All about otitis

When a part of the ear is inflamed, it is called otitis. It is usually caused by viruses or bacteria.

What is it

Otitis is the acute or chronic inflammation of the ear.

Depending on the ear area involved, we are talking about:

• otitis externa
• otitis media
• Otitis interna
• myringitis.

Depending on the duration of the disorder, but regardless of the part of the ear affected by the inflammatory process, we speak instead of:

• acute otitis
• chronic otitis.

The following table summarizes the main characteristics of the different forms of otitis.

Otitis form	Features
Otitis externa	It is located in the external ear canal, which is the channel that connects the auricle with the middle portion of the ear, sometimes also affecting the eardrum
Otitis media	It develops deeper, in the cavity that houses the chain of ossicles of hearing internally bounded by the eardrum membrane; it is a frequent disorder in preschoolers
Otitis interna	It is also called “labyrinthitis” since the inflammation affects the ear internal and, in particular, the labyrinth, that is a restricted area anatomical formed by organs involved in balance control and listening to sounds
Myringitis	To be affected is specifically the tympanic membrane (it is a rarer form than the others)
Acute otitis	The inflammation resolves completely in a few days and without necessarily resorting to pharmacological treatments
Chronic otitis	Inflammation lasts longer and requires medication or other remedies for complete healing

Causes

Generally it is bacterial or viral otitis, more rarely fungal. The triggers and associated risk factors may be slightly different depending on the type of otitis. Here is the description:

Causes of otitis externa

In its acute form it is typical of children and is often due to eczema or the complication of purulent otitis media that have damaged the skin lining the external canal.

Among the main risk factors we find contact with contaminated water which, trapped in the ear canal together with earwax, creates favorable conditions for the proliferation of germs; Hence the definition of “swimmer’s otitis”, a common form that affects those who regularly go to the pool.

To this we can add exposure to cold or moisture, dryness of the external ear canal, states of impairment of the immune system or vitamin deficiencies.

Finally, the use of earphones or hearing aids or the presence of small lesions caused by incorrect ear cleaning maneuvers – with sharp objects or cotton swabs – as well as allergies, psoriasis or scalp dermatitis, can favor the appearance of chronic otitis externa and the formation of painful boils.

Causes of otitis media

Otitis media can result from a common cold or from the spread of an infection of the upper respiratory tract such as pharyngitis, laryngitis or sinusitis by passage of infected secretions into the ear canal through the Eustachian tube, the communication channel between the nose and ear.

Causes of internal otitis

The causes of otitis interna are perhaps the most difficult to identify. Among the most common are:

• bacterial or viral infections such as mumps (also called “mumps”)
• Meningitis or meningoencephalitis
• severe allergic reactions
• high levels of stress.

These can be accompanied by other predisposing factors such as violent coughing, excessive exertion or sudden movements.

Common symptoms

Although the symptoms also vary depending on the form of otitis, ear pain, called in medical terms otalgia, is the hallmark of this disorder.

It occurs at various levels of intensity and may occasionally be accompanied by other characteristic symptoms.

Symptoms of otitis externa

It generally begins with the redness of the auricle and with an intense itching, then turning into persistent pain in the outer ear that is felt at the simple touch or during chewing.

Pain may be accompanied by:

• oedema
• erythema
• increased localized blood (hyperemia)
• impaired hearing ability
• secretion of pus or serum (otorrhea).

Symptoms of otitis media

In otitis media, ear pain may be accompanied by:

• sore throat
• more or less high fever
• nasal congestion
• cough
• muffled hearing.

In some cases it can appear in the purulent form that involves the production of foul-smelling secretions with pus and blood.

Symptoms of internal otitis

Dizziness is usually the first alarm bell and is usually followed by:

• states of anxiety and confusion
• loss of balance
• impaired hearing
• Dizziness
• ringing in the ear.

To these symptoms closely related to the ear can be added:

• nausea or vomiting
• stomach pain
• irritability
• anxiety
• depression (in severe cases).

Diagnosis

For the diagnosis of otitis, several tests and diagnostic tests are available.

Diagnosis of otitis externa

Going to affect the outer portion of the ear is perhaps the simplest to conduct and generally involves the use of an instrument called otoscope to detect the possible presence of edema and increased blood flow on site.

