Otitis Media


Otitis Media-various aspects-                                                                                                                                                                     Your child may visit a doctor for an ear infection, which is an infection that develops in the area beneath the eardrum-otitis media/ear infection .When bacteria or viruses infect and trap fluid behind the eardrum, it results in ear infections, which cause pain and swelling or bulging of the eardrum. Antibiotics, painkillers, and the insertion of ear tubes are all forms of treatment.

Otitis Media
Otitis Media

An ear infection  Otitis Media-what is that?
A sudden infection in the middle ear, or acute otitis media, is the medical word for the popularly used term “ear infection” (the space behind the eardrum). Although ear infections are one of the most frequent reasons why young children visit doctors, anybody can acquire one, including children and adults.

Ear infections frequently go away on their own. Your doctor might suggest a drug to treat your discomfort. Your doctor could recommend an antibiotic if your ear infection has persisted or gotten worse. An antibiotic is typically required for ear infections in children under the age of two.

You should visit your doctor to make sure the ear infection has resolved or if you or your child continue to have pain or discomfort. Frequent ear infections, persistent ear infections, and fluid accumulation behind the eardrum- Otitis Media can all have a negative impact on hearing and have other serious consequences.

The middle ear –
The tiny bones that aid in hearing are located in the middle ear, which is located behind the eardrum (tympanic membrane). The malleus (hammer bone), incus (anvil bone), and stirrup (ossicles) are these bones (stapes). Let’s examine the entire makeup and operation of the ear to get a wider picture:

The external ear, auditory canal, eardrum (tympanic membrane), and inner ear are all components of the ear. The area between the eardrum and the inner ear is known as the middle ear.
Structure and operation of the ear

The outer, middle, and inner are the three primary sections of the ear.

The ear canal and external ear flap make up the outer ear (external auditory canal).
The tympanic membrane (eardrum) and the inner ear are separated by the middle ear, which is filled with air. The fragile bones that carry sound vibrations from the eardrum to the inner ear are housed in the middle ear. Here are ear infections to be found.
The snail-shaped labyrinth in the inner ear is where sound waves from the middle ear are transformed into electrical messages. These impulses are sent to the brain via the auditory nerve.
Other adjacent areas

The middle ear’s air pressure is controlled by the eustachian tube, which connects it to the upper section of the neck.
Little tissue pads called adenoids are found above the throat, behind the nose, and next to the eustachian tubes. Adenoids aid in the defence against infections brought on by bacteria that enter the mouth.
Who is most susceptible to developing an ear infection (otitis media)?
The most typical childhood disease is middle ear infection (other than a cold). Children between the ages of three months and three years are most susceptible to ear infections, though they can develop up to age eight. A quarter of all kids will experience recurrent ear infections.

Ear infections can also occur in adults, but they are much less common than they are in children.

The following are risk factors for ear infections-otitis media-

Age: Ear infections-Otitis Media are more common in infants and young children (between the ages of 6 months and 2 years).
Family history: Ear infections are prone to run in families.
Colds: Catching a cold frequently raises your risk of developing an ear infection.
Allergies: Allergies can cause the adenoids to grow by inflaming (swelling) the nasal passages and upper respiratory tract. The eustachian tube may become blocked by enlarged adenoids, blocking the drainage of ear fluids. This causes fluid to accumulate in the middle ear, which can result in pressure, discomfort, and infection.
Chronic illnesses: Patients with immune deficiencies and long-term respiratory conditions like cystic fibrosis and asthma are particularly susceptible to developing ear infections.
Children of Native Americans and Hispanic descent experience greater ear infections- otitis media– than children of other ethnicities.
Why do ears get infected?
Bacteria and viruses are the main causes of ear infections. A cold or another respiratory infection is frequently followed by an ear infection. The eustachian tube, which is present in each ear, allows bacteria or viruses to enter the middle ear. The middle ear and the back of the throat are connected by this tube. The eustachian tube may expand as a result of the bacteria or virus. The tube may get blocked as a result of the enlargement, preventing the usual production of fluids from being drained away and allowing them to accumulate in the middle ear.

The fact that children’s eustachian tubes are shorter and have less of a slope than adults’ does not help the situation. Due to their physical differences, these tubes are more likely to clog and are more challenging to drain. Pain might result from a viral or bacterial infection of the trapped fluid.

