Acute otitis media is a condition where the inflammatory process involves the mucous membrane lining the middle ear structures. In adults, it occurs primarily in the course of upper respiratory tract infections. In children, on the other hand, it is the second most common disease after upper respiratory tract infections.
It is most severe in the first two years of life. Causes of the condition include both viral and bacterial infections. Predisposing factors include sinusitis, condition after tonsillectomy, trauma to the tympanic membrane, infections in the nasal part of the throat. Young children and infants are particularly susceptible to infection due to the different anatomy of the ear trumpet. In this group, however, acute otitis media can take the form of a severe general illness.
Among the symptoms, there is first of all pain, severe, spreading, increasing gradually. The patient reports a feeling of fullness in the middle ear. This is accompanied by hearing impairment and systemic symptoms, i.e. increased body temperature - especially in children it can reach up to 40 degrees, general weakness and malaise.
The substrate for these symptoms is the changes that occur under the influence of the infection, initially swelling of the middle ear mucous membrane appears, which is the cause of obstruction of the auditory trumpet, an exudate initially serous, then purulent. The accumulation of this inflammatory secretion leads to a convexity of the tympanic membrane, and perforation of the tympanic membrane may then occur, in which case there is a leak in the external auditory canal. With perforation, the pain subsides and the patient is relieved.
Ear examination, photo: panthermedia
Hearing loss, ear leakage and eardrum perforation are the so-called Bezold's triad. The mainstay of treatment is antibiotics and the anti-inflammatory drugs paracetamol and acetylsalicylic acid. When the eardrum becomes protruded, an incision is made - i.e. a paracentesis procedure. Such a procedure is performed under local anaesthesia in adults or under general anaesthesia in children. During the leakage stage, it is also important to clean the external ear canal of secretions. With persistent leakage, bacteriological examination of the discharge and a possible change of antibiotic is indicated.
A cure is said to occur when hearing returns to normal and the ear discharge stops. If this does not happen within three weeks of treatment, it should be suspected that there is still an infection in the sinuses or nasopharynx that needs to be treated. The possibility of progression to chronic inflammation should also be considered.