doctor can determine the most likely cause of the disease and offer appropriate treatment. Sometimes a child needs additional consultation of other specialists, eg., an allergist, since any type of allergy can affect the onset and course of serous otitis media in the child. Treating a child with allergy is also more complex and long-lasting.
Chronic otitis media is characterized by the constant presence of perforation of the tympanic membrane, i.e. rupture, constant or intermittent efussion from the ear, and hearing loss. For this condition the surgical treatment is performed. Chronic otitis media mainly affects adults and is a common consequence of untreated or poorly treated childhood acute otitis media.
– Simple Chronic Otitis Media,
– Otitis Media with Granulation,
– Otitis Media with Choleasteatoma,
– Tuberculous Otitis Media.
There are also inactive forms of chronic otitis media:
– eardrum perforations,
– adhesive otitis media.
They are the results of the previous inflammation of the middle ear.
When should you see a doctor?
Symptoms of the chronic otitis media:
– The main symptoms of the chronic otitis media are hearing loss, effusion from the ear, and dizziness when water has entered the ear (in case of eardrum defect).
– Simple chronic otitis media is characterized by a non malodorous, mucopurulent discharge from the ear and hearing loss.
– Chronic otitis media with granulation is characterized by profuse mucopurulent discharge from the ear, hearing loss, recurrent ear polyps, and the inability to dry the ear, despite proper medical treatment. In the advanced stage of the disease, bone destruction occurs.
– Secondary acquired cholesteatoma is characterized by profuse, often constant, malodorous discharge, and rapidly developing hearing impairment.
– Chronic tuberculous otitis media is characterized by low intensity periodic mucopurulent discharge, damage to the inner ear, and frequent paralysis of the facial nerve.
– The main complaints in tympanosclerosis are hearing loss, often bilateral, and tinnitus.
– The main feature of adhesive otitis media is conductive or mixed hearing loss.