Doctor, Please Explain
Earaches
Insight into otitis media and treatment
• What is otitis media?
• Is it serious?
• What are the symptoms?
• and more...
What is otitis media?
Otitis media means inflammation of the middle ear. The inflammation
occurs as a result of a middle ear infection. It can occur in one or
both ears. Otitis media is the most frequent diagnosis recorded for
children who visit physicians for illness. It is also the most
common cause of hearing loss in children.
Although otitis media is most common in young children, it also
affects adults occasionally. It occurs most commonly in the winter
and early spring months.
Is it serious?
Yes, it is serious because of the severe earache and hearing loss it
can create. Hearing loss, especially in children, may impair
learning capacity and even delay speech development. However, if it
is treated promptly and effectively, hearing can almost always be
restored to normal.
Otitis media is also serious because the infection can spread to
nearby structures in the head, especially the mastoid. Thus, it is
very important to recognize the symptoms (see list) of otitis media
and to get immediate attention from your doctor.
How does the ear work?
The outer ear collects sounds. The middle ear is a pea sized,
air-filled cavity separated from the outer ear by the paper-thin
eardrum. Attached to the eardrum are three tiny ear bones. When
sound waves strike the eardrum, it vibrates and sets the bones in
motion that transmit to the inner ear. The inner ear converts
vibrations to electrical signals and sends these signals to the
brain. It also helps maintain balance.
A healthy middle ear contains air at the same atmospheric pressure
as outside of the ear, allowing free vibration. Air enters the
middle ear through the narrow eustachian tube that connects the back
of the nose to the ear. When you yawn and hear a pop, your
eustachian tube has just sent a tiny air bubble to your middle ear
to equalize the air pressure.
What causes otitis media?
Blockage of the eustachian tube during a cold, allergy, or upper
respiratory infection and the presence of bacteria or viruses lead
to the accumulation of fluid (a build-up of pus and mucus) behind
the eardrum. This is the infection called acute otitis media. The
build up of pressurized pus in the middle ear causes earache,
swelling, and redness. Since the eardrum cannot vibrate properly,
hearing problems may occur.
Sometimes the eardrum ruptures, and pus drains out of the ear. But
more commonly, the pus and mucus remain in the middle ear due to the
swollen and inflamed eustachian tube. This is called middle ear
effusion or serous otitis media. Often after the acute infection has
passed, the effusion remains and becomes chronic, lasting for weeks,
months, or even years. This condition makes one subject to frequent
recurrences of the acute infection and may cause difficulty in
hearing.
What will happen at the doctor’s office?
During an examination, the doctor will use an instrument called an
otoscope to assess the ear’s condition. With it, the doctor will
perform an examination to check for redness in the ear and/or fluid
behind the eardrum. With the gentle use of air pressure, the doctor
can also see if the eardrum moves. If the eardrum doesn’t move
and/or is red, an ear infection is probably present.
Two other tests may also be performed:
• Audiogram – This tests if hearing loss has occurred by presenting
tones at various pitches.
• Tympanogram – This measures the air pressure in the middle ear to
see how well the eustachian tube is working and how well the eardrum
can move.
The importance of medication
The doctor may prescribe one or more medications. It is important
that all the medication(s) be taken as directed and that any
follow-up visits be kept. Often, antibiotics to fight the infection
will make the earache go away rapidly, but the infection may need
more time to clear up. So, be sure that the medication is taken for
the full time your doctor has indicated. Other medications that your
doctor may prescribe include an antihistamine (for allergies), a
decongestant (especially with a cold), or both.
Sometimes the doctor may recommend a medication to reduce fever
and/or pain. Analgesic ear drops can ease the pain of an earache.
Call your doctor if you have any questions about you or your child’s
medication or if symptoms do not clear.
What other treatment may be necessary?
Most of the time, otitis media clears up with proper medication and
home treatment. In many cases, however, further treatment may be
recommended by your physician. An operation, called a myringotomy
may be recommended. This involves a small surgical incision
(opening) into the eardrum to promote drainage of fluid and to
relieve pain. The incision heals within a few days with practically
no scarring or injury to the eardrum. In fact, the surgical opening
can heal so fast that it often closes before the infection and the
fluid are gone. A ventilation tube can be placed in the incision,
preventing fluid accumulation and thus improving hearing.
The surgeon selects a ventilation tube for your child that will
remain in place for as long as required for the middle ear infection
to improve and for the eustachian tube to return to normal. This may
require several weeks or months. During this time, you must keep
water out of the ears because it could start an infection.
Otherwise, the tube causes no trouble, and you will probably notice
a remarkable improvement in hearing and a decrease in the frequency
of ear infections.
Otitis media may recur as a result of chronically infected adenoids
and tonsils. If this becomes a problem, your doctor may recommend
removal of one or both. This can be done at the same time as
ventilation tubes are inserted.
Allergies may also require treatment.
So, remember…
Otitis media is generally not serious if it is promptly and properly
treated. With the help of your physician, you and/or your child can
feel and hear better very soon.
Be sure to follow the treatment plan, and see your physician until
he/she tells you that the condition is fully cured.
What are the symptoms?
In infants and toddlers look for:
• pulling or scratching at the ear, especially if accompanied by
other symptoms
• hearing problems
• crying, irritability
• fever
• vomiting
• ear drainage
In young children, adolescents, and adults look for:
• earache
• feeling of fullness or pressure
• hearing problems
• dizziness, loss of balance
• nausea, vomiting
• ear drainage
• fever
Remember, without proper treatment, damage from an ear infection
can cause chronic or permanent hearing loss.
Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.
