Association Between Pneumonia and Otitis Media - An Overview

Introduction

Pneumonia and otitis media are respiratory infections with common pathophysiology. Otitis media is a common infection caused by bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) and viruses (Adenovirus, Influenza virus, Respiratory syncytial virus, Enterovirus, Coronavirus, Rhinovirus and Parainfluenza virus). Streptococcus pneumoniae, the leading cause of pneumonia, effectively colonizes the nasopharynx and weakens the immune response. In addition, bacterial infection co-exists with viral pathogenesis rather than individual bacterial or viral infection. This further leads to the spread of infection to the middle ear.

What Is Pneumonia?

Pneumonia is an infection that affects one or both lungs. The air sacs in the lungs (alveoli) are filled with fluid or pus, resulting in difficulty in breathing.

Types of pneumonia include:

• Bacterial, viral, or fungal pneumonia.

• Walking pneumonia - The individual is infected but can do daily activities.

• Chemical pneumonia - It is caused by inhaling chemical fumes.

• Aspiration pneumonia -It is caused by inhaling acid from the stomach, vomit, or food particles.

• Hospital-acquired - Infection acquired during a stay in the hospital.

What Is Otitis Media?

Otitis media is a middle ear infection where fluid builds up and causes pain and swelling in the eardrum. Types include:

• Acute otitis media - It is when the middle ear is infected and swollen with fluid build-up.

• Otitis media with effusion- post-infection, some fluid remains inside and causes infection.

• Chronic otitis media - accumulated fluid repeatedly returns to the middle ear and compromises hearing ability. Infection may or may not be present.

Why Does Pneumonia Affect the Middle Ear?

The middle ear is between the tympanic membrane (eardrum) and the inner ear. The eustachian tube connects it to the upper throat (nasopharynx). This connection continues down to the middle throat (oropharynx), the lower throat (hypopharynx), the windpipe (trachea), and finally, the lungs. This interconnection causes the infection from the lungs to reach the middle ear.

How Does Pneumonia Cause Otitis Media?

Persistent and recurrent infection results in colonization of the nasopharynx with Streptococcus pneumoniae. Viral infection co-exists and induces the adherence of bacteria to mucosal epithelial cells of the middle ear, which is close to the nasopharynx. This causes mucosal membrane inflammation, narrowing of the eustachian tube (ear canal), and reduced ventilation. Negative pressure is created, resulting in increased mucosal secretions that allow the growth of bacteria and viruses. As a result, the middle ear is filled with thick, amber-colored fluid and tympanic membrane retraction. In severe cases, perforation of the membrane can also occur.

Who Gets It?

Anyone can get both infections. But it is more common in children between 3 months - 3 years, and eight years of age. It also occurs in adults but is less common compared to infants and children. It also affects individuals with weak immune systems.

What Are the Symptoms?

Pneumonia:

• Chest pain.

• Fatigue.

• Fever and chills.

• Cough with phlegm.

• Nausea, vomiting, and diarrhea.

• Difficulty in breathing.

Otitis Media:

• Ear pain.

• Fever.

• Fluid from the ear.

• Poor sleep.

• Poor appetite.

• Difficulty in hearing.

What Are the Complications?

Complications are often seen in children and adults with pre-existing conditions.

Pneumonia:

• Pleurisy - Inflammation of the lining between the lungs and ribcage, resulting in respiratory failure.

• Lung abscess - Pus formation in the lungs, a rare complication.

• Sepsis - This is a serious complication where the infection travels into the blood, leading to organ dysfunction.

Otitis Media:

• Loss of hearing.

• Perforation of the eardrum.

• Pus formation.

• Facial paralysis.

• Meningitis.

• Brain abscess.

• Otitic hydrocephalus.

How to Prevent It?

• Practice and teach personal hygiene to prevent the common cold.

• Avoid smoking and passive smoking.

• Ask your physician about flu, pneumococcal and other vaccines for your children to prevent respiratory infections.

How Is It Diagnosed?

Pneumonia is diagnosed with a few of the following tests;

• A Chest X-Ray -To examine inflammation of the lungs.

• Blood Tests - Complete blood count to detect infection.

• Pulse Oximeter- To measure blood oxygen levels.

• Sputum Test - To find out the causative microorganism.

• A Polymerase Chain Reaction Test - Blood or sputum is tested to know the DNA (deoxyribonucleic acid) of the microorganism.

• CT Scan - To find if lung abscesses or any pleural disorders are present.

• Thoracentesis - Pleural fluid present between lungs and rib cage is removed and cultured to find microorganisms.

Otitis media is diagnosed based on the symptoms. The tests done for examination are:

• Pneumatic Otoscope -An instrument used to observe the eardrum.

• Tympanometry - To assess the movement of the eardrum. There will be slight or no movement if the eardrum is swollen.

• Acoustic Reflectometry -Measures the sound reflected from the eardrum. More sound indicates high pressure in the eardrum because of fluid accumulation.

• Tympanocentesis - A rare test in which the fluid is removed through a small tube to find the causative microorganisms.

What Are the Treatment Options?

Pneumonia:

Treatment is based on symptoms and severity. Mild pneumonia is manageable at home under the guidance of your doctor.

The following steps are advised:

• Acetaminophen or Ibuprofen is prescribed to control fever.

• Consuming plenty of liquids is essential for hydration.

• Cough medicines should be taken only if your doctor advises you to do so.

• Good rest is essential.

Severe cases are treated in a hospital setup,

• Antibiotics: antibiotics are given only for bacterial pneumonia after the culture test. Systemic antibiotics are given.

• Antivirals: to treat viral pneumonia.

• Acetaminophen or Ibuprofen is given to reduce fever.

• Cough medicines are not given unless it is essential because coughing evacuates sputum.

• Nebulizer with Ventolin, ProAir, or Proventil to ease breathing.

• Oxygen or a ventilator is used to ease breathing.

Otitis Media:

Ear infections settle within one to two weeks. The doctor will advise following management based on symptoms.

• Pain Medications -the doctor will prescribe drugs like Acetaminophen or Ibuprofen to relieve pain.

• Ear Drops - Anesthetic drops to relieve pain.

• Antibiotics -Antibiotics are prescribed in the following cases;

  • Age 6 months and above with moderate to severe pain or temperature 102.2 degrees.

  • 6-23 months with mild pain and fever of less than 102.2 degrees

  • Twenty-four months and above with mild pain and fever less than 102.2 degrees.

• Ear Tubes - A small hole is surgically created in the eardrum, and a tiny plastic or metal tube is placed to prevent fluid accumulation and ventilation. This is done in case of recurrent fluid build-up.

When to Consult a Doctor?

Symptoms can be mild to severe. It is important to consult a physician if the symptoms are present for more than a day. Children and infants with the infection should be consulted to avoid severe illness. Individuals with fluid or blood discharge from the ear should immediately visit the doctor. It is essential to get proper treatment to prevent further progression.

Conclusion

Pneumonia and otitis media are common childhood diseases. Microorganisms are common in the nose and throat of children. They affect individuals with weak immunity. Doctors recommend vaccination for children and adults to protect them from pneumococcal diseases. Consult the doctor for early intervention and treatment.