Middle Ear Infections
These are infections that are behind the eardrum.
The space behind the eardrum is supposed to be dry and all air.
Sometimes, infection or phlegm can reach this space via the auditory tube (Eustachian tube), which link to the back of the nose.
Acute Otitis Media (AOM)
These are fast and furious and very painful. They happen within a short time. It is associated with fever and severe ear pain. They happen quite commonly in children and are frequently missed by parents and doctors.
Other symptoms are:
- General crankiness like crying, irritable and inability to sleep
- Ear pain
- Rubbing and pulling of the ears
- Older children can usually describe a full and blocked feeling in the ears
- Vomiting
- Hearing loss
- Blood or yellowish substance coming out of the ears
Otitis Media with Effusion (OME)
Other related terms are middle ear effusion (MEE) or chronic otitis media (COM) or serous otitis media. For simplicity’s sake, you can take all of them to mean pretty much the same thing, which translates to English as “fluid behind the eardrum”.
These conditions are easier to miss but also very common. Some of their symptoms are similar to those above but they generally have a slower onset and are more subtle.
The patient might notice the following symptoms:
- Fullness or pressure in the ears
- Popping sound that sounds like bubble wrap being popped, especially when going up and down lifts
- Hearing loss and blocked feeling in ears
Many patients come to us thinking they have earwax, but they might actually have this.
Diagnosis
It takes a long time to learn to use the otoscope (the device doctors use to see inside your ears) and even longer to recognise and distinguish between normal and abnormal eardrums. No special scans are required other than the doctor’s good brain and eyes.
We have collected many images of eardrums to help our future colleagues better recognise these conditions.
| Zenith Collections of Middle Ear Infections | |
|---|---|
| Acute Otitis Media | |
 Ouch this looks painful! | |
 Ouch this looks very painful too! |  The left side for comparison |
| Otitis Media with effusion | |
 The right side |  The left side |
 A child's ear, easy to miss diagnosis unless the doctor looks into the ears. | |
 If the doctor doesn't take a second look, he might miss this. | |
 Notice the scar from a healing ear drum hole (healing perforation) |  Left ear also has an effusion |
 Notice the pus/fluid level at the bottom |  Normal left ear for comparison |
Who gets these conditions?
You are more likely to get these if you:
- are very young
- have nasal allergies
- are in a day care
- had a previous similar problem
- use a pacifier
- have a cough and cold
- are not breast fed
Treatment
The mainstay of treatment is use of antibiotics to treat the infections. Painkillers can help to reduce the pain.
Allergies are controlled with anti allergy medications such as nasal sprays or oral medications.
The valsalva maneuvre might be helpful, but stop doing if it hurts.
What are some precautions I can take?
Avoid diving or taking a flight, it might really hurt.
What if it doesn’t go away?
If the condition doesn’t go away, sometimes you (or your child) might need to undergo myringotomy (an incision is made in the eardrum to drain fluid) and tympanocentesis: (a small needle is used to drain fluid from the ear).
A word of caution
If you have the above conditions and you are a middle aged smoking man, you will be asked to undergo a nasal scope. This ear blockage could be a first sign that there is a growth deep inside the nose. So please do not wait till the condition worsens.