Acute otitis media: definition

Acute otitis media (AOM) is an infection of the middle ear involving the eardrum or the eardrum, a small bony cavity located between the eardrum and the inner ear and containing the ossicles.

This cavity is connected by a conduit (the Eustachian tube) to the nasopharynx located at the back of the nasal cavities (see diagram below). The Eustachian tube helps equalize the air pressure between the nasal passages, the middle ear and the outside air.

Acute otitis media (AOM) is characterized by a generally purulent effusion located in the eardrum.

AOM is linked to a bacterial or viral infection, virus or bacteria most commonly contaminating the middle ear as a result of a rhino-sinusitis or a rhino-pharyngite by borrowing the eustachian tube.

Infection or inflammation of the nose and sinuses (nasosinus), enlarged adenoids can also cause obstruction of the eustachian tube, causing fluid to secrete into the eardrum (otitis media). ‘initially inflammatory but susceptible, by becoming infected, to transform into acute otitis media. 

Classically, AOM is manifested by fever and pain in one or both ears (most often just one) which is often very severe, but not always.

Symptoms of otitis in children

The signs can be misleading, especially in children and infants. Think about acute otitis media when: 

• the child often touches his ear
• the child cries, is irritable, has difficulty falling asleep
• has a lack of appetite.
• has digestive disorders, very misleading with diarrhea and vomiting
• has hearing loss (the child does not respond to low sounds).

Symptoms of acute otitis media in adults

• throbbing pain (punctuated by the beating of the heart) in the ear, which may radiate into the head.
• a feeling of blocked ears, hearing loss.
• sometimes ringing in the ears or dizziness

When the eardrum is perforated, otitis can result in a discharge through the ear canal of a more or less purulent discharge

The diagnosis of acute otitis media

A doctor should be consulted to confirm the diagnosis of AOM and to decide on the appropriateness of antibiotic treatment.

Diagnosis is made by looking at the eardrum, ideally with a microscope. It will make it possible to differentiate an AOM with purulent effusion from a congestive otitis, limited to an inflammation of the eardrum.

Note that this examination can show a particular form of acute otitis media, myringitis (i.e. inflammation of the eardrum), of viral origin, very painful which results in the presence of a bubble often covering almost -total eardrum, but which concerns only the eardrum, that is to say that after having pierced this bubble, which generally makes the pain disappear, the eardrum remains intact, without eardrum perforation.

The evolution of acute otitis media

If treated well, AOM heals in 8 to 10 days, but it is always necessary to check the condition of the eardrum after treatment and to ensure, especially in children, that hearing has returned perfectly.

The evolution of AOM is therefore generally benign but a number of complications are possible:

Serous or serum-mucous otitis

After healing of the infection, behind the eardrum, a non-purulent but inflammatory, non-painful effusion persists, which on the one hand promotes the recurrence of AOM.

This effusion can cause a persistent and severe hearing loss in children because it is potentially responsible for language delay; hence the need for monitoring at the end of treatment. An audiogram (hearing test) may be necessary in case of doubt. In the absence of healing, one may be led to suggest the installation of a transtympanic aerator.

Tympanic perforation

The purulent effusion can exert a strong pressure on the weakened eardrum (in this case the pain is particularly intense) and cause a perforation of the eardrum., with sometimes bloody discharge of pus which usually suppresses the pain.

After healing, the eardrum usually closes spontaneously, but in very variable times, which can sometimes last a few months.

Exceptional developments

• la meningitis
• labyrinthite
• mastoiditis, rare today
• chronic otitis – including cholesteatoma, a form of chronic aggressive otitis – has also become rarer. 

Children, more affected than adults

By the age of 3, it is estimated that about 85% of children will have had at least one AOM, and half will have had at least two. AOM mainly affects children, due to the shape and position of their eustachian tube (narrow and positioned more horizontally) as well as the immaturity of their immune system. Boys are a little more at risk than girls, for reasons we don’t know.

The large-scale administration of certain vaccines, in particular vaccines against pneumococcus and against Haemophilus influenza, have made it possible to reduce the frequency of acute otitis media and especially the frequency of AOMs caused by antibiotic-resistant germs. 

AOM occurs mainly in cases of dysfunction of the eustachian tube, serum-mucous otitis (the persistent fluid behind the eardrum is more easily superinfected), repeated infections of the nose or sinuses of allergic or non-allergic origin. .

It is also more common during immunity disorders (children born prematurely, malnourished, etc.) or anatomical abnormalities of the face, trisomy 21, cleft palate (or harelip) for example.

How do you get an ear infection?

•     Attendance at a nursery or crèche.
•     Exposure to tobacco smoke or high levels of pollution.
•     Bottle feeding rather than breastfeeding (see Prevention section).
•     Bottle feeding while lying down.
•     Frequent use of a pacifier
•     The absence of a correct blowing