Everything you need to know about otitis media in children and adults

The ear consists of three main parts: the outer ear, the middle ear, and the inner ear:

• The outer ear: consists of the auricle and the external auditory canal, and its function is to collect sounds and transmit them to the middle ear through the eardrum.
• The middle ear: is a small chamber consisting of the ear ossicles, its function is to transmit and amplify sound 20 times.
• The inner ear: a small chamber inside the skull that contains the cochlea, which converts sound into electrical signals that pass through the auditory nerve to the brain.

⚪ How does the middle ear become infected?

The middle ear is connected to the outside through two paths, which represent the two main sources of infection:

• Eustachian tube:
  It connects the middle ear and the pharynx and has two natural functions, which are to balance the pressure on both sides of the eardrum between the internal pressure and the external atmospheric pressure, and a channel to drain any fluids that accumulate in the middle ear.
  Therefore, the Eustachian tube is the main and most common source of infection, as infection is transmitted through it in cases of infections of the nose, throat, sinuses and adenoids, or through the reflux of fluids such as milk and vomit through it to the middle ear.
• Eardrum:
  When the eardrum ruptures, the infection passes through that hole to the middle ear, but this is rare.

⚪ Is there a difference between children and adults in cases of otitis media?

• Children are the age group most affected by otitis media in general, due to several different factors related to the characteristics of their Eustachian tube, such as: the width of the canal, its short length, and its being less inclined and sloping (more straight), which facilitates the passage of infection through it.
• However, the eardrum in children is considered relatively weak compared to adults, so they are less susceptible to complications that occur due to the accumulation of pus inside the middle ear; due to the ease of its rupture and the drainage of pus through it.
• While otitis media in adults is less common, they are more susceptible to complications; Due to the strength and hardness of the eardrum, which acts as a barrier to the pus accumulated inside the middle ear.

⚪ What are the symptoms of otitis media in children and adults?

Symptoms vary according to the age group due to how the pain and problem are expressed and the body’s different response.

• Symptoms of otitis media in adults:

1. Ear pain.
2. Decreased hearing: As a result of fluid accumulation behind the eardrum; Due to the blockage of the Eustachian tube.
3. Feeling of fullness in the ear: As if the ear is blocked.
4. Ear discharge: In the event of a hole in the eardrum, purulent discharge may come out.
5. High temperature.
6. Dizziness or loss of balance.
7. Tinnitus: A ringing sound inside the ear.
8. Headache.

• Symptoms of otitis media in children:

1. Constant crying due to pain.
2. Rubbing or pulling the ear: The child tries to relieve the pain.
3. Difficulty sleeping: As the pain increases when lying down.
4. Irritability and nervousness: due to pain and discomfort.
5. High temperature.
6. Loss of appetite: Pain makes the child unwilling to eat or breastfeed.
7. Ear discharge: in case of a perforated eardrum.
8. Difficulty hearing: A delayed response may be noticed in the child.
9. Diarrhea or vomiting: may appear as a result of infection in some cases, and may be misdiagnosed as a stomach flu!

⚪ What are the most common possible complications of the middle ear?

• Possible complications of otitis media:

1. Perforated eardrum:
   Pressure from fluid accumulation may cause a perforation in the eardrum, causing discharge from the ear and temporary hearing loss.
2. Temporary or permanent hearing loss:
   Fluid accumulation behind the eardrum can cause temporary hearing loss. In severe or chronic cases, permanent hearing loss may occur.
3. Chronic otitis media:
   Prolonged infection may lead to recurrence of infection and permanent damage to the ear structures, which may lead to the disintegration and erosion of the ear ossicles.
4. Inner ear infection:
   The infection may spread to the inner ear, leading to hearing loss, dizziness, and loss of balance.
5. Mastoiditis:
   When the infection spreads to the skull bones behind the ear (mastoid bone), causing pain and swelling in that area, and may require urgent medical intervention, as in cases of an abscess in the mastoid bone.
6. Meningitis:
   In rare cases, the infection may spread to the membranes of the brain and spinal cord, causing meningitis, a serious condition that may be life-threatening.
7. Facial nerve paralysis:
   If the infection affects the facial nerve that passes near the walls of the inner ear, partial or complete facial paralysis may occur.
8. Cholesteatoma:
   A rare condition in which skin cells accumulate in the middle ear as a result of chronic inflammation, destroying the ear bones and surrounding structures.
9. Spread of infection to blood vessels or the brain:
   Neglected infection may lead to brain abscesses or infection of nearby blood vessels (such as sinusitis).
10. Long-term problems with speech and learning:
    In children, chronic hearing loss resulting from inflammation may lead to delayed language development and other learning problems.

⚪ What is the treatment for otitis media?

Treatment lines include several different approaches, ranging from conservative drug therapy to surgical intervention.

▫ Drug therapy:

• Painkillers and antipyretics.
• Antibiotics: Antibiotics are often prescribed even if the infection is viral and not bacterial, due to the fear of secondary bacterial infection.
• Ear drops: They are used only when there is a hole in the eardrum, or if there is an infection in the external auditory canal.

▫ Otocentesis:
Sometimes it may be necessary to make a surgical incision in the eardrum; to help drain the fluid accumulated inside the ear to protect against possible complications while performing suction