Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Is It Serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal. The infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor.

What Causes Otitis Media?

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems. Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

What Are the Symptoms?

In infants and toddlers look for:

• pulling or scratching at the ear, especially if accompanied by the following...

1. hearing problems
2. crying, irritability
3. fever
4. vomiting
5. ear drainage

In young children, adolescents, and adults look for:

• earache
• feeling of fullness or pressure
• hearing problems
• dizziness, loss of balance
• nausea, vomiting
• ear drainage
• fever

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

What are ear tubes?

Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes. There are two basic types of ear tubes: short-term and long-term. Short-term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.

Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age of ear tube insertion is one to three years old. Inserting ear tubes may:

• reduce the risk of future ear infection,
• restore hearing loss caused by middle ear fluid,
• improve speech problems and balance prob-lems, and
• improve behavior and sleep problems caused by chronic ear infections.

What happens during surgery?

A light general anesthetic is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly. Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.

What to expect after surgery

After surgery, the patient is monitored in the recovery room and will usually go home within an hour if no complications are present. Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily. Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud.