Middle Ear Infection

Middle ear infection (otitis media) is a disease that many people experienced in their child's age.


First, it is important to know some facts about the middle ear. It is a cavity located on both sides of the skull. The middle ear is a connection between the outer ear canal and the inner ear, which contains the auditory organ (cochlea). The external ear canal and the middle ear are divided by eardrum. In addition, the middle ear is directly connected with the nasopharynx by a canal known as the Eustachian tube. Since the eardrum is an impermeable membrane, the only way to clear local debris is just the mentioned Eustachian tube. The cavity of the middle ear contains three tiny bones – the hammer, anvil and stirrup. These little bones anatomically and functionally connect the eardrum with the auditory organ the transmission of vibrations to the cochlea, where it is processed.


The most common cause is a bacterial infection, often of streptococcal origin (usually pneumococcus), which usually enters the middle ear via the Eustachian tube from the nasopharynx. Other possible causative bacterium is the haemophilus.


There are some conditions that increase the risk of otitis media. The common risk factor in children is the adenoid, i.e. enlarged nasopharyngeal tonsil. The tonsil is located in the vicinity of openings of the Eustachian tubes and its enlarged tissue may close these openings and increase the risk of local infection.


Other reasons of recurring middle ear infection may be also weakened immunity (rarely) or Kartagener syndrome (extremely rare). Kartagener syndrome is congenital disorder including among others disrupted function of cilia in the respiratory system causing frequent respiratory infections.


The infection usually begins with vague symptoms of common respiratory tract infection (fever, cough, sore throat, etc.) that are followed with strong ear pain on the affected side. Sometimes, the patient can experience hearing impairment when the infection causes impairment of sound transmission through the middle ear.


There are many possible complications of untreated otitis media. The eardrum may perforate, which is followed with pus and blood outflow from the ear. Already perforated eardrum may heal by a scar, which may permanently impair hearing. The infection may also spread to adjacent bones, which significantly decreases the effectiveness of antibiotics.


The diagnosis is usually quite clear in a patient with the mentioned clinical symptoms. It is important to perform an examination by an otolaryngologist who can use a device known as otoscope to look into the external auditory canal and to see the eardrum. The drum is usually arched in the outside direction by pus accumulating from the other side.


Early stage can be treated only by antibiotics, but usually the treatment should include the paracentesis, which means that the doctor perforates the eadrum by a thin needle to allow the drainage of the pus. The procedure is very painful, btu it is just a short pain, which is followed by a sudden relief. While the spontaneous eardrum rupture is irregular and larger, the medical opening is small, it quickly heals and causes no hearing problems.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources