Otitis Media

Otitis media is a middle ear infection and also a reference to a swelling going on in the middle ear. The word otitis refers to inflammation of the ear. The word media is referring to the location which is in the middle ear.

In the pictures below, #7 is showing the inner ear. It is also showing the location where otitis media occurs and where the fluid will build up. This area (colored in red in the pictures) needs to be an air pocket to transfer sound. Fluid build up will also prevent the ear drum from vibrating properly.

The ear is made up of 3 parts; the outer ear, the middle ear, and the inner ear. The inner ear is responsible for hearing and balance. The middle ear is located behind the ear drum as #7 is showing. Other parts of the ear are labeled below.

1. Ear canal
2. Ear drum
3. Auditory bones
4. Semicircular canals
5. Cochiea
6. Eustachian tube

Quick Facts

• Occurs most often in children ages 3-6.
• Seventy five percent of children experience at least one episode by the third grade.
• Ear infections are the most common illness in babies and young children.
• Bottle feeding babies can increase the risk of an episode.
• It is the most common cause of earaches.
• Colds, allergic rhinitis, and other respiratory infections or inflammation can lead to otitis media.

Types of Otitis Media

The two most common types are:

• Acute Otitis Media: Some type of infection is associated with this condition. It usually occurs rather suddenly. The infection will cause redness and can be painful. Parts of the ear will swell and trap mucus and fluid inside. There will be a feeling of pressure (or ear pain and discomfort) and this can affect the hearing. Usually it can last for several weeks. Antibiotics are usually needed to address the infection.
• Otitis Media with Effusion: This condition is referring to the fluid (effusion) and mucus accumulating in the ear. It can develop on its own or it can develop after there is no more infection. Without the presence of infection, antibiotics are not effective. Without the infection, it does not cause the pain that the acute otitis causes. Fluid in the ear, however, always has the potential of giving a feeling of fullness and affecting hearing and the eardrum.

Symptoms

Symptoms may range from mild to severe. Having an infection or not also determines the type of symptoms. Signs and symptoms may be different for different people. It is very common for young people too young to communicate to develop otitis media. In these cases, signs might be crying more, tugging at the ears, and not wanting to lie down, to indicate that they have a problem. Generally, some signs and symptoms may be;

• a feeling of fullness and/or pressure
• pain/earache
• problems with hearing
• congestion
• dizziness and balance issues
• nausea or vomiting
• sleeping difficulties
• fluid drainage from the ear
• fever
• touching the ears because of the discomfort

The Eustachian Tubes

The eustachian tube is a small channel that connects the upper respiratory passageway to the middle ear. It extends from the middle ear to the back of the throat behind the nose. It is a very narrow passage and can be as small as the width of 3-7 hairs along some places along the tube.

In order for the middle ear to function properly, the air pressure on the inside of the ear drum needs to be the same pressure as on the outside. The eustachian tube is responsible for maintaining this pressure equalization. Feeling your ears pop is feeling the eustachian tube performing this function. Normally, these tubes are closed. As a person yawns or swallows, muscles around the tube will contract which will open the tube and adjust the air pressure inside the middle ear. The air pressure on the inside becomes the same as the air pressure on the outside.

As the tubes open, they are also providing a fresh supply of air and allowing the stale air to escape. The middle ear needs this pocket of air to transfer sound from the ear drum to the inner ear.

The Cause

There are various conditions that can cause otitis media. What all these conditions have in common is that they disrupt the function of the eustachian tubes. Without these tubes functioning properly, fluid builds up and has no way of escape. This condition of fluid replacing the air behind the ear drum describes the condition of otitis media. Blockage of the eustachian tubes can result from:

• allergies: (An allergic reaction from hay fever can cause the mucus membrane to swell which can affect the eustachian tubes.)
• second hand smoke (exposure to any air with irritants)
• colds
• flu
• infection (bacteria or virus)
• enlarged tonsils because they are located close to the opening of the eustachian tube family history
• sinusitis
• any other condition that would cause swelling around the eustachian tube causing it to malfunction.

Part of the function of the fluid produced by the cells in the middle ear is to help keep out bacteria, viruses, and other foreign particles. When the eustachian tubes are not draining this fluid, the middle ear fills up with fluid. This provides an ideal breeding ground for germs. The environment becomes warm and moist. Bacteria and viruses may have been lying dormant or they may have entered through the eustachian tube. In any case, as they begin to breed and multiply, the middle ear becomes inflamed and infected. Bacteria may turn the inflammation into infection which may cause a fever. This is the same scenario that happens with sinusitis when the sinuses become closed off.

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