Diagnosis of otitis media

To recognize otitis media, the doctor may use an otoscope or subject the patient to a series of tests:

• tympanometrics for eardrum movement
• tympanogram to assess the presence or absence of fluid in the middle ear and in the Eustachian tube
• audiometric examination
• CT scan to visualize the anatomical structure of the ear.

Diagnosis of otitis interna

In case of suspicion of otitis internal, the following are indicated:

• Brainstem auditory response test
• electronic recording of eye movements, called electronystagmography
• Bacterial culture assessment
• TAC
• MRI.

Complications

They are rare and depend on the spread of infection to surrounding tissues and organs. Sometimes otitis can cause rupture of the eardrum with fluid leaking from the ear or cerebellar abscess.

In this last case there is the formation of a bag of pus in the brain which, for obvious reasons, must be promptly eliminated through the administration of antibiotics or surgery.

Cures and remedies for otitis

In the case of acute or mild otitis, the infection can heal spontaneously within a few days. However, it is useful to sleep with your head raised to reduce swelling and place a warm cloth on your ear.

For milder forms, natural remedies are also available, while for the more aggressive ones it is good to undertake a targeted pharmacological treatment that takes into account the triggering causes.

Natural remedies

Usually formulated in oily drops, they are useful above all to facilitate the elimination of earwax, one of the predisposing factors of otitis, through their emollient action.

Among the most used oils we find that of:

• olive
• peanut
• vaseline
• sweet almonds
• ylang ylang
• Massacar
• oily macerate of propolis.

Otitis can also be prevented naturally. Read Otitis media: natural remedies.

Pharmacological treatments

Considering that otitis is usually caused by bacterial or viral infections, the first-line drugs for complete healing, depending on the etiology, are:

• local antibiotics (ofloxacin, cefixime) or systemic antibiotics (amoxicillin, clarithromycin, cefuroxime, ampicillin etc.)
• antivirals.

In addition, always under the supervision of the doctor, symptomatic medicines can be taken such as:

• analgesics
• anti-inflammatories
• antiemetics and anticholinergics (in case of labyrinthitis)

Medical treatments

In the most severe forms or those that do not respond to drugs and emollient treatments, mechanical aspiration of earwax or drainage of liquids accumulated inside the ear is used.

What to do in case of otitis

• Once the cause is determined, carefully follow the prescribed therapy.
• Apply warm compresses to temporarily relieve pain.
• Sleep with your head in a slightly elevated position.
• Drink plenty of fluids.

What NOT to do in case of otitis

• Underestimate the problem by not going to a doctor.
• Swim.
• Irrigate the ear in case of tympanic perforation.

What to eat

• Foods to support the immune system, especially in the case of antibiotic therapy, such as yogurt containing live lactic acid bacteria or probiotics, also useful to avoid diarrhea caused by intestinal dysbiosis.
• Lots of fruits and vegetables.
• Drink plenty of fluids.

What NOT to eat

There are no foods to avoid in particular. It is therefore advisable to follow a balanced, varied and healthy diet.

Otitis in children

Otitis, especially the middle one, is a very common disorder in pediatric age, especially under 4 years of age and is generally the result of a cold or flu.

The symptoms are the same as those that occur in adults such as:

• ear pain
• reddening
• swelling
• cough
• fever, in some cases even high fever if the infection is particularly aggressive.

If the first symptoms should not be neglected in adults, it should not be done with children. It is therefore very important to contact the reference pediatrician even if you only suspect.

Therapy in children follows the general indications. In milder cases, anti-inflammatory and/or analgesic drugs are preferred and then antibiotic or antiviral therapy is administered if necessary.

How to prevent otitis

• Practice proper and constant auricular hygiene avoiding the use of cotton-buds.
• Be careful to dry your ears after a hot bath or swim.
• Do not scratch or damage the external ear canal to avoid bacterial contamination.
• Protect the ears from irritating or toxic substances such as hair dyes.
• Especially in the case of predisposed subjects it is recommended to regularly apply emollient drops to avoid the formation of earwax plugs.

When to consult your doctor

If the symptoms do not resolve within a few days or in case of high fever it is advisable to consult your doctor.