Otitis Media Group 2 Presentation Emily Isabella Deborah

Otitis Media Group 2 Presentation – Emily, Isabella, Deborah, Sheila

Why may hearing be affected by cold or congestion? • The middle ear communicates with the nasopharynx via the Eustachian tube. • An upper respiratory infection causes inflammation and swelling of the tissues surrounding the Eustachian tube, resulting in difficulty hearing as sound does not travel efficiently from the outer ear to the inner ear. • Infection that is spread via the Eustachian tube from the nasal cavity and pharynx (throat) to the middle ear, can cause otitis media.

What is otitis media? • Definition: Otitis media is inflammation of the middle ear, or middle ear infection. • Infection causes pressure to build up behind the tympanic membrane, causing intense pain. In severe cases, the membrane may rupture, leading to chronic conditions. • Location: in the area between the tympanic membrane and the inner ear, including the Eustachian tube • Cause: most commonly caused by infection with viral, bacterial, or fungal pathogens. Most common bacterial pathogen is Streptococcus pneumoniae

Acute Otitis Media Risk Factors: • Developmental alterations of the auditory tube • Immature immune system • Frequent infections of the upper respiratory mucosa

Acute Otitis Media: Signs and Symptoms • One or more of the following symptoms: o o o o Otalgia (earache) Fever Otorrhea (discharge from the external ear) Recent onset of anorexia Irritability Vomiting Diarrhoea • Signs Abnormal otoscopic findings of the tympanic membrane including: o o o Opacity Bulging Erythema Middle ear effusion Decreased mobility with pneumatic otoscopy

Acute Otitis Media: Treatment Options • Pain present treatment to reduce pain o E. g. , ibuprofen • Medical treatment o Concern of antimicrobial resistance due to aggressive antibiotic use o Observation without antibiotic use in children with mild acute Otis media o Treatment with antibacterial agent amoxicillin (80 -90 mg/kg/day) • ENT referral if history of recurrent acute Otis media o Surgical intervention

Chronic Otitis Media Chronic otitis media (COM) Chronic suppurative otitis media (CSOM) Perforated tympanic membrane with persistent drainage from the middle ear (i. e. persistent otorrhea) • major cause of acquired hearing impairment in children esp. in developing countries • WHO’s definition: >2 weeks of otorrhea • Otolaryngologists: >3 months of active disease Other forms of COM (non. CSOM group) • Recurrent or persistent effusions in middle ear behind an intact tympanic membrane in which principal symptom (if present at all) is deafness and not ear discharge • i. e. chronic non-suppurative/ secretory / seromucous / serous / mucoid OM (glue ear)

Chronic Otitis Media: Contributing Risk Factors • Young age (children) • (Developing nations) Overcrowding, malnutrition • Being a member of a large family • • History of multiple episodes of acute OM Nasopharyngeal colonisation by bacteria implicated in OM Chronic sinus infection & allergies Upper respiratory infections (certain viruses like RSV, influenza, adenovirus) • Altered eustachian tube anatomy and function o Abnormalities in shape of the face, palate or eustachian tube o Down syndrome

Chronic Otitis Media: Signs and Symptoms Warning signs of chronic otitis media include: Hearing loss (most common) Facial weakness Persistent blockage of fullness of the ear Persistent deep ear pain or headache Chronic ear drainage (can range from a watery consistency to a yellow-green, foul-smelling discharge) Fever Drainage or swelling behind the ear Development of balance problems Confusion or sleepiness • • COM occurs gradually over many years in patients with longstanding or frequent ear trouble. But it can (rarely) develop over several months in a patient with no previous history of ear disease. Any of the above symptoms should prompt an evaluation by an ENT or otologist/neurotologist.

Chronic Otitis Media: Treatment Options • Appropriate topical antibiotic drops (remove small granulations in middle ear resulting from inflammation) AND • Aural toilet (thoroughly cleansing of the ear; reduce quantity of infected material/discharge and facilitate antibiotic action) • Sometimes surgery may be necessary o Mastoidectomy removes mastoid air cells, granulations & debris o Tympanoplasty repairs eardrum; closes perforation of tympanic membrane

Otitis Media with Effusion (Glue Ear) • Not an ear infection • Thick/sticky fluid behind the eardrum • Usually occurs after treatment for OM, when fluid (effusion) can remain in the middle ear for a few days or weeks. • Can lead to OM – when the tube is partially blocked, fluid builds up in middle ear bacteria already inside become trapped and begin to grow infection.

Otitis Media with Effusion: Contributing Risk Factors • Oedema of the lining of the Eustachian tube (creates negative pressure in middle ear that sucks fluid from mucous lining) increased fluid. Due to: • • Blockage/closure of the tube, due to: • • • Drinking while lying on back Sudden air pressure increases e. g. airplane, mountain road Children get more OME than adults (and younger more than older), due to: • • Allergies – most common in spring Irritants Respiratory infections Shorter tube, more horizontal, straighter – easy for bacterial entry Tube floppier, with opening that is small and easily blocked. Immune system not as developed get more colds. Other risk factors include: • • • Congenital abnormalities e. g. Cleft palate, immune deficiencies Genetic factors e. g. Down’s Syndrome Repeated ear infections, especially <6 m, and close succession. Attendance at day care Passive smoking

• • • Signs and Symptoms Often children with OME don’t act sick – no obvious symptoms, as no infection. Muffled hearing (transient) – usually 15 -40 d. B hearing threshold (mild-moderate); loss of >35 d. B in about 20% of cases; fluctuating hearing loss (with varied fluid volume). Sense of ‘fullness’ in the ear Children might have obvious difficulty hearing e. g. turn the tv up louder, as ‘What? ’ often. Can have behavioural impact: • • Distractibility Overactivity Social withdrawal Irritability Inattention Inappropriate response behaviours Specific ‘ear’ symptoms e. g. pulling on ear, head banging, rolling head from side to side Complications: • • • Acute ear infection Cyst in middle ear Permanent damage to the ear with partial/complete hearing loss Scarring of the eardrum (tympanosclerosis) Speech or language delay (rare)

Otitis Media with Effusion: Tests • Examine the eardrum for: o o Air bubbles on the surface Dullness when light is used No movement when little puffs of air are blown at it Fluid behind it • Tympanometry – shows amount and thickness of fluid. • Acoustic otoscope/reflectometer – detects presence of fluid. • Audiometer – to determine what treatment.

Otitis Media with Effusion: Treatment Options • • • Watchful waiting – 2 -3 months (unless there are signs of infection). Smaller, daily dose of antibiotics to prevent new infections, if child has had repeat ear infections (with/without oral steroids) Changes: o o o • If fluid still present after 6 weeks: o o o • Further observation Hearing test Single trial of antibiotics (if not given earlier) – not always helpful. A significant hearing loss (>20 d. B) antibiotics or ear tubes. At 4 -6 m, tubes probably needed, even where there is no significant hearing loss. Adenoids might need to be removed to restore proper functioning of the Eustachian tube. Insubstantial evidence for: o o o • Avoid cigarette smoke Encourage breastfeeding of infants Treat allergies, stay away from triggers. Antihistamine-decongestant combinations Oral mucolytics Eustachian tube autoinflation Surgical: o o o Myringotomy (pressure release) Tympanostomy tubes (grommets) Adenoidectomy (only when concurrent adenoid issues)

Why do children get more middle ear infections than adults? • Children < 7 years old are more prone to otitis media due to shorter, narrower and more horizontal Eustachian tubes than in the adult ear • They also have not developed the same resistance to viruses and bacteria as adults. • Breastfeeding for the first 12 months of life is associated with decrease in number of otitis media infections in children.