INTRODUCTION:-
Acute otitis media (AOM) implies an acute bacterial inflammation of the middle ear cleft, which includes ET (Eustachian tube), middle ear, attic, aditus, antrum, and mastoid air cells.
Though AOM can occur in all ages, it is mainly the disease of children as the ET is shorter, wider, and more horizontal and opens at the lower level in children. Both ears may be involved.
AOM is not only the most common bacterial infection in children but also a leading cause of hearing loss in children.
AOM is the most common disease in childhood, with the exception of viral upper respiratory infection (URI). Most of the children have at least one incidence of middle ear infection.
50% of the children get 3 or more episodes of AOM, and 25% have 6 or more episodes.
The highest prevalence occurs in the first 2 years and decreases thereafter.
AOM is more frequent in the winter months.
The ear is divided into 3 main parts –
- Outer ear,
- Middle ear and
- Inner ear.
It has its most famous component, which is the eardrum right at the entrance of the middle ear (which is apparently the end of the outer ear).
The eardrum is attached to a set of three bones – malleus, incus, and stapes.
The sound wave from the outside environment (be it due to somebody talking, vehicles honking, music, etc.) enters the ear and strikes the eardrum to create a set of vibrations. These vibrations further travel through the 3 set bones where the brain amplifies, hears, and interprets the sound.
Lastly, the Eustachian tube is a part of the middle ear and helps maintain the air pressure across the ear. Alongside that, it also helps in throwing out cellular debris and other waste outside the ear.
Any infection that is seen at the eardrum or middle ear gives rise to acute or severe otitis media, which is an ear infection.
This infection can arise only in that region, or it could be an infection that was spread from some other region where the bacteria was previously brewing.
ROUTES OF INFECTION
1) Eustachian tube (ET):
The infection in the middle ear usually reaches through the ET.
Reflux from the nasopharynx into the middle ear occurs during swallowing; nose blowing
and closed-nose swallowing (Toynbee’s maneuver).
It is the result of negative middle ear pressure (sniffing).
The following conditions may be present in cases of AOM such as–
- Anatomical obstruction: Big adenoids and nasopharyngeal tumors.
It is believed that it is not the obstruction but the bacterial entry into the middle ear due to the failure of protection (abnormally patent tube), which is more important.
Big adenoids, which are elevated during swallowing, may obstruct the posterior choanae
and increase nasopharyngeal pressure that results in reflux. - Infections: Adenoiditis, tonsillitis, rhinitis, sinusitis, pharyngitis.
Adenoids serve as a bacterial reservoir in the nasopharynx in children with AOM. - Forceful blowing of the nose: The forcible blowing of the nose can push the infection into the middle ear through the ET.
- Swimming: Especially during diving, water enters the nose under pressure. If water is infected, it can spread the infection to the nose, sinuses, and middle ear.
- Iatrogenic (means due to surgery): Postnasal packing and after adenoidectomy.
- Feeding bottle: In the lying down position (where the child is lying on its back), bottle feeding may lead milk to enter the middle ear via ET.
- Blood-borne infection: Rare.
2. Pre-existing tympanic membrane perforation:
Trauma while cleaning the external auditory canal (EAC) or an open hand slap on the ear.
3. Fracture of the temporal bone:
In cases of head injury, the middle ear may be involved with the fracture of the temporal bone.
CAUSES
Also, at times there are instances where Acute otitis media is caused due by various other reasons like —
- Allergies
- Cold
- Flu
- Sinus infection that spreads to the ear
- Lymphatic tissue infection near the ear
- Malpractice like smoking
- Feeding the babies while lying down
- Bottle feeding to infants instead of breastfeeding
- Pollution
- Change in weather
- When we move from ground level to high-altitude places
- Minus degree temperatures
Thus, depending on the kind of bacteria, its source, and other diseases associated with it, if any, the symptoms and treatment are determined.
SYMPTOMS
- Ear pain
- Neck pain
- Headache
- Pus and fluids leaking out of the ear
- Stuffiness in the ear
- Irritation or a tingling sensation with severe pain
- Sleeplessness
- Feeling of heaviness in the ear that pulls it down
- Fever
- Vomiting
- Diarrhea
- Lack of hearing
- Lack of balancing by the Eustachian tube
DIAGNOSIS
1. Otoscope:- it is a device that helps to see if there is any, Redness, Swelling, Pus, Blood Air bubbles, Fluids leaking, or Hole in the eardrum
2. Tympanometry:- it is a device that induces some air pressure into the ear. This changes the pressure inside the ear and thus causes the eardrum (tympanum) to move back and forth. This movement is recorded on a tympanogram which will tell us if there is any fluid or infection behind the ear and, if so, how much fluid is present (extent of infection).
If the result is negative, it means that the ear is normal.
3. Hearing test:- the ability of a person to hear is determined by conducting a normal hearing test.
TREATMENT
Home remedies:- they are the first line of treatment for most infections and otitis media as well. Some of them are,
- A warm cloth placed over the ear
- Steam using a dispenser
- Drinking hot water
OTC (over-the-counter) medicines:-
- Pain killers
- Ibuprofen (Advil, Motrin)
- Acetaminophen (Tylenol)
Note: the above-mentioned medicines should be taken on a doctor’s prescription.
MEDICATIONS
Antibiotics
Surgery
Considering to be the last option, some of the surgeries recommended for otitis media are,
- Adenoid removal:- adenoids are a mass of lymphatic tissue near the ear that is surgically removed when infected.
- Ear tubes:- a thin tube is inserted into the eardrum that drains out all the fluid and puss present on the other side of the ear during an infection.
It is of utmost importance to look into the problem at the earliest as it can turn up again and again, giving rise to adverse effects like,
- Enlarged adenoids
- Worsening tonsils
- Damage in the eardrum
- Cysts of small lumps form in the middle ear. They are basically extra growth.
- Delayed speech as they take longer time to hear than normal.
PREVENTION
- Maintain hygiene, and wash hands regularly to avoid colds.
- Get yourself vaccinated for flu and other diseases
- Avoid smoking
- Do not breastfeed infants while they are sleeping.
- Prevent pollution.
THANK YOU
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