What are the signs of otitis media?
The most common sign for acute otitis media is pain in the ear. In children, this may manifest as irritability or tugging of one or both ears. Other symptoms include fevers, pressure, ear fullness, ringing in the ears, or hearing loss. Otitis Media with Effusion (non-infected) typically does not present with pain or fevers but rather fullness, decreased hearing, and ringing in the ears.
Where is the eustachian tube and what does it do?
The Eustachian tube is a small channel that goes from the middle ear space to the back of the nose. The Eustachian tube allows pressure or fluid to drain out of the middle ear and into the back of the nose. When you “pop” your ears by blowing gently while closing your nose and mouth you may force open this tube to relieve any pressure behind your eardrum. The Eustachian tube is lined with the same mucosa (lining) that lines the inside of your nose. Any condition that causes swelling of the inside of your nose (allergy, infection, etc…) may also cause swelling within this small tube causing the tube to close. If this tube does not open then fluid and pressure may build up behind the eardrum causing intermittent ear pain, popping sounds, ear fullness, or hearing loss. If the fluid persists, it may cause otitis media with effusion or if infected may cause acute otitis media. If the Eustachian tube continues to dysfunction, the pressure and fluid behind the eardrum may rupture allowing fluid to leak out of the ear canal.
What is the first line of treatment of acute otitis media?
Acute otitis media is caused by viral or bacteria most commonly Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. There are many antibiotics that are used to kill these bacteria. The most common is amoxicillin. Amoxicillin has a long record of safety; however there has been an increase in resistance from some bacteria. To counter this resistance, amoxicillin is often prescribed in higher doses in an effort to combat these bacteria.
Many other antibiotics may also be prescribed – each has their benefits. Some common drugs include azithromycin (Zithromax), clarithromycin (Biaxin), and amoxicillin-clavulanate (Augmentin), or cefdinir (Omincef). Some bacteria may be resistant to one antibiotic and not another therefore you may have to change your antibiotics if the infection does not improve.
Otitis media with effusion may be present after a resolving ear infection. In this case, you may just observe until the fluid goes away. If the fluid is causing pain, pressure, fullness, hearing loss, or it does not go away you may be prescribed a decongestant or nasal spray to help open your Eustachian tube to “drain” the fluid more quickly. If fluid persists for more than 3 months, pressure equalization tubes (PETs) or Eustachian Tube Dilation may be required.
What is the role of allergies with ear infections?
Allergies cause the mucous membranes of the nose to swell and enlarge. The Eustachian tube is also lined with the same membranes as the nose and therefore also may swell with allergy exposure. The swelling in the Eustachian tube may be significant enough to cause the tube to close and become dysfunctional resulting in pressure sensation, popping, or hearing loss of the ears.