Otitis Media: Symptoms, Causes, Diagnosis, and Treatment

Otitis media is an infection that occurs in the middle ear, which is the space behind the eardrum that has three small bones with the function of capturing vibrations and transmitting them to the inner ear. Although it can occur at any age, this condition is more common in infants and children under 10 years. Check out the full explanation below.

What is Otitis Media?

Otitis media occurs when a virus or bacteria causes the area behind the eardrum become inflamed. When a child has this condition, his middle ear will be filled with pus. Pus can push the eardrum and cause pain. Often, this condition can disappear without any medication. However, you should seek medical attention if the pain continues or a fever occurs.

Otitis Media Symptoms

The most common symptoms of middle ear infection are pain and hearing loss. Inside the middle ear, three small bones (ossicles) usually transfer sound vibrations from the eardrum to the inner ear, where they are converted into nerve impulses that the brain understands as sound.

In people with otitis media, inflammation and infection can change this normal process. In addition, the onset of signs and symptoms of infection usually takes place quickly. The following symptoms can be recognized, including:

In children, common signs and symptoms include:

  • The ear hurts, especially when lying down
  • Frequently pulling ears
  • Hard to sleep
  • Cry more than usual
  • Difficulty hearing or responding to sounds
  • Lost balance
  • Fever 38 degrees Celsius or higher
  • Fluid out of the ear
  • Headache
  • Loss of appetite

In adults, common signs and symptoms include:

  • Fluid out of the ear
  • Hearing problems
  • The ear hurts

When is the Right Time to See a Doctor?

Signs and symptoms of ear infection can indicate a number of conditions. It’s important to get an accurate diagnosis and prompt treatment. Call a doctor if:

  • Symptoms last more than a day
  • Symptoms are present in children younger than 6 months
  • Ear pain is very severe
  • Your child cannot sleep or is easily offended after a cold or other upper respiratory tract infection
  • A discharge such as pus or bloody fluid from the ear

Causes of Otitis Media

Otitis media is caused by bacteria or viruses in the middle ear. This infection is often caused by other diseases such as colds, flu or allergies. When the tube that connects the middle ear to the pharynx (eustachian tube) is blocked, fluid will collect behind the eardrum. Bacteria will develop in the fluid that causes pain and infection.

Colds, throat infections, stomach acids, or allergies can make the eustachian tubes swell. This condition prevents mucus from drying out, so viruses or bacteria grow in the fluid and make pus, which then accumulates in the middle ear.

Children (especially aged 2 to 4 years) get ear infections more often than adults for several reasons:

  • Shorter and more horizontal eustachian tubes make bacteria and viruses more easily enter the middle ear. The channel is also narrower, so it is more likely to be blocked.
  • The adenoid condition, a gland-like structure in the back of the throat, is larger and can interfere with the opening of the eustachian tubes.

Other Related Conditions

Infection often occurs during winter weather, when many people get upper respiratory tract infections or colds (children with ear infections may also have cold symptoms such as nasal congestion or coughing).

Middle ear conditions that may be related to ear infections or cause similar middle ear problems, including:

  • Otitis media effusion. Swelling and accumulation of fluid (effusion) in the middle ear without bacterial or viral infections. This condition may occur because fluid buildup continues after an ear infection gets better. This can also occur due to some dysfunction or blockage of the non-communicable eustachian tubes.
  • Chronic otitis media with effusion. The condition that occurs when fluid in the middle ear continues to appear without bacterial or viral infections. This condition makes children vulnerable to new ear infections and can affect hearing.
  • Chronic suppurative otitis media. Ear infections that do not go away with usual care. This condition can cause holes in the eardrum.

Risk Factors

The following are some risk factors that increase otitis media, including:

  • Age. Children aged 6 months to 2 years are more susceptible to ear infections because of the size and shape of the eustachian tubes and because the immune system is still developing.
  • Childcare. Children who are treated in care are more likely to catch colds and ear infections than children who stay at home. Children in care are at risk of more infections.
  • Breastfeeding position. Babies who drink from a bottle, especially when lying down, tend to have more ear infections than breastfed babies.
  • Seasonal factor. Ear infections are most common during the fall and winter. People with seasonal allergies may have a greater risk of ear infections.
  • Air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of otitis media.
  • Chippy. Differences in bone structure and muscles in children with cleft palate may make the eustachian tubes more difficult to flow.

Otitis Media Diagnosis

Doctors can usually diagnose otitis media or other conditions based on symptoms. However, doctors can also use an otoscope to see the inside of the ear, throat, and nose. In addition, the doctor can also listen to the child’s breathing using a stethoscope.

Pneumatic Otoscope

This tool allows the doctor to see the condition of the ear and assess whether there is fluid behind the eardrum. With a pneumatic otoscope, the doctor gently inserts air into the eardrum. Usually, this puff of air will cause the eardrum to move. If the middle ear is filled with fluid, the doctor will observe the presence or absence of movement in the eardrum.

