Complications of Otitis Media - What Are They?

Introduction:

Viral infections are very common these days and can affect children and adults. Our ear is divided into three parts: the outer, middle, and inner ears. The function of the middle ear is to transfer sound waves from the outer ear to the inner ear. Viral infections like cold, flu, and other upper respiratory tract infections can result in the swelling of the middle ear, referred to as otitis media. It results in the build-up of fluid or pus behind the eardrum resulting in pain and pressure changes in the ear. Otitis media is a prevalent ear infection that affects children more than adults.

What Are Different Types of Otitis Media?

• Acute Otitis Media (AOM) - Spontaneous ear infection on exposure to cold or flu resulting in pain and swelling in the middle ear.

• Otitis Media with Effusion (OME) -The absence of early symptoms of ear infections characterizes it. Still, fluid build-up is behind the eardrum, resulting in temporary hearing loss or reduced hearing ability.

• Chronic Otitis Media with Effusion (COME) - It is characterized by the repeated fluid build-up behind the eardrum despite treatment for ear infection. It can result in the perforation of the eardrum.

What Is the Prevalence of the Complications Associated With Otitis Media?

The prevalence of intracranial (affecting brain) complications and extracranial (affecting other body parts except for the brain) complications of otitis media is approximately 0.69 to 5 percent.

What Is the Incidence of the Complications Associated With Otitis Media?

• The incidence of complications due to otitis media is around 0.78 percent.

• The incidence of complications due to otitis media is observed mostly in young children in the age group of fewer than 20 years.

What Are the Causes of Otitis Media?

Various causes of middle ear swelling include:

• Cold or flu.

• Upper respiratory tract infections.

• Bacterial infections.

What Are the Signs and Symptoms of Otitis Media?

• Ear pain.

• The fullness of the ear.

• Loss of balance.

• Fever.

• Pressure changes in the ear.

• Ringing sensation in the ears (tinnitus).

• Mild to severe hearing loss.

• Discharge from the ears.

• Headaches.

• Disturbed sleep.

What Are the Complications Associated With Otitis Media?

Repeated ear infections and fluid build-up in the middle ear can turn into complications which are divided into:

1. Extracranial complications (other body parts except for the brain).

2. Intracranial complications (affecting the brain).

Extracranial Complications:

• Hearing Loss: The build-up of fluid repeatedly in the middle ear can lead to perforation of the eardrum due to repeated ear infections that can result in significant hearing loss.

• Facial Nerve Paralysis: It is one of the most severe complications associated with otitis media. Facial nerve (seventh cranial nerve) palsy occurs due to the compression of the nerves by pressure produced by the fluid build-up in the ears. It accounts for about 25 percent of extracranial complications.

• Labyrinthitis: It is a common complication that occurs due to the spread of infection from the middle ear to the inner ear resulting in swelling in the inner ear. It also causes swelling of the hearing nerve that supplies the ears (the eighth cranial nerve- vestibulocochlear nerve). It accounts for about 23 percent of extracranial complications.

• Mastoiditis: It occurs due to the spread of the infection from the middle ear to the mastoid bone (present behind the ear), resulting in damage or swelling of the mastoid bone (mastoiditis). It accounts for about 25 percent of extracranial complications.

• Mastoid Abscess: It occurs due to the accumulation of pus in the mastoid air cells (within the mastoid bone present behind the ear).

Intracranial Complications:

• Meningitis - It is the most common life-threatening complication of otitis media that results in swelling of the outer layer of the brain (meningitis). It accounts for about 35 percent of extracranial complications.

• Brain Abscess - It occurs due to the spread of the infection from the ear to the brain resulting in fluid build-up in the brain (brain abscess), mostly in the temporal part (lateral part of the skull). It can lead to symptoms like changes in the pupils of the eye and paralysis of the oculomotor nerve (the third cranial nerve that supplies the eyes).

• Extradural Abscess - It occurs due to the accumulation of pus in between the outer covering of the brain. It accounts for about nine percent of extracranial complications.

• Subdural Abscess - It occurs due to the accumulation of fluid between the outer and the middle layers of the brain. It accounts for about four percent of extracranial complications.

What Are the Methods Used to Diagnose the Complications Associated With Otitis Media?

• Computed Tomography (CT) Scan - These scans of the brain help to rule out complications like meningitis (swelling of the outer layer of the brain) and brain abscess (fluid build-up in the brain tissues).

• Lumbar Puncture - A fluid (cerebrospinal fluid) sample is collected from the spinal cord to diagnose underlying brain infections like meningitis and brain abscess.

• Pure Tone Audiometry Test - It is done to check the severity and type of hearing loss.

How To Manage the Complications of Otitis Media?

Complications associated with otitis media are treated by a multidisciplinary team (doctors from different specialties). It can be managed by:

• Antibiotics - Antibiotics are prescribed to the patient to control the underlying infections.

• Steroids - Steroid therapy is given to the patient to reduce the swelling of the middle ear and brain tissues in case of the spread of infection to the brain.

• Neurological Treatment - An increase in the pressure within the brain to fluid build-up is managed by neurosurgeons (specialists in brain disorders) by performing surgical drainage. After the patient is neurologically stable, the intracranial complications are managed, then other complications management is carried out further.

• Mastoidectomy - This procedure done by an ENT (ear, nose, and throat) specialist, and it involves surgical drainage of the fluid-filled sacs within the mastoid bone is done to treat the mastoid abscess.

• Ophthalmologic Management - An increase in intraocular (eye) pressure or other symptoms affecting the eyes are managed by an ophthalmologist (eye specialist).

• Hearing Aids - Hearing aids (artificial devices that aid in hearing) is recommended for a patient with permanent hearing loss.

Conclusion:

Otitis media infections are common among young children in the age group below twenty years. Early diagnosis and management of the middle ear infection are crucial to avoid the associated complications. Any delay in the diagnosis and management of the ear swelling can lead to the worsening of the condition due to the spread of the infection to the brain resulting in life-threatening complications like meningitis and brain abscess that may lead to death.