Middle ear infections

Middle ear infections (otitis media) is inflammation of the middle ear. It occurs in the area between the tympanic membrane and the inner ear, also effecting a duct known as the eustachian tube (Pic. 1). It is one of the two most common causes of earache - the other being inflammation of the ear canal (otitis externa). 

The middle ear infections have several types:

• acute otitis media - fullness, bulging, cloudiness and redness of the eardrum
• otitis media with effusion - a collection of effusion (fluid) that occurs in the middle ear space
• chronic suppurative otitis media - occurs following an upper respiratory tract infection that has led to acute otitis media
• adhesive otitis media - occurs when a thin retracted ear drum becomes sucked into the middle-ear space and stuck

An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Though painful, otitis media is not threatening and usually heals on its own within 2–6 weeks. Typically, acute otitis media (Pic. 2) follows a cold. After a few days of a stuffy nose, the ear becomes involved and can cause severe pain. The pain will usually settle within a day or two, but can last over a week. Sometimes the ear drum ruptures (Pic. 3), discharging pus from the ear, but the ruptured drum will usually heal rapidly.

Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).

Otitis media is most commonly caused by infection with viral, bacterial, or fungal pathogens. The most common bacterial pathogen is Streptococcus pneumoniae. Others include Pseudomonas aeruginosa, nontypeable Haemophilus influenzae and Moraxella catarrhalis. Among older adolescents and young adults, the most common cause of ear infections is Haemophilus influenzae (Pic. 4). Viruses like respiratory syncytial virus (RSV) and those that cause the common cold may also result in otitis media by damaging the normal defenses of the epithelial cells in the upper respiratory tract. A major risk factor for developing otitis media is Eustachian tube dysfunction, which leads to the ineffective clearing of bacteria from the middle ear.

Treatment depends on the type of infection, but could include antibiotics and surgery. Oral and topical pain killers are effective to treat the pain caused by otitis media. Oral agents include ibuprofen, paracetamol (acetaminophen), and opiates. Topical agents shown to be effective include antipyrine and benzocaine ear drops. Decongestants and antihistamines, either nasal or oral, are not recommended due to the lack of benefit and concerns regarding side effects. Half of cases of ear pain in children resolve without treatment in three days and 90% resolve in seven or eight days. The use of steroids is not supported by the evidence for acute otitis media.

One of the main consequences of otitis media is conductive hearing loss. Hearing loss may result in speech and language disorders as well as a delay in academic development. Subsequent behavioural problems from hearing impairment could also increase the risk of mental health disorders. Otitis media affects children’s quality of life, and depending on the severity of infection, may also result in a wider impact on caregivers and health services.

Turner syndrome

Turner syndrome (TS) is a genetic disease that effects the development of the body in females caused by the complete or partial absence of one of the two X chromosomes. Turner syndrome is associated with shortening and extending of the Eustachian tube thus middle ear infections are more common, mainly in early childhood or infancy.