otitis media
Meaning of otitis media: Children are affected far more than adults because the tube ventilating the middle ear is shorter and lies more level.
Definition of otitis media
Otitis media is inflammation of the middle ear, the small air-filled chamber behind the eardrum that houses the three hearing bones. Fluid gathers there when the tube linking it to the back of the nose stops ventilating properly, producing earache, muffled hearing and fever. It is one of the commonest illnesses of early childhood, and episodes usually follow a cold.
Why are young children affected so often?
The middle ear is not sealed. A narrow tube runs from it down to the back of the nose, opening briefly with each swallow to let air in and fluid out. In a young child that tube is short, wide and nearly horizontal, so material from the nasopharynx travels up it easily and drains back down poorly. A cold, often caused in infants by RSV, swells the lining until the tube stops opening at all. Air already in the middle ear is absorbed, pressure falls, fluid is drawn in from the lining, and organisms carried up the tube grow in that fluid. The tube lengthens and tilts as the face grows, which is why episodes become much less frequent with age.
What are the different forms?
| Form | What is present | Typical picture |
|---|---|---|
| Acute otitis media | Infected fluid under pressure | Earache, fever, bulging red eardrum |
| Otitis media with effusion | Fluid without acute infection | Dull hearing, no pain or fever |
| Chronic suppurative form | Persistent hole with discharge | Painless drainage, hearing loss |
| Otitis externa | Inflamed canal outside the drum | Pain on pulling the outer ear |
The last row belongs to a different space altogether and is listed because the two are constantly confused. Otitis externa affects the canal in front of the eardrum, while otitis media affects the chamber behind it.
What follows an episode?
Pressure can split the eardrum, which relieves the pain abruptly and produces discharge in the canal; the hole usually closes on its own. Fluid frequently remains behind an intact drum for weeks after fever and pain have gone, muffling hearing at an age when speech is being learned, and that lingering effusion rather than the acute attack is what prompts hearing assessment. Infection spreading into the air cells of the bone behind the ear produces mastoiditis, with the ear pushed forward and swelling over the bone. An otolaryngologist becomes involved where episodes repeat, where fluid persists, or where the eardrum is damaged.
Also known as
Used in a sentence
The child was seen with a bulging eardrum consistent with acute otitis media.
Good to know
Otitis media affects the chamber behind the eardrum while otitis externa affects the canal in front of it, and pain provoked by pulling the outer ear points to the canal. Fluid can persist behind an intact eardrum after pain and fever settle, dulling hearing without further symptoms.
Word origin
Where “otitis media” comes from
From the Greek ous, otos, meaning ear, with the suffix -itis for inflammation; media is Latin for middle.