Additional Test

The doctor can do other tests if there are doubts about the diagnosis, previous treatments that have not produced results, or other serious problems. Some of these tests include:

·         Tematometri

This test measures the movement of the eardrum. This tool works by closing the ear canal, regulating air pressure in the canal, causing the eardrum to move. This tool measures how well the eardrum moves and provides an indirect measure of pressure in the middle ear.

·         Acoustic Reflectorometry

This test measures how much sound is reflected back from the eardrum. Usually, the eardrum absorbs most of the sound. However, the more pressure from the fluid in the middle ear, the more noise from the eardrum.

·         Tympanocentesis

Tympanocentesis is the procedure of inserting a small channel through the eardrum to drain fluid from the middle ear. The fluid is tested to determine whether a virus or bacteria is causing otitis media. This method helps if the infection does not respond well to the treatment that has been done.

Types of Otitis Media

In general, there are two types of middle ear infections: acute otitis media (AOM) and effusion otitis media (OME).

·         Acute otitis media

This type of ear infection comes quickly and is accompanied by swelling and redness in the ears behind and around the eardrum. Fever, earaches, and hearing loss often occur as a result of trapped fluid or mucus in the middle ear.

·         Otitis Media Effusion

After the infection is gone, sometimes mucus and fluid will continue to accumulate in the middle ear. This condition can cause feelings of ‘full’ ears and affect the ability to hear clearly.

Otitis Media Treatment

Treatment of otitis media is dependent on the cause, some infections can disappear without treatment. But your doctor may recommend other treatments to speed up the healing process. Some treatments that can be done are:

·         Compress

Warm compresses can help relieve the pressure that builds up in the ears. How to use it, compress the ear for 20 minutes at rest to help reduce pain. This method can be done in conjunction with other pain treatments, including over-the-counter medicines.

·         Eardrops

Over-the-counter ear drops can help treat cases of otitis externa, an infection that swimmers often experience. Ear drops can be purchased at a pharmacy. However, these drops should not be used on someone who has ear tubes (T-tubes), permanent injuries to the eardrum, or certain ear surgeries.

If the infection does not improve or other symptoms arise, you should stop using drops and consult a doctor.

·         Over-the-counter Drugs

These drugs, such as acetaminophen and ibuprofen, help adults with ear infections associated with inflammation. Decongestants or antihistamines such as pseudoephedrine or diphenhydramine can also help relieve some symptoms, especially those caused by excess mucus in the eustachian tubes.

Medications like this can help relieve pain from ear infections, but will not treat the infection itself.

·         Antibiotics and Other Prescription Medications

According to the Centers for Disease Control and Prevention (CDC), using antibiotics by mouth to treat ear infections is not recommended in cases of middle and external ear infections.

Treatment depends on the cause and severity of the infection, along with other health problems that a person might have. Antibiotics are not effective against ear infections caused by viruses.

Prescription ear drops may be the way doctors treat some ear infections. Prescription ear drops can also sometimes be used to treat pain symptoms.

Otitis Media Complications

Most ear infections do not cause long-term complications. It’s just that if the infection occurs repeatedly, it can cause serious complications. Some complications that can occur are:

·         Hearing disorders

Mild hearing loss that comes and goes is quite common when experiencing an ear infection, but usually improves after the infection heals. Ear infections that occur repeatedly or discharge from the middle ear can cause more significant hearing loss. If there is permanent damage to the eardrum or other middle ear structures, permanent hearing loss can occur.

·         Speech Delay

If hearing is impaired temporarily or permanently, a child may experience speech, social and developmental delays. Stages of speech and
normal language in children can be seen based on the child’s age.

·         Spread of infection

Untreated infections or infections that do not respond well to treatment can spread to nearby tissues. Mastoid infection, a bone bulge behind the ear called mastoiditis is a condition that can occur. This infection can cause damage to the bones and formation of pus-filled cysts.

Although rare, serious middle ear infections can spread to other tissues in the skull, including the brain or the membranes that surround the brain (meningitis).

Prevention of Otitis Media

A few simple steps can help prevent many ear infections. The following are some steps that can be taken to prevent otitis media, including:

·         Maintain Personal Hygiene

Teach children to wash their hands often and not to share eating and drinking utensils. If there are no tissues or handkerchiefs, teach the child to close the cough and sneeze in the elbow. If possible, rarely leave the child too often in day care.

·         Avoid cigarette smoke

For parents who have a smoking habit, this habit should be reduced or if possible try not to smoke. It is intended that your child is not affected by otitis media. Create a smoke-free living environment.

·         Give Exclusive Breastfeeding

If the physical condition of the mother makes it possible to give ASI, it is better to give ASI for at least 6 months. Breast milk contains antibodies that can offer protection from ear infections.

·         Adjust breastfeeding position with the right bottle

If you are giving a bottle, set the baby’s position a little upright. Avoid supporting the bottle in the baby’s mouth when he is lying down. To prevent this, do not place the bottle near the crib.

·         Vaccination

Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for the child. Seasonal flu shots, pneumococci, and other bacterial vaccines can help prevent otitis media.


by Abdullah Sam
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