Otitis: how to cure and take away the pain

For many, ear pain means otitis media. In reality, the painful symptomatology is not always the one that leads to the diagnosis of ear infection, which prefers children without sparing adults.

Otitis is a generic term. It indicates inflammation of the ear, although in most cases this is due to an infection affecting the middle portion of the ear, the cavity which houses the chain of hearing bones and which the tympanic membrane separates from the so-called ear internal.

Otitis media can be acute or persist and/or recur over time, configuring a so-called chronic-relapsing picture.

For the sake of completeness it must be said that otitis media can also be external when it involves the auricle and the ear canal, or internal, if it affects the labyrinth, i.e. the innermost portion of the ear.

Below is a summary of the characteristics of the different forms of otitis, classified according to
the area of ​​the ear canal involved.

Form of otitis	Characteristics
Otitis externa	It is located in the external auditory canal, i.e. the canal 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 hearing bones bounded internally by the tympanic membrane (it is a frequent disorder in preschool children)
Otitis interna (or labyrinthitis )	The inflammation affects the inner ear and, in particular, the labyrinth, which is a small anatomical area formed by organs involved in the control of balance and listening to sounds
Miringite	Specifically affects the tympanic membrane (it is a rarer form than the others)

Some suspicious clues

The symptoms that suggest an ear infection are:

• ear pain (not always present);
• temporary reduction in hearing ability (hearing loss);
• feeling dizzy and/or hearing high-pitched sounds (for example whistling) when, in fact, there are none;
• fever.

In young children, ear infections usually involve:

• irritability;
• refusal to feed;
• vomiting or diarrhea .

In adults, the pain can be similar to that of a toothache: it is accentuated when lying down and swallowing.

Usually the culprits are bacteria

Seven out of ten otitis episodes are caused by bacteria (Streptococcus pneumoniae, haemophilus influenzae, branhamella catarrhalis, moraxella). They can be identified by an appropriate examination of the secretion present in the ear.

These microorganisms are also responsible for other respiratory infections that are more common in children than in adults, such as rhinitis, sinusitis, pharyngitis, laryngitis, bronchitis and pneumonia.

A disease that prefers infants

Infants are more prone to otitis for anatomical reasons: the Eustachian tube, which connects the middle ear with the throat, is shorter and less inclined than in adults (ear and throat are almost aligned). Thus the eventual ascent of secretions and therefore of microorganisms from the pharynx is not sufficiently hindered.

This explains, among other things, why bilateral otitis is more frequent in children rather than localized in one ear alone, as is most often observed in adults.

Exposure to secondhand smoke and the use of pacifiers also favor otitis, which is less frequent in breastfed and in cases where the baby’s nostrils are cleaned with repeated and accurate washings.

Classification of otitis media

Otitis media is said to be acute when it resolves within three weeks (if the form lasts from three weeks to three months, it is referred to as subacute otitis media).

Symptoms develop rapidly and the middle ear appears inflamed with effusion in the tympanic cavity.

If not properly treated, the inflammation can spread to nearby structures attacking the nerves of the face giving temporary paralysis of the muscles and meningitis .

When the ear inflammation lasts for more than three months it is called chronic otitis media. It can be a recurrent form, in which the episodes repeat themselves (at least three episodes in six months or four episodes in a year), with obvious symptoms such as redness, pain, irritability and fever.

Or it may be due to Eustachian tube dysfunction, often with no obvious inflammatory signs and symptoms. In these cases, the utmost attention must be paid because, since there is a decrease in hearing, if it is not recognized it can compromise learning and lead to delays in language development.

The diagnosis is also visual

In addition to the detection of the classic symptoms, the diagnosis of otitis media is based on the observation of the tympanic membranes using a particular instrument called an otoscope. From this simple and immediate exploration, the doctor can obtain important information and prescribe the most appropriate therapy.

The prevention of relapses

The approach to acute otitis media involves three stages:

• timely shape recognition;
• the prevention of any complications;
• monitoring of evolution over time to prevent any relapses.

The cornerstone of the treatment of acute otitis media is often the administration of an antibiotic , on the basis of a careful evaluation made by the doctor who has the task of choosing effective preparations also against those bacteria which unfortunately tend more and more to develop resistance to drugs.

Depending on the specific case, antipyretics or analgesics may also be indicated.

The use of surgery is necessary in the presence of chronic forms with persistence of inflammatory effusion or reduction of hearing capacity.