Introduction
Otitis media is the name given to the condition which refers to fluid in the middle ear. The middle ear is the space which lies on the inside of the tympanic membrane. Otitis media is very common, 60% of children will have had an episode of acute otitis media by the age of 2.
Causes
The causes for otitis media are multiple. The main cause of otitis media is eustacian tube dysfunction. The eustacian tube connects the back of the nose to the middle ear. The eustacian tube serves the following purposes:
- Protect the middle ear from secretions in back of nose
- Pressure regulation of the middle ear
- Clear secretions from the middle ear
A child’s eustacian tube is shorter, wider and more horizontal than in adults. As a result, the eustacian tube in children does not work as well as in adults. Consequently, fluid can build up in the middle ear in children and they aren’t able to clear the fluid resulting in otitis media. Otitis media also has the following associations:
- Cleft palate
- Children being in daycare
- Parental smoking
- Allergy
- Overweight
- Indigenous population
Symptoms
Otitis media is divided into acute otitis media (infected) and otitis media with effusion (not infected). The symptoms of these 2 conditions are different.
Acute otitis media is where the fluid in the middle ear is infected. The symptoms of acute otitis media are those associated with an acute inflammatory process and are as follows:
- Pain
- Insomnia – children may wake multiple times during night in pain
- Irritability
- Discharge of pus from ear
- Fever
Otitis media with effusion does not have an infective process. Therefore the symptoms are associated with the fluid being present in the ears causing a reduction in the transmission of sound. These symptoms are as follows:
- Speech delay
- Poor hearing
- Poor concentration at school
- Deterioration in behavior
Investigations
The investigation which should be done in patients who have either acute otitis media or otitis media with effusion and who are about to undergo an operation is an audiogram (hearing test). A hearing test has 2 components, one being testing the patient for their response to sound, the second being testing the patient for movement of their tympanic membrane in response to pressure. The second component which measures the response to pressure chance is called a tympanogram.
If the patient has had acute otitis media which has resolved, the audiogram will commonly be normal. If the patient has otitis media with effusion, then the audiogram will demonstrate a reduction in hearing and the tympanogram will demonstrate that the tympanic membrane does not move with fluctuation in pressure.
Treatment Options
Acute otitis media should be treated with pain relief until it resolves or if the pain and symptoms are getting worse, antibiotics. Grommets are inserted for acute otitis media if one of the following criteria are satisfied:
- 3 episodes of acute otitis media in 6 months
- 4 episodes of acute otitis media in one year
Otitis media with effusion doesn’t necessarily require treatment when it is first diagnosed. If the otitis media with effusion is present for less than 3 months then treatment should be started in the form of a trial of nasal sprays. Grommets are inserted for otitis media with effusion if one of the following criteria are satisfied:
- Otitis media with effusion in both ears for 3 months
- Otitis media with effusion in one ear for 6 months
- Otitis media with effusion with speech delay
Grommets
A grommet is a tube which is inserted into the tympanic membrane to allow air to get in through the grommet into the middle ear. Grommets are inserted under general anaesthetic. The procedure is safe to perform and is relatively quick. Grommets usually stay in the ear drum for between 6 months to 2 years. Grommets fall out by themselves and usually don’t leave a hole in the tympanic membrane. After the grommets have fallen out it is usually recommended that the patient has another hearing test.
