Middle ear infection


middle ear injection

An infection in the space behind the tympanic membrane that causes inflammation of the middle ear is called a middle ear infection. In addition to severe earache, it can cause hearing loss. Untreated middle ear infection is the most common cause of hearing loss, which can lead to serious learning disabilities, especially in children. Because of the importance of this disease, in this article we want to introduce you the symptoms and causes of otitis media, ways to diagnose and treat it to some extent. Other names for this disease are:

  • Glue ear
  • Otitis media (otitis media)
  • Secretory media otitis
  • Serous otitis media


Common age of middle ear infection

Where is the middle ear and what does its structure looks like?

Sound and vibration transmission through the middle ear

Why is the middle ear infection or otitis media a serious and dangerous disease?

What are the symptoms of a middle ear infection?

What causes a middle ear infection?

Types of middle ear infections

How is otitis media or middle ear infection diagnosed?

What are the treatments for the middle ear infection?

Returning otitis media

What are the predisposing factors for middle ear infection?

Prevalence of middle ear infection

How to prevent middle ear infection?

Complications of untreated middle ear infection


At what age would you develop a middle ear infection?

Middle ear infection also known as otitis media is a common disease in childhood but it can also affect adults in adulthood. Otitis media can affect one or both ears. To better understand the problem, let's learn a little bit about the location and internal structure of the middle ear.

Where is the middle ear and what does it consist of?

The human middle ear is an air-filled chamber located between the tympanic membrane and the inner ear. The main components of the middle ear from outside to inside are:

  • Tympanic membrane (eardrum)
  • Ear bones called:
    • Hammer bone (Malleus)
    • Anvil Boone (Incus)
    • Stapes Bone
  • Eustachian tube: It is a tube that connects the middle ear space to the throat. This tube opens when swallowing and yawning. The proper operation of this tube is critical to maintain the health of the ear and hearing. The benefits of the Eustachian tube are:
    • Middle ear air conditioning
    • Cleaning secretions and pollutions from the middle ear
    • Ear protection
  • Oval window
  • Round window


Transmission of sounds and vibrations through the middle ear:

Sound and vibrations enter the external ear canal from the eardrum and reach the tympanic membrane. Each part of the tympanic membrane vibrates at a certain frequency. Malleus bone handle is attached to the back of the tympanic membrane. Vibration of the tympanic membrane also vibrates malleus and since the ear bones mentioned above are connected together, when one vibrates, all other bones also vibrate. Since the stapes bone is attached to the curtain of the oval, the vibration will reach the oval window, where with the help of round window, it causes fluid to move in the cochlea of the inner ear. in other words, it is the round Window who transmits the vibrations to the inner ear. Therefore, the function of the middle ear is to transmit sound vibrations to the inner ear.


Why is middle ear infection or otitis media a serious and dangerous disease?

Otitis media, if diagnosed late or not treated properly, can lead to serious and lasting hearing damage. Because the most common age of onset of otitis media is childhood, hearing loss can cause delayed speaking abilities and learning disabilities. Terrible complications such as meningitis (inflammation of the meningeal membranes of brain), brain abscess, and mastoid bone infection of  the ear (mastoiditis) will happen following undiagnosed or delayed treatment of otitis media.


What are the symptoms of a middle ear infection?

Otitis media can have a wide variety of symptoms. These include:

  • Ear pain: patients experience severe pain.
  • Irritability: the patient with otitis media becomes restless and irritable, motivating the person to complain. Children with middle ear infections are highly excited and impatient.
  • Fever
  • Middle ear secretion (bloody, colorless discharge from the ear)
  • Balance disorders
  • Feeling of fullness in the ear
  • Hearing impairment (hearing loss)
  • Decreased appetite
  • Nausea and vomiting
  • Diarrhea, yes you may experience Diarrhea

Symptoms of middle ear infection in infants include:

  • Fever
  • Crying
  • Restlessness
  • Ear discharge
  • Anorexia
  • Vomiting
  • Touching the ear and scratching and ear pulling
  • Hearing loss (infant does not respond to sound)


What causes a middle ear infection?

