Acute Otitis Media Treatment
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What is Acute Otitis Media?
It is an acute inflammation of the middle ear cleft usually with duration of less than 3 weeks. In most cases, it is preceded by a viral upper respiratory tract infection.
Source of infection:
- Eustachian tube: This is a tube that connects the posterior part of the nose ( nasopharynx) and the middle ear. Infections of the nose can travel to the middle ear via the eustachian tube.
- Perforation in the ear drum: Infections can travel from the outside environment to the middle ear through a pre-existing perforation in the ear drum.
Acute Otitis Media stages:
- Stage of tubal occlusion: Due to infections in the nose and nasopharynx, the nasal end of the eustachian tube swells up and gets occluded. This leads to loss of air pressure in the middle ear leading to tympanic membrane retraction and earache. There is usually no fever at this stage.
- Stage of presuppuration: In this stage, the bacteria invade the middle ear cavity and inflammatory exudate appears. There is ear pain which may be throbbing in nature and severe enough to disturb sleep. Adult patients may even complain of hearing loss.
- Stage of suppuration: This is the stage of pus formation. There is pus formation in the middle ear which makes the eardrum bulge out. The patient may have fever, severe ear ache and conductive deafness
- Stage of resolution: If proper antibiotic therapy is initiated, then the resolution may occur without any complication. If treatment is not started, then the pus may lead to rupture of eardrum leading to a perforation and pus discharge from the ear.
- Stage of complications: If the bacteria is very virulent, then the disease may extend beyond the confines of the ear and cause mastoid abscess, brain abscess or meningitis.
Acute Otitis Media Symptoms
Earache is the most distinct and the commonest symptom of acute otitis media. The earache may be worse in the night, throbbing in nature and severe enough to disturb sleep.
Ear blockage is another common symptom that the patient may present with. Fever may or may not be present.
Acute otitis media in adults: Apart from these symptoms, adults may even notice a hearing deficit in the affected ear. This hearing loss is conductive in nature and reversible with the successful resolution of acute otitis media without any complication.
Acute otitis media in children: Children are the most susceptible age group for developing acute otitis media. The reason is more frequent upper respiratory tract infections and the structure of eustachian tubes (more horizontal ) which make it easier for upper respiratory tract infections to reach the middle ear.
In infants, the presentation may be a little difficult for parents to understand due to the inability of these infants to communicate the pain. So, the parents need to look for other signs of acute otitis media. The child may show inconsolable crying, irritability, refusal to accept feed, repeated ear holding/pulling. In case of any of these symptoms, the parents should take the child for an ENT visit.
Secondly, it is very important to not feed children in supine position as fluid can enter the eustachian tube and then the middle ear. Children should be fed with their heads slightly elevated than the rest of their bodies to prevent fluid entry into the eustachian tube and further into the middle ear.
Acute Otitis Media Treatment
The treatment consists of:
- Antibiotics: they are the mainstay of treatment of acute otitis media. Antibiotics initiated at an appropriate time help in resolution without any complication.
- Nasal decongestants: they can be given through oral route and even topical preparations are available. Their function is to decrease the oedema of the eustachian tube and help in maintaining the proper ventilation of the middle ear.
- Anti inflammatory agents: these are meant to provide analgesic effect and decrease the inflammation. They are mainly responsible for symptomatic relief.
