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Acute otitis media

Definition

Otitis is an inflammation of the skin or mucosa in the ear. Depending on the location and characteristics of the inflammation, the type of otitis is different. The acute otitis media is an infection of the middle ear that may be caused by bacteria or viruses. It is frequently associated with upper respiratory tract infection (URTI). 

To understand otitis pathogenesis, it is important to clarify the role of the Eustachian tube. The Eustachian tube connects the throat to the middle ear (the cavity behind the eardrum that is filled with air). The eardrum acts like a drum membrane and, to vibrate properly, both sides must be in contact with air at equal pressure. The Eustachian tube is closed at rest and opens momentarily during swallowing or yawning to allow air to come up or down from the middle ear. In other words, this tube balances the air in the middle ear and allows the eardrum to vibrate correctly.

Most often, acute otitis media is triggered by an infection of the upper respiratory tract (eg. colds, flu). This infection can come up through the Eustachian tube to reach the middle ear. URTIs can affect or block the Eustachian tube, preventing it from opening and fulfilling its role. Thus, the middle ear can run out of air and negative pressure is then created behind the eardrum. Subsequently, to protect itself from that pressure, the body secretes a fluid that accumulates in the cavity of the middle ear. The faulty Eustachian tube cannot drain the fluid correctly. The infiltration of viruses or bacteria into this fluid creates an inflammation of the middle ear, which is called “acute otitis media”.

Manifestations

The symptoms of acute otitis media are mainly fever, one- or both-ear pain and hearing loss. Sometimes it is possible to see a purulent fluid (otorrhea) flow from the ear, revealing that there has been tympanic perforation. These symptoms are usually temporary. When the infection resolves, the fever and pain dissipate. Hearing impairment may persist longer.

Children are more likely to develop acute otitis media as they contract more URTIs compared to adults. In addition, their Eustachian tubes are shorter and more horizontal, allowing pathogens to easily infiltrate the middle ear. About 75% of children have at least one ear infection before entering school.

The Audiologist’s Role

If fever and ear pain occur, it is recommended that you seek medical attention. The infection must be treated or followed by a doctor.

The audiologist evaluates hearing by determining the degree and nature of the impairment. If there is an ear infection, the auditory assessment will show signs of damage to the middle ear. If not already done, the audiologist can refer the patient to the family doctor or an ENT for a medical follow-up of the condition. In addition, the audiologist may offer recommendations related to nasal hygiene to try to restore (or maintain) the proper function of Eustachian tubes. If a hearing loss is noted at the audiological assessment, communication strategies will be recommended. Audiological monitoring may also be recommended to ensure hearing recovery.

It should be noted that audiological assessment can be performed at any age. Do not hesitate to consult, even for the toddlers. Children are sensitive to the effects of hearing loss, even temporary, as it can affect the development of language and learning.

Ressources

MSSS

Canadian Paediatric Society

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