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Otitis media: all about otitis in children and adults Symptoms and Treatment

Note: this file only mentions acute otitis media , thus excluding chronic otitis media and otitis externa, an infection of the external ear canal whose causes and treatment are different from those of otitis media. medium and otitis interna, or labyrinthitis, very different and rare. For more information about it, see our Labyrinthite fact sheet  .

Acute otitis media: definition

Acute otitis media (AOM) is an infection of the middle ear that affects the eardrum or tympanic cavity, a small bone cavity located between the eardrum and the inner ear and containing the ossicles.

This cavity is connected by a duct (the Eustachian tube) to the nasopharynx located behind the nasal fossae (see diagram below). The Eustachian tube is used to equalize the pressure of the air between the nasal fossae, the middle ear and the outside air.

Acute otitis media (AMO) is characterized by a generally purulent effusion in the eardrum.

OMA is linked to a bacterial or viral infection, virus or bacteria most often contaminating the middle ear as a result of rhino-sinusitis or rhino-pharyngitis by borrowing the Eustachian tube.

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An infection or inflammation of the nose and sinuses (naso-sinus), hypertrophy of the adenoids can also cause an obstruction of the Eustachian tube, resulting in secretion of fluid in the tympanic cavity (mucous otitis media). initially inflammatory but susceptible to becoming infected with acute otitis media.

Classically, AOM is manifested by fever and pain in one or two ears (usually one) often very intense, but not always.

Symptoms of otitis in children

Signs can be misleading, especially in children and infants. Think of acute otitis media when: 

  • the child often touches the ear
  • the child cries, is irritable, has difficulty falling asleep
  • has a lack of appetite.
  • has digestive disorders, very misleading with diarrhea and vomiting
  • has a hearing loss (the child does not react to weak sounds).

Symptoms of acute otitis media in adults

  • pulsating pain (punctuated by the heartbeat) in the ear, which can radiate into the head?
  • a clogged ear sensation, hearing loss.
  • sometimes tinnitus or dizziness

When the eardrum is perforated, otitis can result in a flow through the auditory canal of a flow more or less purulent

Diagnosis of acute otitis media

It is necessary to consult a doctor to confirm the diagnosis of AMO and decide on the relevance of an antibiotic treatment.

The diagnosis is made by looking at the eardrum, ideally with a microscope. It will differentiate an OMA with purulent effusion of congestive otitis, limited to inflammation of the eardrum.

Note that this examination may show a particular form of acute otitis media, myringitis (ie inflammation of the eardrum), of viral origin, very painful which results in the presence of a bubble often covering the quasi -total tympanum , but which concerns only the eardrum, ie after piercing this bubble, which usually causes the pain to disappear, the eardrum remains intact, without tympanic perforation.

The evolution of acute otitis media

Well treated, the OMA cures in 8 to 10 days, but it is always necessary to check after treatment the state of the eardrum and to make sure, especially in the children, that the hearing returned perfectly.

The evolution of AMO is therefore generally benign but a certain number of complications are possible:

Serous or serosal otitis

After healing of the infection, there persists behind the eardrum a non-purulent but inflammatory, non-painful effusion, which favors on the one hand the recurrence of AMO.

This effusion may result in a decrease in persistent and severe hearing in the child as potentially responsible for delayed language; hence the need for surveillance at the end of treatment. An audiogram ( hearing test ) may be necessary if in doubt. In the absence of cure, one can be brought to propose the installation of an aerator-transtympanique.

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Tympanic perforation

The purulent effusion can exert a strong pressure on the damaged eardrum (in this case the pain is particularly intense) and cause perforation of the eardrum , with sometimes bloody discharge that usually leads to the suppression of pain.

After healing, the eardrum usually closes spontaneously, but in very variable time, sometimes lasting a few months.

Exceptional evolutions

  • the  meningitis
  • labyrinthitis
  • mastoiditis, rare today
  • chronic otitis – including cholesteatoma, a form of aggressive chronic otitis – has also become more rare.

Children more affected than adults

Before the age of 3, it is estimated that about 85% of children will have at least one AMO, and half will have done at least two. OMA mainly affects children, because of the shape and position of their Eustachian tube (narrow and positioned more horizontally) as well as the immaturity of their immune system. Boys are slightly more at risk than girls, for unknown reasons.

The large-scale administration of certain vaccines, in particular the pneumococcal and Haemophilus influenza vaccines, has made it possible to reduce the frequency of acute otitis media and especially the frequency of antibiotic-resistant AMI.

