Ear Infection: Otitis Media
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Otitis Media: or Inner ear infection, inflammation of the middle ear, may be acute or chronic, suppurative or secretory.. Acute otitis media occurs commonly in children. It's incidence rises during the winter months, paralleling the seasonal rise in nonbacterial respiratory tract infections. It is a result from disruption of eustachian tube patency. In the suppurative form, respiratory tract infection, allergic reaction, or positional changes (such as holding an infant supine during feeding) allow reflux of nasopharyngeal flora through the eustachian tube and colonization in the middle ear.
In secretory otitis media, obstruction of the eustachian tube results in negative pressure in the middle ear that promotes transudation of sterile serous fluid from blood vessels in the membrane of the middle ear that promotes transudation of sterile serous fluid from blood vessels in the membrane of the middle ear. With prompt treatment, the prognosis for acute otitis media is excellent, however, prolonged accumulation of fluid within the middle ear cavity causes chronic otitis media.
Cause: Suppurativre otitis media occurs as a result of pneumococci, beta hemolytic streptococci, and gram negative bacteria. In children under age 6 the most common cause is Hemophilus influenza, and in children over age 6, it is usually cause by staphylococci.
Chronic suppurative otitis media results from inadequate treatment of acute infection as well as infection by resistant strains of bacteria.
Secretory otitis media occurs as a result of a viral infection, allergy, or pressure injury caused by an inability to equalize pressures between the environment and the middle ear (barotrauma).
Chronic secretory otitis media is cause by an adenoidal tissue overgrowth that obstructs the eustachian tube, that obstructs the eustachian tube, edema resulting from allergic rhinitis or chronic sinus infection, and inadequate treatment of acute suppurative otitis media.
Patient with acute suppurative otitis media may be asymptomatic ( without symptom ), but the common symptoms include, severe, deep throbbing pain; signs of upper respiratory tract infection; mild to high fever; hearing loss, usually mild and conductive; dizziness; obscured or distorted bony landmarks of the tympanic membrane (evident on otoscopy); and nausea and vomiting. patient may also experience, bulging of the tympanic membrane, with erythema (redness), and purulent drainage in the ear canal from tympanic membrane rupture.
Patient with acute secretory otitis media is commonly asymptomatic but may develop severe conductive hearing loss ranging from 15 to 35 decibels, depending on the thickness and amount of fluid in the middle ear cavity. Other signs and symptoms may include a sensation of fullness in the ear; popping, crackling, or clicking sounds with swallowing or jaw movement; hearing an echo when speaking or experiencing a vague feeling of top heaviness; and tympanic membrane retraction, which causes the bony landmarks to appear more prominent (seen on otoscopy). Clear or amber fluid behind the tympanic membrane is seen on otoscopy. Some patients develop a blue - black tympanic membrane, seen also with an otoscopy if hemorrhage into the middle ear has occurred.
Chronic otitis media usually begins in childhood and persists into adulthood. Its effects include decreased or absent tympanic membrane mobility; cholesteatoma ( a cystlike mass in the middle ear ); and a painless, purulent discharge (in chronic suppurative otitis media). Conductive hearing loss varies with the size and type of tympanic membrane perforation and ossicular destruction. Some patients develop thickening and sometimes scarring of the tympanic membrane, evident on otoscopy.
Acetaminophen or aspirin to control pain and or fever
Nasopharyngeal decongestant therapy
For acute secretory otitis media: May require myringotomy (incision of the tympanic membrane) and aspiration (removal of fluids) of middle ear fluid, followed by insertion of a polyethylene (a synthetic plastic material) tube into the tympanic membrane, are necessary for immediate and prolonged equalization of pressure. The tube falls out spontaneously after 9 to 12 months.
For chronic otitis media : treatment includes antibiotics for exacerbation of acute infection, elimination of eustachian tube obstruction, treatment of otitis externa (when present), myringoplasty (surgical restoration of the tympanic membrane), and tympanoplasty to reconstruct middle ear structures when thickening and scarring are present.
* If your hearing loss or your ears stay plugged up for more than a couple of days after a cold, see your doctor , you could already have an ear infection or fluid in the middle ear.
If left untreated, an ear infection can cause a permanent hearing loss in children and adults.
* If on antibiotic therapy, and pain persists after 48 hours, call your doctor promptly.
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