Otitis Media

What is Otitis Media?

Otitis media is essentially an infection of the middle ear space. This condition occurs very frequently in kids and less commonly in adults. The otitis media typically results from eustachian tube dysfunction which leads to blockage of the natural drainage pathway from the ear to the back of the nasal airway.  Eustachian tube dysfunction is very common in kids and is likely worsened by viral infections such as the common cold and possibly by nasal allergies. The otitis media typically occurs in phases. The initial inflammatory infection is called acute otitis media and can cause pain and hearing loss. Once the acute inflammation has subsided, the middle ear fluid may drain in a short time, or the fluid may be retained leading to otitis media with effusion (serious otitis media). In some cases, this fluid collection can remain for several months but typically does not cause pain. This condition can cause significant conductive hearing loss.

 

Figure 1  Left acute otitis media.

Figure 2  Right otitis media with effusion.

Treatments

Most cases of acute otitis media resolve without antibiotic treatment, but some require antibiotic treatment and analgesics. Rare cases can progress to more serious infections of the mastoid or brain. Serious otitis media can be observed for some time, but surgical drainage may be considered if there is a prolonged duration of hearing loss. Ventilation tubes (pressure equalization tubes) can be placed for cases of multiply recurrent acute otitis media or long duration of serious otitis media with hearing loss.

Figure 3  Left tympanic membrane with pressure equalization tube.

Myringotomy and Tube Placement

In adults, the ventilation tube can typically be placed in the office under local anesthesia. In kids, the procedure is performed as an outpatient surgery that takes a few minutes. The surgery is performed through the ear canal. Some children benefit from adenoidectomy if multiple sets of ventilation tubes have been needed in the past.

How the Surgery Works

The ventilation tube provides a secondary path of middle ear ventilation that helps the middle ear stay clear of retained fluids. It is the most effective method of keeping fluid from accumulating in the middle ear.

After Surgery Care

In many cases, antibiotic ear drops are used in the ear after surgery for a few days. Regular activities are started at any time. Patients remain at risk for ear infection related to water exposure, but these infections can typically be treated with antibiotic ear drops without the need for oral antibiotics. The tube usually comes out spontaneously within a year, but some tubes fail to come out in a timely fashion, in which case there may be an increased risk of a chronic tympanic membrane perforation.