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Middle ear infection in Wikipedia

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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Otitis media". (Source - Retrieved 2006-09-07 14:20:43 from


Otitis media is an inflammation of the middle ear segment of the ear. It is one of the two conditions that are commonly thought of as ear infections, the other being otitis externa. Otitis media is very common, and includes a whole range of medical conditions; all of which involve inflammation of the ear drum (tympanic membrane), and are usually associated with a buildup of fluid in the space behind the ear drum (middle ear space).


There are several kinds of otitis media:

  1. Acute otitis media is an infection that produces pus, fluid, and inflammation within the middle ear. It is frequently associated with signs of upper respiratory infection, such as a runny nose or stuffy nose. It is often associated with Mastoiditis.
  2. Otitis media with effusion is the presence of middle ear fluid for six weeks or more from the initial acute otitis media.
  3. Chronic otitis media may develop when the infection persists for more than two weeks.
  4. "Adhesive Otitis Media"


The typical progress of otitis media is: the tissues surrounding the Eustachian tube swell due to an infection and/or severe congestion. The Eustachian tube remains blocked most of the time. The air present in the middle ear is slowly absorbed into the surrounding tissues. A strong negative pressure creates a vacuum in the middle ear. The vacuum reaches a point where fluid from the surrounding tissues accumulates in the middle ear. This is seen as a progression from a Type A tympanogram, to a Type C, to a Type B tympanogram. The fluid may become infected. It has been found that dormant bacteria behind the Tympanum (eardrum) multiply when the conditions are ideal infecting the middle ear fluid.

Otorrhea: Infected Drainage from the Middle Ear

When the middle ear becomes acutely infected, pressure builds up behind the ear drum and, in severe cases, the tympanic membrane may rupture. Once perforated, the pus drains out into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a dramatic and traumatic process, the opening is not only not painful, but associated with the dramatic relief of pressure and pain. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals up again.

Instead of resolution of the infection, however, drainage from the middle ear can become a chronic condition. The World Health Organization defines CSOM as 'a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane (i.e. perforated eardrum) and discharge (otorrhoea), for at least the preceding two weeks' (WHO 1998)


Streptococcus pneumoniae and Haemophilus influenzae are the most common bacterial causes of otitis media. Tubal dysfunction leads to the ineffective clearing of bacteria from the middle ear.

As well as being caused by Streptococcus pneumoniae and Haemophilus influenzae it can also be caused by the common cold.

Another common culprit of otitis media includes Moraxella catarrhalis, a gram-negative, aerobic, oxidase positive diplococcus.

Susceptibility in children

Children below the age of seven years are much more prone to otitis media since the Eustachian tube is shorter and at a different angle than that of the adult ear. They also have not developed the same resistance to viruses and bacteria as adults. There is also an association with maternal smoking habits.$[1]$


Whilst antibiotics were previously routinely immediately started, there is poor evidence as to their efficacy at shortening disease duration compared to the illness's natural history in the majority of children.$[2]$$[3]$

Protocols now exist for deferring the start of antibiotics for up to 72 hours.$[4]$ This results in 2 out of 3 children avoiding the need to start antibiotics,$[5]$ and no adverse effect on longterm outcomes for those whose treatment is deferred.$[6]$

In chronic cases or with effusions present, surgery is sometimes performed to insert a grommet (called a "tympanostomy tube") into the eardrum to allow air to pass through into the middle ear, and thus release any pressure buildup and help clear excess fluid within.

Along with medical treatment it is possible to use the Valsalva maneuver to reestablish middle ear ventilation.

Alternative method

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An effective alternative of relieving the pain felt by an earache is to have a physician or chiropractor perform endonasal therapy, which is a useful form of local treatment for catarrh problems. Endonasal therapy is a basic treatment used to initiate the draining and cleansing processes necessary to remove congestion in the Eustachian tubes.

Behind the nose and up above the tonsils is a small indentation called the "fossa of Rosenmuller." In this area the proximal end of the Eustachian tube opens into the throat. The Eustachian tube begins in the middle ear, passing downward, to come to an end in this fossa. Owing to the nature of the surface anatomy and of the draining pathways of the mucus, the fossa of Rosenmuller invariably becomes clogged with this draining fluid in catarrhal conditions. With the passage of time, the material that accumulates in this small cavity solidifies and becomes jelly-like. In this stage, it may clog the opening of the Eustachian tube and even some of the sinus drain tubes. In time the accumulated material becomes harder; both small capillaries and adhesions may form in this mass as time goes on. Because of this material's placement at the end of the Eustachian tube, its persistent pressure can cause catarrhal afflictions of the ear.


  1. Ilicali O, Keleş N, Değer K, Savaş I (1999). "Relationship of passive cigarette smoking to otitis media.". Arch Otolaryngol Head Neck Surg 125 (7): 758-62. PMID 10406313.
  2. Damoiseaux R, van Balen F, Hoes A, Verheij T, de Melker R (2000). "Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years.". BMJ 320 (7231): 350-4. PMID 10657332.
  3. Arroll B (2005). "Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews.". Respir Med 99 (3): 255-61. PMID 15733498.
  4. Damoiseaux R (2005). "Antibiotic treatment for acute otitis media: time to think again.". CMAJ 172 (5): 657-8. PMID 15738492.
  5. Marchetti F, Ronfani L, Nibali S, Tamburlini G (2005). "Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care.". Arch Pediatr Adolesc Med 159 (7): 679-84. PMID 15997003.
  6. Little P, Moore M, Warner G, Dunleavy J, Williamson I (2006). "Longer term outcomes from a randomised trial of prescribing strategies in otitis media.". Br J Gen Pract 56 (524): 176-82. PMID 16536957.

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