The OMA mainly occurs in case of dysfunction of the Eustachian tube, otitis media (the persistent fluid behind the eardrum is more easily infected), repeated infections of the nose or sinuses of allergic origin or not .

It is also more common during disorders of immunity (children born prematurely, malnutrition … etc.) or anatomical abnormalities of the face, trisomy 21, cleft palate (or hare beak) for example.

How is otitis caught?

  •     Attendance at a day care center or nursery.
  •     Exposure to tobacco smoke or high levels of pollution.
  •     Bottle feeding rather than breastfeeding (see Prevention section).
  •     Bottle feeding in the supine position.
  •     Frequent use of a pacifier
  •     The absence of a correct blowing

Prevent acute otitis media

Preventive measures to prevent AMO

One of the essential measures to prevent AOM and their recurrence is to limit naso-sinus infections:

  • ensure good nasal hygiene, essential measure, with regular instillations of physiological saline and a good blowing, spontaneous or with the help of a fly-baby
  • look for and treat respiratory and food allergies
  • consider removal of adenoids if they are hypertrophied

Vaccination against pneumococcus and Haemophilus influenza reduces the frequency of ear infections in children, especially those with resistant germs.

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Other basic measures against AMO

  • Wash your hands regularly .

Teach children to do the same. This is the main way to prevent colds , which can lead to ear infections.

  • Do not smoke and avoid exposure to second-hand smoke .

Children exposed to second-hand smoke are much more likely to get ear infections. Besides, the healing is often longer. There is evidence that child whose parents smoke at home have up to 4 times more ear infections than children living in a smoke-free environment . Second-hand smoke impairs the functioning of the Eustachian tube and the protective properties of the mucous membrane of the nasopharynx.

  • Choose a small daycare as much as possible.

The greater the number of children in the daycare or crèche, the more likely the child will be exposed to colds.

  • Focus on breastfeeding as much as possible.

According to experts at the Mayo Clinic in the United States, bottle-fed babies are 2 to 3 times more likely to have ear infections than breastfed infants. Breastfeeding strengthens the baby’s immune defenses.

  • The installation of a transtympanic aerator allows to ventilate the tympanic cavity and to evacuate the secretions.

It improves hearing and reduces the recurrence of AMO. An audiometric test must be performed before and after the pose. The trans-tympanic aerator “falls” spontaneously after several months during which it is advisable not to put water in the ear. The eardrum usually closes spontaneously.

What you should not do

Some had proposed regular antibiotics as a preventive measure. Not only does this practice prevent acute otitis media, but it exposes the child to the side effects of antibiotics and leads to resistance of germs to antibiotics, both bad at the individual level (risk of not having effective antibiotic during subsequent infection) and collectively (increase of resistant bacteria in the population).

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How to treat otitis?

Analgesics against pain

To relieve fever and pain, it is essential to use pain medication, with paracetamol (acetaminophen) as a priority. The use of an anti-inflammatory type ibuprofen is also possible as an alternative after the age of 3 months.

Disinfect the nasal cavity

Disinfection of the nasal cavity with saline or other solutions derived from seawater and / or nasal drops is essential, OMA is always linked to rhino-pharyngeal involvement.

Antibiotics if the symptoms are moderate

Antibiotics have no interest in either sero-mucositis or congestive otitis. The majority of AMOs are free of antibiotics, so antibiotic treatment beyond 2 years of age can be avoided if the signs (pain, fever) are mild, and monitoring of temperature and pain . Antibiotic therapy is indicated in children under 2 years of age, in severe pain or fever over 39 ° C or if the pain or fever does not decrease after 24/48 H.

The prescribed antibiotic is usually amoxicillin alone or amoxicillin / clavulanic acid in the form of tablets or oral solutions in the absence of allergy to penicillin.

Ear drops

Instillation of drops in the ear canal is of little use in acute otitis media, with the infection behind the eardrum. Some may nevertheless help to reduce the pain. Anyway, it is much more important in case of AMO to put drops in the nose than in the ears!

Ear drops, however, are necessary when the eardrum is perforated, but only some are used in this case, the others, potentially toxic to the ear being contraindicated in case of perforation

Paracentesis

Paracentesis, opening of the eardrum by a very thin blade, practiced by the ENT under a microscope, remains interesting in very painful forms, with a very rounded tympanum and leads to the immediate disappearance of pain.

At the end of the treatment, the condition of the eardrum and its return to normal hearing should be checked. A consultation with an ENT is necessary when otitis persist, recurrence, in case of perforation tympanic or doubt on the hearing.  

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