The middle ear infection known as acute otitis media is the one previously mentioned. an unexpected ear infection that typically follows a cold or other respiratory ailment. The bacteria or virus infects and traps fluid behind the eardrum, resulting in pain, eardrum swelling or bulging, and the condition known as a “ear infection.” Acute otitis media is an ear infection that develops suddenly and clears up quickly. Other ear infections recur often and for extended periods of time (chronic middle ear infections).
It is possible for acute otitis media to be followed by otitis media with effusion. The acute otitis media symptoms go away. Although the illness is dormant, the fluid is still present. The accumulated fluid increases the risk of ear infections and might temporarily impair hearing. A block in the eustachian tube, unrelated to the ear infection, is another factor contributing to this illness.
Chronic suppurative otitis media refers to an ear infection that persists despite medical intervention. The eardrum may eventually develop a hole as a result of this.
What signs and symptoms indicate a middle ear infection, or otitis media ?
Among the signs of an ear infection are:

Ear pain: Older kids and adults clearly present with this symptom. Look for indicators of pain in infants who are too young to communicate, such as rubbing or tugging at their ears, crying more frequently than normal, having problems falling asleep, or behaving fussy or irritated.
Lack of appetite: Little children are more likely to experience this, especially while being fed by bottle. As the youngster swallows, the pressure in the middle ear shifts, intensifying the pain and decreasing the child’s appetite.
Irritability: Any type of ongoing discomfort has the potential to make you irritable.
Sleeplessness: Pain may intensify when the youngster is lying down due of an increase in ear pressure.
Ear infections can raise your body temperature to as high as 104 degrees Fahrenheit. About 50% of kids with ear infections also have a fever.
Drainage from the ear: Earwax-free yellow, brown, or white fluid may leak from the ear. This could indicate a punctured eardrum (broken).
Hearing difficulties: The middle ear bones are connected to the nerves that carry electrical signals to the brain in the form of sound. These electrical signals pass more slowly through the inner ear bones as a result of fluid behind the eardrums.
TESTS AND DIAGNOSIS for otitis media-
How are ear infections identified?
Examination of the ears-

With an otoscope, your healthcare practitioner will examine the ear of you or your kid. A healthy eardrum will be transparent and pinkish grey in colour (clear). The eardrum may be inflamed, enlarged, or red if an infection is present.

Your doctor may also use a pneumatic otoscope, which blows a tiny quantity of air at the eardrum, to examine the middle ear fluid. The eardrum ought to oscillate as a result. If there is fluid in the ear, it will be more difficult for the eardrum to move.

Tympanometry is a different examination that uses air pressure to look for fluid in the middle ear. Hearing is not tested in this test. If you or your kid has experienced prolonged or repeated ear infections-otitis media or fluid in the middle ears that is not draining, your healthcare practitioner may prescribe a hearing test, carried out by an audiologist, to identify any potential hearing loss.

Various checks-

In addition, your doctor will examine your throat and nasal passages and use a stethoscope to listen to your breathing to look for indications of upper respiratory infections.

How do you treat an ear infection?/otitis media
Age, infection intensity, kind (first-time, continuous, or repeated infection), and whether or not fluid is present in the middle ear for an extended period of time all affect how an infection is treated.

To treat the pain and fever in you or your kid, your doctor may prescribe drugs. Depending on the child’s age and the severity of the ear infection, your doctor might decide not to prescribe an antibiotic right immediately and instead wait a few days to see if the infection goes away on its own.

Antibiotics for otitis media-

If it is believed that bacteria are to blame for the ear infection, antibiotics may be recommended. If the child is older, your doctor might advise waiting up to three days before recommending antibiotics to see whether a minor illness goes away on its own. If the ear infection in you or your child is serious, antibiotics may be begun straight soon.

Based on your child’s age, the severity of their sickness, and their temperature, the American Academy of Pediatrics has recommended when to prescribe antibiotics for and when you should think about waiting before prescribing. The table below displays their suggestions.

