Conditions: Otitis Media
Otitis media is a group of conditions, all of which include abnormal fluid collection in the space behind the eardrum (the middle ear). This fluid may be infected (suppurative) or not, and it may be short lasting (acute) or long lasting (chronic). These differences are detailed below. The term “otitis media” technically ear inflammation in the middle (middle ear), but this strict meaning of the terms is misleading because not all cases of fluid in the middle ear are inflamed, as with serous otitis media.
Fluid in the middle ear (shown in brown) impairs movement of the eardrum and attached bones, dampening hearing. This video depicts spontaneous rupture of the eardrum and fluid drainage.
Fluid in the middle ear (shown in brown) dampens transmission of sound saves to the inner ear. A surgeon can create a small opening in the eardrum to let the fluid out. A surgeon may also place a tube (not shown) to keep this opening from closing rapidly.
suppurative Otitis media (middle ear infection)
Suppurative otitis media is the presence of a bacterial infection in the middle ear space (behind the ear drum).
Infection in the middle ear space usually results from bacteria in the throat progressing up the Eustachian tube. Another potential route for infection to reach the middle ear is through a hole (perforation) in the eardrum, if one exists.
The infection causes pus to develop in the middle ear and the mastoid cells behind the ear. The pus can develop pressure, which may cause severe pain. Sometimes, the pressure builds until the eardrum ruptures, which is associated with decreased pain as the pus is released through the ruptured eardrum and into the ear canal.
As long as fluid exists in the middle ear space, the transmission of sound waves from the ear canal to the inner ear is dampened, leading to hearing loss. Once the fluid has resolved, and barring other problems like a large hole in the eardrum or scar tissue in the middle ear, hearing returns to normal.
It is possible that the bacteria in suppurative otitis media can be sterilized by the immune system with or without the help of antibiotics, but with persistence of noninflected fluid, a condition called serous otitis media, discussed below.
Acute suppurative otitis media is notable for dramatic onset over a day or two. Chronic suppurative otitis media is an infection of the middle ear that lasts more than three months and is almost always accompanied by tympanic membrane perforation.
serous otitis media (Middle ear fluid)
Serous otitis media (also known as otitis media with effusion or secretory otitis media and nonsuppurative otitis media) is the presence of non-infected fluid in the middle ear space. This may be acute (rapid onset and lasting less than 3 months) or chronic (lasting greater than 3 months).
Serous otitis media is usually caused by Eustachian tube dysfunction.
Acute serous otitis media may develop from Eustachian tube dysfunction caused by a cold, sore throat or upper respiratory infection.
Chronic serous otitis media is more commonly the result of Eustachian tube dysfunction typically the result of
Serous otitis media usually resolves spontaneously within 6 weeks. Medical therapy to lessen Eustachian tube dysfunction may increase chances or speed of successful resoluition. Surgical therapies are reserved for cases where conservative (medical) measures have failed.
Serous otitis media is more common in the Fall and Winter than in Spring or Summer. Serous otitis media is most common in ages 6 months to 3 years, and given this age group’s decreased ability to recognize and explain its primary symptom—hearing loss—it may easily go unnoticed by family, especially if the problem is one-sided and the other ear hears normally. Older kids and adults usually seek attention proactively for the hearing loss.
In a clinical setting, serous otitis media may be diagnosed or suspected based on the visual appearance of the eardrum with use of an otoscope. Also, an audiogram (hearing test) and tympanogram (test of eardrum movement) may more definitively support this diagnosis.
how to get the most from your EAR appointment
Appointment time is valuable. Here are some suggestions to make the most of your appointment. This preparation will help you and your doctor maximize efficiency and accuracy, freeing up time for questions and answers.
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