Eustachian tube obstruction: 

Eustachian tube obstruction is the final step in the creation of middle ear infections. Any factor that closes the Eustachian tube interferes with the cleansing and ventilation of the middle ear. so secretions, viruses or bacteria remain in the middle ear space and will not be cleaned. Increased volume of secretions in the middle ear space put pressure on the tympanic membrane. Finally, they will cause the tympanic membrane to protrude. Examination of the ear with an otoscope (device doctors use to see you ear) shows the presence of fluid behind the tympanic membrane, inflammation of the tympanic membrane, and its protrusion. The presence of fluid and secretions trapped behind the curtain prevents the curtain from vibrating and moving, which reduces hearing abilities. Eustachian tube obstruction due to inflammation is the most common cause of otitis media, especially in children and young adults.

The causes of inflammation and obstruction of the Eustachian tube are:

Respiratory infections:

  • Viruses:
  • Bacteria: 

    • Streptococcus pneumoniae 
    • Haemophilus influenzae
    • Moraxella Catarrhalis
    • Enteric gram-negative bacteria
    • Staphylococcus aureus
    • Combine 
  • Allergy 

Note: In adults, recurrent otitis media can be due to pharyngeal tumors.


Types of middle ear infections:

Acute otitis media:

This type has a rapid onset and your doctor will see redness and swell around the tympanic membrane during the examination. As we said, the accumulation of secretions behind the tympanic membrane will prevent the transmission of vibrations and sounds, therefore you may experience hearing loss, fever, anorexia, and severe earache beside having difficulty in keeping the balance of the body.

Chronic middle ear infection or serious otitis media:

Occasionally, after an acute infection has healed, fluid accumulation and viscous discharge continue. These viscous that discharges, cause a feeling of fullness in the ear and reduce hearing ability over time if left untreated.


How is otitis media diagnosed?

When you see your doctor, he or she will get a history of your recent illnesses and medications. During a clinical examination, your doctor uses a device called a otoscope to look inside your ear. The tympanic membrane is raised, swollen, red, inflammation around the membrane and the accumulation of fluid behind it will be seen if you have middle ear infection. Sometimes a test called tympanometry is used to assess how the middle ear works.  

How is middle ear infection treated?

The type of treatment chosen depends on the general health, underlying diseases, and drug allergies of the patient. The severity of the infection and the type of infection are also important in choosing the right treatment. In children, the child's ability to take and tolerate medication is also taken into account. Antipyretics such as acetaminophen and ibuprofen which also have analgesic properties are used to relieve symptoms. Ibuprofen also reduces ear inflammation. If the cause of the middle ear infection is bacteria, antibiotics are prescribed according to the infection.

Because viral infections are more common, many doctors prescribe painkillers, anti-inflammatories, and antipyretics for up to three days for symptoms to vanish. If the disease does not resolve within three days, the following antibiotics may be prescribed:

  • Amoxicillin
  • Co-amoxiclav
  • cotrimoxazole (Prohibited in children with favism)
  • Azithromycin
  • Clarithromycin
  • Cefixime

These antibiotics should be taken according to the doctor's prescription and until the end of the treatment period. Avoid taking antibiotics arbitrarily. Even if the patient's symptoms have improved before the end of the treatment period, it is still necessary to take the drugs until the end of the period.


Returning otitis media:

There is a term called recurrent otitis media which is an acute otitis media for at least three periods during six consecutive months. Or when a person experiences four episodes of acute otitis media within twelve consecutive months. In recurrent middle ear infection, amoxicillin is prescribed for thirty-six months or during the summer.


What are the predisposing factors for middle ear infection?

  • Have a history of recurrent colds
  • Have a history of previous otitis media
  • Have a family history of otitis media
  • Premature infants
  • Low birth weight
  • Children being at kindergarten
  • Children with respiratory allergies, especially those that cause nasal congestion
  • Babies who use a bottle of milk while sleeping
  • The baby falls asleep with a pacifier or bottle of the milk


Prevalence of middle ear infection:

  • It can occur at any age, but is very common in children aged three to six years.
  • It is more common in boys than girls.
  • It happens more in autumn, winter and early spring.
  • It is more common in white people.
  • Congenital malformations, allergies, and exposure to cigarette smoke can predispose a person to infection.


How to prevent middle ear infection?

  • Regular hand washing
  • Avoid putting a bottle or pacifier in the baby's mouth while sleeping
  • Timely vaccination of children
  • Avoid being in an environment where someone is smoking


Complications of untreated middle ear infection:

  • Permanent hearing loss
  • Meningitis
  • Brain abscesses
  • Mastoiditis





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