Acute Otitis Media Treatment Recommendations from the American Academy of Pediatrics (AOM)

Age, acute  severity, and temperature treatment for children

older than six months; in either ear

48 hours or more of moderate to severe symptoms, or a temperature of at least 102.2 °F

Use an antibiotic to treat
from six months to 23 months; both ears
Moderate for about 48 hours and a temperature of 102.2
Use an antibiotic to treat
6 months to 23 months; mild for 48 hours; temperature of 102.2 F.
Antibiotic therapy OR observation If the child’s condition worsens or doesn’t improve within 48 to 72 hours of the onset of symptoms, start antibiotics. for
older than 24 months; in either ear
A 48-hour mild spell with a 102.2° F temperature.
Antibiotic therapy OR observation If the child’s condition worsens or doesn’t improve within 48 to 72 hours of the onset of symptoms of otitis media start antibiotics.
Follow the directions properly while taking an antibiotic that your doctor has prescribed. A few days after beginning treatment, you or your child will begin to feel better. Do not stop taking the medication until instructed to do so, even if you are feeling better and the discomfort has subsided. If you don’t take the prescribed dosage in its entirety, the infection can return. Use a measuring spoon made for liquid drugs if the antibiotic recommended for your child is a liquid to ensure that you provide the correct dosage.

Antibiotic eardrops and occasionally the use of a suctioning equipment to drain fluids are used to treat chronic suppurative otitis media, which is a hole or tear in your eardrum brought on by a severe illness or an ongoing infection. You’ll receive detailed instructions from your healthcare practitioner on what to do.

medicines that reduce pain

Acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) are over-the-counter medications that can treat fever or ear pain. Eardrops for pain relief may also be administered. Within a few hours, these drugs normally start to reduce the discomfort. Your doctor will advise you on painkillers for yourself or your child and provide you any extra advice.

Never give children aspirin in otitis media -Reye’s Syndrome, a potentially fatal illness, can be brought on by aspirin.

During night, earaches typically pain more. A warm compress applied to the outer ear may also help to reduce discomfort. (This is not advised for babies.)

Aural tubes (tympanostomy tubes)

It’s possible for ear infections to be persistent (chronic), recurrent, or even to have fluid in the middle ear for months after the illness has subsided (otitis media with effusion). By the age of five, the majority of kids will get an ear infection, and some kids may get them frequently. Children may experience pain within the ear, a feeling of fullness in the ear, muffled hearing, fever, nausea, vomiting, diarrhoea, crying, irritability, and tugging at the ears as telltale indicators of an ear infection (especially in very young children). You might be a candidate for ear tubes if your child has had recurrent ear infections in case of  otitis media (three ear infections in six months or four infections in a year), ear infections that weren’t treated with antibiotics, or hearing loss caused by fluid buildup behind the eardrum. Ear tubes can offer instant relief, and they are occasionally advised for young children who are still learning to speak and communicate verbally. In order to do this outpatient surgical treatment, known as a myringotomy with tube placement, you can be sent to an ENT expert. During the procedure, a tiny incision (cut) in the eardrum is used to implant a small metal or plastic tube. The tube permits fluid to drain and allows air to enter the middle ear. The process takes only a few minutes, and there are very few complications associated with it. Normally, this tube is left in place for six to twelve months. Although it frequently comes out on its own, your doctor can also remove it. Once the eardrum hole has fully healed and closed, the outer ear must be kept dry and free of contaminated water, such as lake water.

What are the negative effects of persistent ear infections due to otitis media or fluid buildup in the ears?
Although most ear infections don’t last long, when they do, complications can include:

Hearing loss: An ear infection frequently results in a slight, transient hearing loss (muffling or sound distortion). More severe hearing loss can be brought on by ongoing infections, infections that recur frequently, and damage to the internal ear tissues caused by an accumulation of fluid.
Delay in language and speech development: Children must hear in order to learn language and grow in speech. Development can be greatly slowed down or prevented if hearing is muffled for an extended period of time or if it is lost.
Tear in the eardrum: When there is persistent fluid in the middle ear in otitis media pressure from it can cause a tear to form in the eardrum. A tiny eardrum rip appears in 5% to 10% of kids who have an ear infection. Surgery can be required if the tear cannot heal on its own. Do not insert anything into your ear canal if you have ear leakage or discharge. If the item accidentally touches the ear drum, doing so could be harmful.
Infection spread: Infections that don’t go away on their own, are left untreated, or are only partially cured by treatment, may spread outside of the ear. A adjacent mastoid bone may become damaged by infection (bone behind the ear). Rarely, an infection may extend to the meninges, the membranes that protect the brain and spinal cord, and result in meningitis.
PREVENTION of otitis media-
What can I do to keep my child and I from getting ear infections?
These are some techniques to lower your or your child’s chance of developing ear infections:

