What Is Otitis Media?

Otitis media is the inflammation or infection of the middle ear, the space behind the eardrum where the small ossicles responsible for conducting sound are located. It is one of the most common conditions of childhood: about 80% of children have at least one episode of acute otitis media before the age of 3, most often between 6 and 24 months. It is also the leading reason for antibiotic prescriptions in young children. Although it predominates in childhood, it can also affect adults. Recognizing the signs early and seeking specialized guidance is essential to relieve discomfort and protect hearing.

Symptoms

The presentation varies according to age and the type of case. The most frequent symptoms include ear pain, which can be intense, a sensation of pressure or of a blocked ear, decreased hearing, tinnitus and, in some cases, fever. Yellowish or greenish discharge may appear when the eardrum perforates, which usually relieves the pain. In infants and young children, who cannot yet describe what they feel, the most common signs are irritability, persistent crying, difficulty sleeping, fever, the habit of pulling or rubbing the ear and a reduced response to sounds.

Risk Factors

Several factors increase the chance of otitis media, almost always linked to obstruction of the Eustachian tube, the channel that ventilates the middle ear. Attending daycare is one of the most important and raises the risk of recurrent ear infections by about two and a half times, due to greater exposure to respiratory infections. Other well-established factors are exposure to passive smoking, pacifier use after the first months of life, age between 6 and 24 months and a family history of otitis. Respiratory viral infections, allergic rhinitis and the habit of bottle-feeding while lying down also favor the accumulation of secretions in the middle ear. In adults, anatomical changes of the Eustachian tube and reflux can contribute. In children, Eustachian tube obstruction is often linked to adenoid hypertrophy.

Warning Signs

Some signs indicate the need for prompt evaluation: intense pain that does not subside with common analgesics, persistent high fever, discharge from the ear, swelling or redness behind the ear, significant dizziness or imbalance and worsening of the general condition. In children, a delay in speech or the impression that the child is not hearing well deserves attention, because it may indicate persistent fluid in the middle ear. These signs help to distinguish a case that can simply be monitored from one that needs immediate treatment.

Types of Otitis Media

Acute otitis media has a rapid onset, with pain and signs of inflammation, and is usually triggered by a respiratory infection.

Otitis media with effusion, also called serous otitis media, is the accumulation of fluid in the middle ear without active infection. It generally causes a sensation of a blocked ear and mild hearing loss, and it is the leading cause of hearing decline in school-age children. It is very common: most children will have at least one episode by the age of 4.

Chronic suppurative otitis media is marked by persistent perforation of the eardrum and continuous discharge, and requires specialized management.

Treatment

Treatment depends on the type and severity of the condition, and not every ear infection needs antibiotics.

In acute cases, controlling the pain with analgesics is the first measure and brings relief within the first hours. In some cases, especially in children over 2 years of age with a mild condition, it is possible to adopt what is called watchful waiting: monitoring closely for 48 to 72 hours and starting the antibiotic only if there is no improvement or if the condition worsens. The antibiotic is recommended from the outset when there is intense pain, high fever, discharge from the ear or in younger infants with otitis in both ears. This individualized approach avoids the unnecessary use of antibiotics without failing to treat those who truly need them.

In otitis media with effusion, most cases resolve on their own: about half of the effusions disappear within 3 months. For this reason, when there is no significant impairment of hearing or speech, the recommendation is usually to monitor during this period before considering any surgery. When the fluid persists for more than 3 months and is associated with hearing loss, recurrent discomfort or delayed speech development, the placement of a ventilation tube may be indicated. The tube drains the fluid, normalizes the pressure of the middle ear and restores hearing, reducing the recurrence of episodes.

Complications

When it is not treated properly, otitis media can progress to more serious conditions. Perforation of the eardrum is the most common and usually heals on its own, but it can become chronic. The infection can spread to the mastoid bone, behind the ear, causing mastoiditis, which is uncommon today thanks to proper treatment. Chronic conditions can lead to a cholesteatoma, an abnormal accumulation of skin inside the middle ear capable of eroding the ossicles, which requires surgical treatment.

Regarding hearing, it is worth clarifying a point that often causes confusion. The hearing loss caused by otitis media is, in the vast majority of cases, of the conductive type, that is, related to fluid in the middle ear, perforation of the eardrum or changes to the ossicles, and it is usually reversible or treatable. It should not be confused with otosclerosis, which is a disease of the bony capsule of the ear itself, of genetic origin and unrelated to infection. Permanent, sensorineural hearing loss is rare in otitis and occurs only in specific situations, such as chronic suppurative otitis or labyrinthitis. Specialized follow-up exists precisely to prevent repeated or chronic conditions from lastingly affecting hearing.

Prevention

A few simple measures reduce the risk of otitis, especially in children. Breastfeeding is protective: nursing for at least 3 to 6 months lowers the chance of ear infections, including recurrent ones. Keeping vaccinations up to date also helps, since the pneumococcal vaccine reduces episodes of otitis caused by the bacterial types it covers. The list also includes avoiding cigarette smoke indoors, not bottle-feeding the child while lying down, limiting pacifier use after the first months, maintaining nasal hygiene and treating respiratory infections and allergies early. In children with repeated episodes, assessment for a ventilation tube can prevent hearing complications.

At the practice of Dr. José Eduardo Marcondes, an ENT physician (CRM SP 107711 | RQE 43840), more than twenty years of experience in otolaryngology combine with a humanized approach for an accurate diagnosis and an individualized treatment of otitis media, from newborns to adults. Schedule your appointment in São Paulo or Alphaville and take care of the hearing health of your entire family.

References

1. Lieberthal AS, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3):e964-e999 (American Academy of Pediatrics).
2. Rosenfeld RM, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology-Head and Neck Surgery. 2016;154(1 Suppl):S1-S41 (American Academy of Otolaryngology-Head and Neck Surgery).
3. Danishyar A, Ashurst JV. Acute Otitis Media. StatPearls, NCBI Bookshelf, 2023.
4. Harmes KM, et al. Otitis Media: Diagnosis and Treatment. American Family Physician. 2013;88(7):435-440.

This content is informational and does not replace a medical consultation.