Otitis media or middle ear infection is a common reason for children needing to visit doctors. Ear infections often cause feeling pain, swelling, and bursting of the eardrum. Although Otitis Media can resolve on its own without any complications – sometimes it leads to hearing loss and long-term consequences.
- By age 3, more than 80% of children experience one episode of otitis media at least
- Otitis media can also infect adults, though children are the primary victim
You might be paying frequent visits to an ENT specialist for ear infections in your child. So, it’s important to have some understanding of this common disease.
Let’s get started.
Otitis media is an umbrella term. The term covers a range of diseases, such as:
- Acute otitis media (AOM)
- Otitis media with effusion (OME aka Glue Ear)
- Chronic suppurative otitis media (CSOM)
These three conditions are closely related and can easily overlap. Now we will see how.
This ear infection occurs suddenly, frequently alongside, or shortly after a cold or other respiratory infection. Bacteria or virus infects and traps fluid behind the eardrum – resulting in pain and eardrum swelling – and thus the term “ear infection.”
Ear infections can start quickly and disappear in a few days (acute otitis media), or they can recur frequently and for lengthy periods (chronic otitis media).
It’s a complication that can occur after a case of acute otitis media. If this has remained present for more than three months, but with effusion (fluid accumulation in the middle ear), the condition is known as glue ear. This fluid is thick and sticky (hence the term “glue”)
Many factors contribute to glue ear, the most common being:
- A malfunctioning Eustachian
- Previous ear infections
- Colder season
- Structural factors like a cleft palate
If the Eustachian tube doesn’t properly function and the air from the back of the nose can’t properly enter the middle ear – then the fluid can’t drain down the Eustachian tube. This thick and sticky fluid interferes with the sound transmission through the middle ear and causes mild to moderate hearing loss.
Most glue ear cases will settle and resolve without any medical treatment. However, treatment is recommended if the condition is present for more than three months.
In children, ongoing glue ear can also be associated with slow speech development, attitude problems, difficulty coping with school, frequent earaches, and some imbalance – all symptoms of hearing loss.
The fluid remains in the middle ear for long periods or returns again and again, even though there is no ear infection. This is a condition where the ear infection doesn’t go away even with treatment. Over time, this can cause a rupture in the eardrum.
Middle ear infections are typically caused by the Eustachian tube (a canal that connects the middle ear to the throat) malfunctions. The eustachian tube aids in the equalization of pressure between the outer and middle ear.
When this tube malfunctions, it prevents normal fluid drainage from the middle ear – resulting in a fluid buildup behind the eardrum – this stuck fluid is an ideal habitat for bacteria and viruses – leading to acute otitis media.
Some of the reasons why the eustachian tube may not function properly are:
- A cold or allergy that causes swelling and nose congestion, throat, and eustachian tube lining – this swelling prevents the normal fluid drainage from the ear)
- A Eustachian tube malformation
While anyone, especially children, is at the risk of getting infected with otitis media, the following are common factors
Age: Ear infections are more common in infants and young children (aging 6 months – 2 years).
Feeding approaches: Children who are laid flat while drinking milk from a bottle are at risk of getting ear infections. The milk can slip down into the eustachian tubes, causing irritation and inflammation.
Allergies: Allergies lead to inflammation (swelling) of the upper respiratory tract and nasal passages, possibly causing the adenoids to enlarge. Adenoids that are too large can obstruct the eustachian tube, which prevents ear fluids from draining. This causes fluid build-up in the middle ear, resulting in pressure, pain, and the possibility of infection.
Family history of ear infections: Ear infections can run in families.
Colds: Having a cold increases the likelihood of getting an ear infection.
Chronic illnesses: People with long-term illnesses are more prone to get ear infections, particularly those with immune deficiencies and chronic respiratory diseases like asthma and cystic fibrosis.
The symptoms of middle ear infections are most common, but it slightly differs among children and adults.
- Ear pain (especially while lying down): The most common symptom. As the baby can’t speak, look for signs of pain like repetitive ear rubbing and crying more than usual
- Tugging or pulling at an ear: Your child will tend to pull or tug at their infected ear in hopes of making the pain go away
- Trouble sleeping: The pain and irritation won’t allow your baby to sleep properly. You’ll find yourself up in the middle of the night pretty often
- Loss of appetite: It will be most notable during bottle feedings. As your child swallows, the pressure in the middle ear changes, causing more pain and a decreased desire to eat
- Fever: Fever of 100 F (38 C) or higher can be seen among children while in the phase of ear infection. More than 50% of the affected children experience a fever at this stage
- Fluid drainage from the ear: White, slightly bloody, or yellow discharge can drip from the ear. This means the eardrum may have been damaged
- Trouble Hearing: Middle ear is an integral part of the hearing process. So many complications in the region naturally result in hearing difficulty for the affected child.
- Ear pain
- Drainage of fluid from the ear
- Trouble hearing
Glue ear can thin the eardrum and pull it toward the middle ear (retraction pocket). This can result in damage to the small middle ear bones, further impairing hearing.
A “cholesteatoma” can form if the eardrum is severely retracted. A cholesteatoma is an abnormal skin growth in the middle ear. It is almost always surgically removed.
Children usually outgrow glue ear and acute otitis media. In general, Children over the age of seven or eight are much less prone to middle-ear problems than younger children.
The surgeon will look into the eardrum with lights to investigate and see if the eardrum has any symptoms that might suggest otitis media or glue ear. Sometimes, they use a Tympanogram test to determine the air pressure in the middle ear or find whether there’s fluid in there.
An audiogram (hearing test) helps determine the degree of hearing loss. This will measure the patient’s ability to notice sounds at varying pitches and indicate whether the patient has hearing loss.
A puppet test is done for children between seven months to three and a half years of age. Puppets are used for the visual reinforcement orientation audiometry (VROA) test – a test through which hearing in both ears can be measured. For children older than three and a half years, a pure tone audiogram (PTA) can be used to measure the hearing level separately in each ear.
Audiometry for young children is difficult and not always available. It takes a long amount of time to schedule a test. As a result, grommets are often inserted first – and if doubts of deafness remain, audiometry is done afterwards.
A diagnosis of glue ear, recurrent or acute otitis media is based on physical examinations, tests, the patient’s medical history, and most importantly – the referring doctor’s comments.
- About the Author
- Latest Posts
Dr Ronald Chin is an Australian trained Otolaryngologist Head and Neck Surgeon.
After graduating as a Fellow of the Royal Australasian College of Surgeons, Dr Chin undertook further specialized training in Head and Neck Cancer at the Royal College of Surgeons in Ireland.
He has published many research papers and is an active teacher and scholar.
As part of his sub-specialty training, Dr Chin has training in Laser, Da Vinci Robotic, Flex Robotic and complex surgical techniques.
In addition to specialized Head and Neck Cancer, Dr Chin also enjoys general adult and paediatric ENT Surgery and practices sinus, snoring/sleep and general paediatric ENT Surgical procedures.
Dr Ronald Chin
Conjoint Associate Professor
Otolaryngology Head and Neck Surgery
Western Sydney University