Avoid smoking. According to studies, secondhand smoke increases the risk of ear infections. Make sure no one smokes inside the house, in the car, at the daycare centre, or anywhere else where children may be present.
Managing allergies The eustachian tube can get blocked due to inflammation and mucus brought on by allergic reactions, which increases the risk of ear infections-otitis media
fend against colds. Minimize your child’s first year of life exposure to colds. Never share utensils, food, drinks, or toys. Always wash your hands. The majority of ear infections begin with a cold. Delay using huge daycare facilities for the first year if at all possible.
Give your baby breast milk. During the first 6 to 12 months of life, breastfeed your child. Ear infections are less common because breast milk contains antibodies.
baby with a bottle at a straight angle. If you bottle-feed, hold your child at an angle that is upright (head higher than stomach). Formula and other liquids may return into the eustachian tubes when feeding in the horizontal posture. A baby holding his or her own bottle may also allow milk to enter the middle ear. This issue can be resolved by weaning your infant from the bottle between the ages of nine and twelve months.
Look out for snoring or mouth breathing. Large adenoids could be the reason why you snore constantly or breathe through your mouth. They could be a factor in ear infections-otitis media .It may be essential to undergo an otolaryngologist examination and potentially an adenoidectomy (the removal of the adenoids).
Grab your shots. Ensure that your child has received all recommended vaccinations, including the annual influenza vaccine (flu shot) for those 6 months of age and older. Ask your doctor about the meningitis, pneumococcal, and other immunisations as well. Ear infections-otitis media can be avoided by avoiding viral and other illnesses.
PERSPECTIVE / PROGNOSIS in otitis media-
What can I anticipate if my child or I get an ear infection?
Infections of the ears are frequent in kids. Adults can also acquire them. The majority of ear infections are minor. To treat fever and pain, your doctor may provide over-the-counter drugs. After taking the medication, pain relief could start as soon as a few hours later.

A few days may pass before an antibiotic is prescribed by your doctor. Many infections resolve without the need for antibiotics. After two to three days after receiving an antibiotic, you or your kid should begin to feel better.

In order to avoid fluid from draining from the eustachian tube as it typically should, ear tubes may be surgically installed in the eardrum if you or your kid has persistent or frequent infections or if fluid lingers in the middle ear and threatens hearing.

Never be reluctant to ask any questions or voice any concerns to your healthcare professional regarding otitis media .

LIFE WITH otitis media
When should I make a follow-up appointment with my doctor?
You will be informed by your healthcare practitioner when you need to schedule a follow-up appointment. Your eardrum or the eardrum of your child will be checked at that appointment to make sure the infection is clearing up. Your doctor might also want to check the hearing of you or your child.

Follow-up checks are crucial, particularly if the illness resulted in an eardrum perforation.

How soon after an ear infection  otitis media should I call the doctor?
Contact your medical professional right away if:

You or your kid starts to get stiff necks.
Your child is unresponsive, exhibits signs of extreme sickness, or won’t stop sobbing despite your best attempts.
Your child is physically very frail, and it shows in the way he or she walks.
Your child’s or your own ear discomfort is quite bad.
104° F (40° C) or above is the fever you or your child has.
Your child is displaying facial symptoms of weakness (look for a crooked smile).
You observe fluid flowing from the ear that is bloody or pus-filled-sign of otitis media
Contact your medical professional during business hours if:

After taking an antibiotic for more than 48 hours, the fever persists or returns.
After taking an antibiotic for three days, ear ache has not improved.
Severe ear ache exists.
You have any inquiries or worries.
Why do kids suffer ear infections so much more often than adults do? Will my kid consistently develop ear infections?
For the following reasons, children are more likely than adults to have ear infections:

Young children have shorter, more horizontal eustachian tubes. This kind promotes fluid accumulation behind the eardrum.
Children’s immune systems, which are part of the body’s system for combating infections, are still developing.
Children’s adenoids are generally larger than those of adults. The little tissue pads found above the neck, behind the nose, and next to the eustachian tubes are known as adenoids. They may obstruct typical ear drainage from the eustachian tube into the throat when they enlarge to battle infection. A middle ear infection otitis media may result from this fluid obstruction.
At age 8, most kids no longer experience ear infections.

