Otitis media

What is otitis media?

Acute otitis media is infection and inflammation of the middle ear.

Otitis media with effusion (also know as glue ear) is when fluid (often sticky and thick) builds up behind the tympanic membrane (ear drum). This occurs without signs or symptoms of infection. It is very common in childhood and may resolve spontaneously, leading experts to think that it may be a natural phenomenon.

However, sometimes the build up of fluid may lead to hearing loss which may cause language problems if it occurs when children are learning to speak.

Symptoms

Acute otitis media causes pain and fever. Young children may point at or tug their ear. They may be generally irritable, off their food, and have problems hearing. Occasionally, there is sudden discharge of pus from the ear, which may relieve pain but is a sign their eardrum has ruptured. (Normally the eardrum heals by itself.)

Glue ear is not painful and can go unnoticed, even though there may be considerable hearing loss and poor performance at school.

Causes and risk factors

Acute otitis media is an infection due to either a virus or bacteria. It often follows an upper respiratory tract infection such as a cold.

It is not entirely clear exactly what causes otitis media with effusion but it is thought that bacteria, poor immune response and problems with the drainage tube from the middle ear (eustachian tube) play a role.

The diagnosis should be made by a doctor who will look for changes in the eardrum, which is bright red and bulging in acute otitis media, and drawn in and dull in glue ear.

Treatment and recovery

Trials have shown that antibiotics are not very useful for acute otitis media. They do not make much difference to the pain and may cause unwanted side affects such as diarrhoea. The mainstay of treatment is pain relief such as paracetamol.

There may be no symptoms in glue ear but the child may complain of problems hearing or seem inattentive. Your doctor can arrange for a hearing test. Glue ear may settle over several weeks.

In persistent cases, an operation may be needed to drain the ear and insert tiny drainage tubes called grommets.