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Common Diseases and Disorders of the middle ear

Problems of the Middle Ear

Otitis Media
Glue Ear and grommets in children
Burst eardrum in children
Burst Eardrum in adults
Chronic Suppurative Otitis Media
Mastoid Infection
Cholesteatoma
Damaged Ossicles (ossicular chain disruption)
Otosclerosis

Common terms for the bones of the middle ear (Ossicles) are: Stirrup (Stapes), Hammer (Malleus). Anvil (Incus)

Otitis Media (Middle Ear Infections)

Otitis media is an infection or inflammation of the middle ear usually caused by a viral or bacterial infection.

Symptoms of Middle Ear Infection

Some of the symptoms of middle ear infection include:

Earache

Headache

Fever

Discharge from the ear

Mild deafness

Difficulties in sleeping

Loss of appetite.

The causes of middle ear infection can be:

A progressive head cold
A viral sinus infection that spreads
An otitis externa infection left too long that spreads to the inner ear
Blowing the nose too hard, forcing sinal or Eustachian material into the middle ear.
An opportunistic infection entering through a perforated eardrum

Treatments for Otitis Media

Mild bacterial infections often clear up by themselves in a matter of days. Over-the-counter painkillers can help alleviate the pain. Warm olive oil dripped in the ear can also soothe the pain as long as there is no ruptured eardrum. Repeat every few hours.

In more severe cases, antibiotics might be needed which usually includes an initial antibiotic shot, antibiotic pills and ear drops.

In many cases of middle ear infection, the Eustachian tube is blocked and can cause or at least contributes to a middle ear infection. (See also Glue Ear, below). A Eustachian tube can become blocked from any combination of the following:

The body's inflammation reaction to an infection, swelling the Eustachian tube to where it closes completely.

A contributing factor can be the discharge of the dead bacteria and dead lymphocytes from the middle ear. The lymphatic system contains the white blood cells or lymphocytes which are the body's defense against foreign objects such as bacteria. When the white blood cells kill bacteria, the lymphatic fluid becomes pus-like due to a build up of dead white blood cells and dead bacteria. This discharge from the middle ear can irritate the Eustachian tube causing it to close.

A blocked Eustachian tube is often what causes the pain of a middle ear infection. Pus builds up in the inner ear cavity with no where to go, putting pressure on the inner ear and the ear drum. If left without treatment, the pressure can be so great that it bursts the ear drum. The initial excruciating pain of a burst eardrum is immediately compensated for by pain reduction from the release of pressure. Whereas, prior to the burst eardrum, sleep was impossible, the pain relief from the pressure reduction allows the sufferer to finally sleep. If the middle ear infection is cured on its own, the ruptured ear drum will also usually heals on its own, although sometimes surgery (tympanoplasty) is indicated if the rupture is extremely large.

Otitis Media Variants

Chronic Suppurative Otitis Media (CSOM)

CSOM is the name given to a condition when there is an infection of the middle ear which fails to heal and is draining all the time (suppurating). There are two forms of this condition:

Glue Ear
There is a natural flow of fluids from the middle ear (the fluids keep the middle ear cavity moist) that migrate through the Eustachian tube to the back of the throat. A blocked Eustachian tube prevents air from reaching the middle ear. When this happens the middle ear can fill up with the fluid that can becomes thick, like glue over time. This problem is called glue ear or otitis media with effusion. The buildup of fluid in the middle ear reduces the movement of the eardrum and ossicles, and hearing is reduced. This condition is quite prevalent in children.
More detailed information on Pediatric Glue Ear

Tubo-Tympanic Otitis Media

The tubo-tympanic form usually involves a perforation of the central part of the eardrum. This can be caused by infection, injury or surgery.

Symptoms of tympanic otitis media

You may have a hearing loss and a discharge, which may come and go, and will become noticeable particularly if you get a cold or the ear gets wet. You might also get tinnitus.

Treatment of tympanic otitis media

If the opening is not too large, it may close and heal on its own. Failing that, an ENT (Ear, Nose, and Throat specialist) may close it with surgery or by covering it with a special material to keep the opening closed while it heals.

You can usually help the symptoms by taking simple steps - for example, by wearing an ear plug or keeping the ear dry when you are having a bath or swimming. A hearing aid can improve the hearing. However, you may need an operation to repair the hole in the eardrum (tympanoplasty or myringoplasty)

Attico-antral CSOM

The attico-antral form of CSOM might also involve a hole in the eardrum - usually in the upper part. This form of CSOM can be more of a problem than the tubo-tympanic form because the eardrum sheds dead skin which can build up and enter the middle ear.

There are two major complications of the attico-antral variant of CSOM - Cholesteatomas and Mastoid infections (Mastoiditis).