Serous otitis media


Serous otitis media

Description, Causes and Risk Factors:

The middle ear is a hollow chamber in the bone of the skull. It is separated from the outside world by a thin membrane about half-an-inch in diameter, the eardrum. The middle ear area is lined by the same kind of mucous membrane that lines nose and mouth. It is connected to the back of the nose, just above the soft upper portion of the mouth, by a narrow passage called the eustachian tube.

The eustachian tube lies closed until the swallowing movement pulls it open and allows fresh air to enter the middle ear. The fresh air is needed to replace oxygen that has been absorbed by the middle ear lining. The fresh air equalizes the middle ear pressure with the air pressure outside the head. Some people hear this burst of fresh air as a pop or click.

Suspended within the middle ear is a chain of three small bones, the ossicles, which conduct sound vibrations from the eardrum across the middle ear into the fluid-filled inner ear. Inside the inner ear these vibrations are converted to nerve signals that are carried by the auditory nerve to the brain.

The mastoid bone is an extension of the air space of the middle ear. It is made up of small interconnected air spaces similar to a honeycomb. Its function is not clear, but it is often involved in chronic ear infections. Within it lie the structures of the inner ear responsible for balance and facial expression.

The term otitis media means that there is inflammation of the middle ear. Otitis media can be associated with an infection or be sterile. In the first case, otitis media is usually caused by bacteria that migrate into the middle ear via the eustachian tube (a tube leading from the tympanic cavity to the nasopharynx; it consists of an osseous (posterolateral) portion at the tympanic end, and a fibrocartilaginous (anteromedial) portion at the pharyngeal end; where the two portions join, in the region of the sphenopetrosal fissure, is the narrowest portion of the tube (isthmus); the auditory tube enables equalization of pressure within the tympanic cavity with ambient air pressure, referred to commonly as “popping of the ears.”). Occasionally otitis media may be caused by fungi (Aspergillus or Candida) or other pathogens, such as the herpes virus. In this situation, usually either there is a problem with immune function or (there is a hole (perforation) in the eardrum. Persons with diabetes are particularly susceptible to unusual pathogens such as pseudomonas. In underdeveloped parts of the world, tuberculosis should be considered.

Sterile otitis media is usually called serous otitis media, or "SOM". The serous variety of otitis media is usually not painful. There is usually a clear or straw colored fluid behind the eardrum. The serous variety is often attributed to allergy but may also occur from numerous other potential sources including radiation treatment or virus. Serous otitis media may be associated with both hearing loss and vertigo.

Chronic otitis media may be associated with a chronically draining ear, mastoiditis, and cholesteatoma.

Symptoms:

• A feeling of fullness or blockage in middle ear that can radiate to your neck.

• Frequent ear infection.

• Mild hearing loss and/or tinnitus.

• Persistent blockage of fullness of the ear.

• Chronic ear drainage.

• Development of balance problems.

• Facial weakness.

• Persistent deep ear pain or headache.

• Fever.

• Confusion or sleepiness.

• Drainage or swelling behind the ear.

Diagnosis:

Otitis media is usually diagnosed by the combination of symptoms (ear pain and reduced hearing), and direct observation of an inflamed eardrum with fluid behind it. There is usually fever too. Acutely, in uncomplicated cases, while a thorough examination is necessary, no additional testing is usually required. Certain types of ENT specialists, "otologists", are especially good at making these diagnoses and seeing one of these doctors early on may make it possible to avoid unnecessary testing.

Otitis externa is easily diagnosed by looking into the external ear with an otoscope. The main problem with diagnosis is deciding whether or not there is also an otitis media, as often one cannot see the ear drum very well as the external ear canal is swollen, painful and filled with debris.

Hearing in otitis media and otitis externa is generally reduced in a "conductive" pattern, to a modest amount (20-50 dB). More details about hearing loss can be found here. Hearing testing is often done to be sure that the condition is improving. The fluid behind the eardrum is associated with immobility of the ear drum as well as a "flat" tympanometer trace. Tympanometry is a test done generally when the hearing is tested.

