Otitis Media

Otitis media is an inflammatory condition of the middle ear space, the part of the ear between the outer and inner ear. It may also involve the mastoid air cell system (a honey comb like bony structure present in the back portion of the ear) owing to its direct linkage to the middle ear.

Otitis media is an extremely common illness. 70% of children have at least one episode. Peak incidence is in the first two years of life and is thought to be linked to day care entry. The second peak occurs at 5 yrs. of age and may be related to school attendance.

Otitis Media can be classified as:

    • Acute: When the duration of the disease lasts from 0 to 3 weeks.
    • Sub-acute: When the duration is for 3 to 12 weeks.
    • Chronic: When the duration is greater than 12 weeks.


There are different stages of otitis media and symptoms will vary depending on the stage as follows:

Stage of Hyperemia

This stage is characterized by earache, ear fullness and fever. The eardrum appears red on examination.

Stage of Exudation

In this stage, there is an increased pain and fever accompanied by hearing loss. In infants, vomiting, convulsions and irritability may accompany it. The eardrum appears red, swollen and bulged. There may be associated pain on the bony area behind the ear.

Stage of suppuration

In this stage, there is discharge from the ear. Initially the discharge may be blood stained; later it becomes mucoid (mucus like) and then pus like. The fever and hearing impairment worsens. There may be a small hole in the eardrum.

Stage of resolution

The resolution stage is a return of tissues to normalcy.


The cause of Otitis Media can be viral or bacterial infections. Below is a list of specific infections that can lead to a diagnosis of Otitis Media.

Viruses including:

  • Respiratory syncytial virus (RSV)
  • Influenza A & B
  • Rhinoviruses

Bacteria including:

  • S. Pneumoniae
  • Beta hemolytic streptococcus
  • H. Influenzae and M. catarrhalis are responsible for Acute Otitis media
  • Pseudomonas aeruginosa, Staph aureus, Streptococcus, K Pneumonia, H Influenza, Peptostreptococcus and Bacteroids are responsible for Chronic Otitis media.

Risk Factors

Otitis media is high in lower socioeconomic groups due to overcrowded living conditions.

Maternal smoking and day care attendance increase the risk of otitis media.

Other Risk Factors include:

    • Eustachian tube dysfunction
    • Nasal Allergies
    • Adenoids and other masses in the Nasopharynx
    • Gastroesophageal reflux (GERD)
    • Immune deficiency
    • Scarlet fever, measles, pneumonia, influenza and some other systemic febrile conditions increase the risk of developing Otitis Media.


Complications can occur from untreated Otitis Media and can be very serious. It is important that you seek treatment early for symptoms of Otitis Media to prevent the following complications from occurring:

Extracranial Complications

  • Facial nerve palsy
  • Deafness
  • Labyrinthine complications (balance impairment)
  • Abscess in the neck or behind the ear.

Intracranial Complications

  • Meningitis
  • Raised intracranial pressure
  • Intracranial abscess

Incomplete treatment can also lead to Otitis media with effusion, sometimes referred to as Glue Ear because a thick, glue-like fluid collects behind the eardrum and can impair hearing.


Diagnosing Otitis Media is done at your physician’s office and includes:

    • Medical History
    • Examination of the ear with otoscope


Conservative treatment measures include:

  • Treat contributing factors such as upper respiratory tract infections and nasal allergies.
  • Appropriate oral antibiotics are prescribed according to the sensitivity of the antibiotic to the infecting organism.
    • Regular cleaning of the ear discharge.
    • Keeping the ear dry with ear plugs while bathing and avoiding swimming.

Depending on the severity of Otitis Media, the stage of the condition and the patient’s response to conservative treatment, your physician may recommend a surgical procedure.


This is a procedure where a small incision is made on the eardrum to release the pus from the middle ear. This procedure is indicated in the early stage before perforation of eardrum has occurred.


This surgery removes the adenoids at the back of the throat if they are enlarged and interfering with the function of the Eustachian tube.


If the eardrum has ruptured from Otitis Media, surgical treatment includes repair of eardrum perforation and hearing conduction mechanism.


This surgery involves removal of infected portions or all the mastoid bone, located behind the ear, thereby clearing the disease from the mastoid air cell system.

Risks and complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

Complications can be medical (general) or specific to ear surgery.

Medical complications include those of the anesthetic and your general well-being. Almost any medical condition can occur so this list is not complete. Complications include

    • Allergic reactions to medications
    • Blood loss requiring transfusion with its low risk of disease transmission
    • Heart attacks, strokes, kidney failure, pneumonia, bladder infections
    • Complications from nerve blocks such as infection or nerve damage
    • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.

Specific complications of ear surgery can include:

    • Residual deafness
    • Ear discharge and cavity problems especially after Mastoidectomy
    • Injury to facial nerve
    • Loss of taste on the side of surgery

Although every effort is made to educate you on Otitis Media and take control, there will be specific information that will not be discussed. Talk to your doctor or health care provider about any concerns you have about Otitis Media.