OTITIS MEDIA (ENGLISH)

Otitis media is one of the most frequent causes for a consultation with an Otolaryngologist. This disease is more common in young children due to the more horizontal position of the Eustachian tube (tube that connects the middle ear to the nose), compared to in an adult.

The function of the Eustachian tube is to drain the fluid produced in the middle ear to the nasopharynx. If for any reason, it is blocked, the liquid will tend to accumulate and may cause an infection.

What causes Otitis Media?

There are several reasons why the Eustachian tube can clog, such as allergies, infections of the upper airway, including sinus infections (sinusitis), excess mucus and saliva produced during teething, adenoiditis (growth of the adenoids), exposure to tobacco smoke and other irritants, gastro-esophageal reflux disease and even feeding in a bad position (lying face up) while feeding from a bottle.

There are certain risk factors increasing the likelihood of a child suffering from acute otitis media such as attending day care, changes in altitude, cold climate, exposure to smoke, not being breastfed, and frequent upper airway infections.

What are the most common symptoms of Otipis Media?

In a young child, the most common manifestations are inconsolable crying, fever (greater than or equal to 38 ° C) or have trouble with sleeping. In older children or adults otalgia (ear pain) may occur, sensation of a clogged ear, malaise, hypoacusia (diminished hearing) of the affected ear.

We can also find a variant to otitis media which is otitis media with effusion, which is the sudden discharge of a yellowish or greenish liquid, thick, sometimes with blood, accompanied by an improvement in ear pain that can signify the rupture of the tympanic membrane.

How to diagnose a patient with otitis media?

The diagnosis is made when the doctor examines the ear with an otoscope or an ear endoscope. What is seen in these cases is known as "doming" of the tympanic membrane which includes fluid or bubbles behind the tympanic membrane, blood or puss and in some cases, a tympanic membrane perforation may be seen.

Otoscope

What is the best treatment for otitis media?

In Otitis Media, one of the most important things in treatment is to relieve the pain. Depending on the origin of Otitis Media, antibiotics and pain killers (paracetamol, ibuprofen, etc) may be given and antihistamines and analgesics either orally or topically.

In general, all children under 6 months, with fever or symptoms as described above (and especially if there is no improvement thereof), should be seen by their physician to determine the best treatment for them.

The trend now is to try to determine if the cause of an ear infection is due to a virus or a bacterial infection since antibiotics have no effect on virus infections. For this reason, you should not prescribe antibiotics for EVERY ear infection.

However, all children under 6 months which present with an ear infection, should be given antibiotics.

If a treatment does not seem to be taking effect within the first 48 to 72 hours of starting the medication, consult your doctor again as he/she may have to change treatment or add other medications.

When to consider surgical treatment?

If an infection does not go away with the usual medical treatment, or if a child presents with repeated infections over a short period of time, thoughts should be considered for inserting ventilation tubes.

This procedure consists of introducing into the tympanic membrane, a very minute tube, which allows entry of air into the middle ear so the liquid which accumulates in it can drain through the eustachian tube easily.

These ventilation tubes usually fall out by themselves. If this does not happen within 6 months after placement, they should be removed by the physician.

If the cause of otitis media is adenoid hyperplasia (growth of the adenoids) then, an adenoidectomy (surgical removal of the adenoids) should be considered.

Usually ear infections are a minor medical problem, which improves without any complications, however, it should be noted that during infection, that children may have a minor and temporary hearing loss. This is due to the presence of fluid in the middle ear.

What are some of the complications of otitis media if not treated properly?

Sometimes, an otitis media, can worsen and may evolve into serious infections such as mastoiditis (infection of bone found behind the ear) or meningitis (infection of the coverings of the brain).

Other complications include a perforated tympanic membrane, chronic and recurrent ear infections, adenoid hyperplasia and of the tonsils, otitis media with effusion, formation of a cholesteatoma (secondary to a chronic infection), delayed language development (as they do not understand the words properly when there is fluid in their ears).

As always, the most important thing is prevention. If you think your child may be having this disease, look for a consultation with your doctor.