X-rays, CT scans, or MRI scans are generally not necessary to diagnose otitis media or otitis externa. In persons who have rapidly worsening course however, a CT scan or MRI scan may be recommended to evaluate the mastoid sinus area. A lumbar puncture may be necessary in persons in whom meningitis is suspected.

Treatment:

Typically, otitis media is treated with oral antibiotics. A bacteria named Streptococcus pneumoniae (a species of Gram-positive, lancet-shaped cocci and diplococci frequently occurring in chains; cells are readily lysed by bile salts. Virulent forms are enclosed in type-specific polysaccharide capsules, the basis for an effective vaccine. Normal inhabitants of the respiratory tract, and the most common cause of lobar pneumonia, they are the most common causative agents of meningitis, and pneumonia worldwide, and also cause sinusitis, and other infections. It is the type species of the former genus Diplococcus ) is associated with about 30-45% of cases. Other bacteria that cause otitis media include Haemophilus influenzae (about 40%), Moraxella catarrhalis, and Strep pyogenes.

There are no strict criteria for use of antibiotics and it is presently thought that overly facile use of antibiotics is responsible for the present rather high incidence of resistant bacteria. Other antibiotics such as cephalosporins, macrolides, and trimethocin-sulfa are used if the initial treatment fails. The main problem with these antibiotics is the development of resistance to them and gastrointestinal side effects (such as diarrhea). The increase in resistance to penicillins such as amoxicillin has been accompanied by resistance to other classes of medications.

There is presently an effort underway to avoid treatment early on with antibiotics in children who are otherwise well, as it appears that they do little to alter the course of the disorder and tend to increase antibiotic resistance in the population at large. Serous otitis media is particularly common to be managed this way. If the patient is immunosuppressed or has diabetes mellitus, however, all agree that treatment should be more aggressive. Sometimes local pain medications applied as drops to the external ear are helpful too.

In situations where there is a perforation in the eardrum or a tube, antibiotic drops may be prescribed. These may include sulfacetamide, neomycin/polymyxan, fluoroquinolones as well as many others. Inclusion of steroids in the drops improves prognosis.

Uncommon treatments: Steroids -- oral, nasal and injected steroids are occasionally used but their use is presently controversial. Recent studies have suggested that nasal steroid sprays are ineffective for serous otitis media

Auto-ventilation. This involves the patient blowing ear into their middle ear through their nose. It is very unpleasant and the results are unpredictable.

Surgeries to achieve these objectives include tympanoplasty (operative correction of a damaged middle ear), mastoidectomy (a group of operations on the mastoid process of the temporal bone and middle ear to drain, expose, or remove an infectious, inflammatory, or neoplastic lesion), or typanomastoidectomy. The ENT doctor or otologist makes an incision within the ear canal or behind the external ear. Part of the mastoid bone is then drilled away to gain access to the middle ear space. The abnormal tissues are removed. If possible, efforts are made to rebuild the eardrum and the sound-conducting bones. It is sometimes necessary, however, to complete the hearing reconstruction at a later date (a second stage) rather than at the same time as removal of the infected or damaged parts. Patients are usually discharged from the hospital on the same day or one day after surgery.

Healing after surgery takes several months. In 90 % of cases, surgery is successful in repairing the eardrum and a dry, healthy ear results. Hearing improvement is more difficult to predict and varies greatly depending on the severity of the disease, including the presence of cholesteatoma, ossicular erosion, mastoid disease, and eustachian tube function. If a hearing reconstruction was performed, it will take several weeks and months for hearing to begin improving. During this time middle ear packing and fluids are being reabsorbed and scar tissue is being formed to help stiffen the bones. In addition, the eardrum thins out. These factors contribute to a gradual hearing improvement. Routine checkups by the physician are recommended at least yearly after the healing is complete, and in some cases may be required two or more times yearly to maintain adequate local hygiene.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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