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Understanding Otitis Media, Ear Infections, and Fluid Buildup in the Ear

You have heard that children are prone to ear infections, but this simply isn’t normal. Your child is continually crying, pulling at his ear, and can’t sleep for more than a few hours—and it seems to happen all over again every few months. Is there a reason this keeps happening, and is there anything you can do to prevent it?

Serous Otitis Media

Otitis media (OM) is the medical term for an ear infection. "Media" means middle, and “otitis" is the technical term for inflammation inside the ear. Serous otitis media (SOM) occurs when the Eustachian tube, the valve that controls inner ear pressure, becomes blocked. Since air cannot get into the middle ear space, fluid from the ear lining (called serous fluid) collects in the space instead, blocking the eardrum. In the early stages, SOM causes a hearing problem, but as time goes on, the trapped fluid may become infected with bacteria and cause further complications.

Young children with ear infections may exhibit a number of symptoms, including:

  • Tugging at the infected ear
  • Crying or fussiness
  • Complaining of pain or a plugged feeling in the ear
  • High fever
  • Headaches
  • Balance problems
  • Problems sleeping
  • Difficulty hearing soft noises
  • Fluid draining from the ear

Children are more likely to suffer ear infections than adults for many reasons. Their Eustachian tubes are smaller and less developed, making it harder for fluid to drain out of the ear. Children are also more prone to infections, and their narrow Eustachian tubes are often swollen or blocked with mucus when the child develops a cold.

Causes of Serous Otitis Media

SOM commonly develops after a child has suffered a cold, sore throat, or upper respiratory infection. When a child is ill, the lymphatic tissues in the throat (called adenoids) filter bacteria that enters through the nose and mouth. This bacteria may get trapped in the adenoids, eventually traveling to the Eustachian tubes and into the middle ear. Viral infections such as colds can also lead to SOM because they weaken the immune system, making it easier for bacteria to take root in the ear.

There are many different classifications of otitis media, and each one describes the patient’s particular symptoms. Acute otitis media (AOM) indicates earache, infection, and high fever, while chronic otitis media may simply indicate a fluid buildup that causes hearing loss. Otitis media with effusion (OME) means that a child has overcome the ear infection, but fluid has stayed trapped behind the eardrum. Although a hearing specialist may be able to see the fluid behind the eardrum, a child with OME may not have any symptoms.

Acute Serous Otitis Media

Acute otitis media (AOM) is the most common ear infection, causing pain and swelling in the ear. A doctor can diagnose AOM simply by looking into your child’s ears with an otoscope. By shining a light into the ear, a doctor can check for the presence of a red, swollen eardrum, a hallmark of infection. If the eardrum is not red, the doctor may check the fluid pressure behind the eardrum using a pneumatic otoscope, which emits a small puff of air into the ear canal. If the eardrum does not move easily, there is likely a blockage.

Acute serous otitis media is usually caused by a blockage in the Eustachian tube as a result of an upper respiratory infection or an allergic attack. Doctors may prescribe medications to kill the bacteria (antibiotics), or antihistamines and decongestants to control allergies. Over-the-counter pain relievers, ear drops, and nasal sprays may be used to control pain, discomfort, or fever.

Acute Suppurative Otitis Media

If the fluid in the middle ear becomes purulent, your child may be diagnosed with acute suppurative otitis media. Bacterial infection may cause pus to gather in the middle ear space, resulting in an abscessed middle ear. To diagnose the condition, the doctor will use a needle to aspirate the fluid to determine if it is purulent. Treatments include placing an ear wick, a piece of gauze material which is soaked in antibiotic drops, into the ear canal to drain the fluid. In some cases, a doctor may make a small incision in the eardrum membrane (myringotomy) to relieve pressure and drain the pus.

Chronic Serous Otitis Media

If the inflammation in your child’s ear persists for several months, he or she may be suffering from chronic serous otitis media. This condition is commonly caused by long standing Eustachian tube blockage, or from a thickening of the fluids so that it cannot be absorbed or drained down the tube. Chronic otitis media may be irritating or painless, but ear pressure and popping of the ears is often constant.

While chronic serous otitis media may not directly cause hearing damage, it can make a child vulnerable to recurrent ear infections, which place the child at risk of hearing loss. If your child continues to suffer infections despite antibiotic treatment, the doctor may recommend a surgical procedure to place tubes in your child’s ears, allowing air to flow into the middle ear and prevent fluid buildup in the middle ear. These tubes usually stay in place for several months and fall out on their own.

Chronic Serous Mastoiditis and Idiopathic Hemotympanum

Chronic serous mastoiditis and idiopathic hemotympanum are less common conditions, but they share many of the same symptoms as chronic serous otitis media. Chronic mastoiditis is a persistent bacterial infection of the bone behind the ear (mastoid) that helps drain fluid from the middle ear space. The condition is commonly treated with antibiotics, ear drops, and regular ear cleanings, but may require surgery to remove the infected bone in serious cases.

Idiopathic hemotympanum is a condition where the tympanic membrane has turned blue or black due to a sterile, dark fluid in the middle ear. The condition can cause hearing loss, and may require surgery to drain the fluid from the middle ear (myringotomy).

The Abnormally Patent Eustachian Tube

In contrast to patients who suffer from chronic blockages of the Eustachian tube, some patients have difficulty getting their Eustachian tubes to close. A patulous Eustachian tube remains open most of the time, and can cause an echoing of the patient’s voice, a full sensation in the ear, and dizziness or vertigo.

Causes of patulous Eustachian tube may include weight loss, pregnancy, stress, hormone fluctuations, anxiety, and temporomandibular joint (TMJ) problems. Neurological disorders that cause muscle atrophy, including multiple sclerosis and Parkinson’s disease, have also been linked to patulous Eustachian tube.

This condition is harmless, but is also difficult to treat. Surgical treatment is available, but often results in creating a less functional Eustachian tube by purposely obstructing the tube.

Has your son or daughter suffered multiple ear infections in the past year? Call us today at 866-517-4415 to speak with one of our Florida hearing care providers. Together, we can find a solution to ease your child’s pain and prevent otitis media from coming back.