If I have an ear infection and walk outside, do I need to cover my ears?
If you go outside, you do not need to cover your ears.

Can someone with an ear infection –otitis media swim?
As long as your eardrum is not perforated and there is no drainage coming from your ear, swimming is safe.

I have an ear infection. Can I fly or be at high altitudes?
It is safe to travel by plane or to the mountains, though flying may cause brief discomfort during takeoff and landing. During flight, discomfort can be reduced by drinking liquids, chewing gum during descent, or giving a youngster a pacifier.

Are  ear infections –otitis media contagious ?
Ear infections are not spread via contact.

When is my child able to resume their regular daily activities?
Once the fever has subsided, kids can go back to school or daycare.

What other reasons might an earache have?
Other reasons for ear pain include:

an aching throat
Baby teeth starting to erupt.
an infection of the ear canal’s lining. Also known as “swimmer’s ear,”
Allergies and colds can lead to middle ear pressure buildup.

What is otitis media/ear infection ?
Otitis medis is infection located to middle ear.
Usually it occurs due to cold common or any upper respiratory tract infection that travels to middle ear through the eustachian tube.
Patient of otitis media usually complains of earache ,decreased hearing,ocassionally ear discharge,headache.
Whenever you have such complaints ,you usually visit your regular doctor.
But if you are getting only temporary relief with medicines and the problem keeps on recurring again and again,then you need to consult  an ENT specialist doctor.
If patient neglects these symptoms ,then over a period of months-1 yr-2 yrs  he may develop tympanic membrane central perforation or cholesteotoma which may require tympanoplasty surgery or mastoid surgery respectively  .

Cholesteotoma if untreated has  chances of landing in intracranial complications, so till waiting for the eleventh hr, it is always better to start treatment at the earliest.-but this explanation is not just sufficient ,for detailed information on causes, signs ,symptoms ,investigations ,diagnosis ,prevention and treatment of otitis media ,pl go through this above article .

Otitis media with effusion-

Otitis medium with effusion (OME) is a thick or sticky fluid in the middle ear that surrounds the eardrum. It takes place devoid of an ear infection.

The back of the neck and the interior of the ear are connected via the Eustachian tube. This tube aids in the drainage of fluid to stop it from accumulating in the ear. The liquid exits the tube and is ingested.

There are two links between OME and ear infections:

A few days or weeks pass after the majority of ear infections have been treated before fluid (an effusion) returns to the middle ear.
Middle ear fluid swells when the Eustachian tube is partially occluded. Once trapped, bacteria inside the ear start to multiply. The result could be an ear infection.
Increased fluid in the middle ear can result from the Eustachian tube lining swelling, which can be brought on by the following:

Irritants (especially cigarette smoke) (particularly cigarette smoke)
breathing infections
The Eustachian tube may close or get clogged for the reasons listed below:

drinking in a backwards lying position
Unexpected rises in air pressure (such as descending in an aeroplane or on a mountain road)
A baby’s Eustachian tube will not become plugged as a result of getting water in their ears.

It can happen at any time of year, but it is more often in the winter or the early spring. People of all ages may be affected. Although rare in infants, it happens most frequently in children under the age of two.

Otitis media with effusion affects children more frequently than older children or adults for a variety of reasons:

Because the tube is shorter, more horizontal, and straighter, bacteria can enter more easily.
The tube has a smaller, more easily blocked aperture and is floppier overall.
Because it takes time for the immune system to develop the capacity to recognise and combat cold viruses, young children are more likely to have colds.
OME fluid frequently has a thin, watery consistency. It was once believed that the fluid thickened the longer it remained inside the ear. (A frequent moniker for OME with thick fluid is “glue ear”). The ear itself, rather than how long the fluid has been present, is now regarded to be connected to fluid thickness.

If any patient requires to undergo any ENT surgery or requires online consultation,actual consultation in clinic of  ENT specialist doctor-Dr Sagar Rajkuwar, he may contact him at the address given below-
Prabha ENT clinic, plot no 345,Saigram colony, opposite Indoline furniture Ambad link road ,Ambad ,1 km from Pathardi phata Nashik 422010,Maharashtra,India -Dr Sagar Rajkuwar (MS-ENT), Cel no- 7387590194,9892596635

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