Otitis media: symptoms and diagnosis

Otitis media is a disease characterized by inflammation of the middle ear, which is composed of:

  • Eardrum
  • Ossicular chain (hammer, anvil and stirrup).


Causes of otitis media

Most middle ear infections are caused by an upper respiratory tract infection that spreads to the middle ear.

The infection can be:

  • Viral
  • Bacterial.

The otitis media can be caused by:

Risk factors of otitis media in children

Risk factors include:

  • Season: Autumn-Winter
    • Cold
    • Wind.
  • Premature babies
  • Young children, because they have a Eustachian tube that is too short and thus the spread of infection is more likely.
  • In addition, these children do not blow their noses and thus the mucus is not expelled, but accumulates and can reach the ear.
  • Children with allergies or children exposed to tobacco smoke may experience irritation of the Eustachian tube.
  • Infants who have not been breastfed. Breast milk contains antibodies that help fight infections.
  • Bottled children and children drinking milk lying down. The milk can penetrate the Eustachian tube and increase the risk of ear infection.

Symptoms of acute otitis media

Each child may experience symptoms differently, but the most common in otitis media are:

  • Unusual irritability,
  • sleep and sleep disturbances,
  • Very severe and tapping earache,
  • fever,
  • tinnitus (whistling or buzzing in the ear),
  • fluid leakage from the ear,
  • hearing difficulty,
  • feeling of blocked ears,
  • Secretions leaking from the ear can cause itching, but this symptom is usually provoked by an external ear infection.

According to a study by Stephan Lang and Benjamin Kansy from the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, the child may also have enlarged lymph nodes due to the respiratory infection.

Signs and symptoms of acute otitis media in infants
Although the history of acute otitis media varies by age, there are some constant signs in very young children: toddlers do not speak, but there are signs to understand that the child has an ear infection:

Some children have secretions from the ear.

Complications of otitis media

Labyrinthitis is an inflammation of the circular ducts in the inner ear. It can be a complication of otitis media.

Mastoiditis is an infection of a bony process on the temporal bone, which is the bone located behind the ear.
Symptoms include:

  • An abscess may form in the bone (accumulation of pus),
  • The skin behind the ear can be reddened and very painful.

In order to avoid further diseases such as meningitis (infection of the meninges), antibiotic treatment is required.

The cholesteatoma is an epithelial tissue (skin) that grows in the middle ear and mastoid bone.

Initially, secretions with characteristic foul odor may appear from the ear, which is affected by the cholesteatoma. At a later stage, when the cholesteatoma inside the middle ear enlarges, it can lead to:

  • bloating or pressure in the ear,
  • Hearing loss.
  • Dizziness, which occurs due to the involvement of the vestibular organs on the side where the cholesteatoma is located.

Complications of advanced cholesteatoma include:

  • damage to the ossicle chain,
  • Mastoiditis
  • Labyrinthitis
  • Meningitis
  • brain or cerebellar abscess,
  • Thrombophlebitis of the endocranial venous sinus or internal jugular vein.
  • Facial palsy.

After the diagnosis of this disease has been made, an examination by the specialist, an ear, nose and throat specialist, must be carried out very quickly.

Diagnosis of otitis media

The doctor can diagnose an infection of the ear based on the symptoms and clinical examination.

Objective investigation
To assess the ear, the doctor must use an otoscope. This instrument has a light source and a magnifying glass at the end.
The doctor inserts the device into the ear to examine the ear canal and tympanic membrane.
There is an otoscope that can be used to assess the mobility of the eardrum, the pneumatic otoscope.

The pneumatic otoscope blows air against the eardrum. If this structure does not move, it means that there is liquid there, which is why liquid leakage can also occur.

Examination of the ear with the otoscope
The tympanic membrane is tender and semi-transparent, it has an edge, the so-called annulus fibrosus.
With the otoscope, the only bone you can see is the hammer handle, because it is integrated into the eardrum.
The long process of the anvil can be seen when the tympanic membrane membrane:

  1. is completely transparent,
  2. is not inflamed,
  3. has no calcifications.

Under physiological conditions, you can’t see the stirrup.
The light from the otoscope causes the formation of a luminous triangle, but this does not affect the appearance of the ear.
The eardrum is not exactly vertical, but is oblique:

  • From top to bottom,
  • From the outside in.

The hammer is inclined from top to bottom and from front to back.

4-eardrum quadrants

The tympanic membrane is divided into four quadrants:

  • A line along the hammer handle (oblique),
  • The other perpendicular to it.

In this way, four quadrants are formed:

  • front-upper,
  • front-lower,
  • posterior-upper,
  • Back-lower.

The eardrum resembles an umbrella: it is slightly obliquely and has an indentation.

It is formed by:

  • A tight part,
  • A limp part.

The taut part has a larger surface, the limp part is smaller and is located in the upper area, above the short process of the hammer.
The taut and flaccid parts have a different composition and structure.
The flaccid part is formed only by two layers:

  • Skin
  • Airway mucosa.

It lacks the fiber layer, so it is more elastic and mobile.
The taut part consists of three layers:

  • A very fine outer layer of skin (the skin of the external auditory canal, which continues on the tympanic membrane);
  • fibrous layer for support, which consists of connective tissue and fibers that lead in different directions (circular, radial, etc.). This layer is very robust.
  • An inner layer (in the tympanic cavity or middle ear) formed by a respiration-type mucosa, that is, a pseudolayered cylindrical respiratory epithelium.

If during otoscopic examination the patient closed his mouth, covers his nose and blows against it, one can observe the movement of the tympanic membrane.
The evaluation of this movement is important to determine whether the Eustachian tube is functioning correctly.
This is very important for pressure equalization when flying or diving.
If one observes the eardrum in a patient after an eardrum reconstruction through the ear mirror, one sees the complete loss:

  • The identification points of the eardrum (reference points),
  • The normal anatomy.

In earroscopy, the use of the largest possible otoscope for the appropriate ear canal is to allow that:

  • More light gets inside,
  • The visibility is better.

Read more: