2023-10-20 12:39:42
What does “middle” otitis mean?
The ear is divided into three parts: middle, inner and outer.
The outer ear includes the pinna and the ear canal up to the eardrum.
The inner ear is the auditory nerve and the cochlea.
The middle ear, between the two, is composed of small cavities filled with air, located just behind the eardrum. Air pressure is balanced there by the Eustachian tube, a tube that connects this area to the back of the throat. “When we swallow, the Eustachian tube opens to restore air pressure,” explains Dr. Jean-Marc Juvanon, otolaryngologist, member of the board of the French ENT and Face and Neck Surgery Society.
When this part of the ear becomes inflamed or infected – the famous “acute otitis media” – the cavities fill with fluid or pus. As the air is expelled, the pressures are no longer balanced and the eardrum no longer vibrates correctly.
How do you get an ear infection?
The middle ear is sensitive to variations in atmospheric pressure, for example when flying or scuba diving.
It is also prone to infections, as viruses and bacteria that colonize the nose and throat can reach it easily. In fact, acute otitis media often occurs following a respiratory infection, a cold or nasopharyngitis for example.
When this area is irritated, the mucous membrane of the middle ear becomes inflamed and, as a reaction, secretes a fluid. Depending on its thickness, we speak serous or seromucous otitis media.
If this fluid comes into contact with bacteria from the nose or throat, it can become infected and turn into pus. We are talking purulent otitis. The accumulation of pus in the cavities of the middle ear risks, in extreme cases, perforating the eardrum.
Viral or bacterial otitis?
Most often, acute otitis media is of bacterial origin. Two germs are mainly involved: pneumococcus and haemophilus, bacteria also responsible for meningitis. “Since vaccines against these bacteria became compulsory, we have seen the number of ear infections drop,” notes Dr. Juvanon.
Why is otitis media so painful?
In reality, the pain is not systematic. It depends on the stage of the disease:
At the stage of serous or seromucous otitis media, when the spilled fluid is not infected “there is no pain yet”explains Dr. Juvanon.
Ear pain occurs when infected fluid, pus, puts strong pressure on the eardrum.
What are the symptoms of ear infection?
Pain is the best known. In toddlers, it is not difficult to recognize. “We necessarily think of acute otitis media in a child who holds his ear, cries a lot, has a fever, does not sleep well and no longer eats, especially if pus flows from the ear,” notes the ENT doctor.
Hearing loss can also alert. The eardrum can no longer vibrate properly, and sounds are muted. After healing, everything returns to normal.
Fever is not systematic. It concerns otitis media in children more than that in adults.
Why do children have more ear infections than adults?
Ear infections are very common in young children because their immune system, which is still immature, does not defend them sufficiently. Babies in daycare, exposed to multiple microbes, easily catch ear infections.
Furthermore, adenoids (growths located behind the nose) swell in some children to the point of obstructing the Eustachian tube. The air pressure in the middle ear is no longer properly regulated, which favors the appearance of otitis. The removal of adenoids is also recommended in children prone to recurrent ear infections.
How do you know if it’s acute otitis media?
To diagnose acute otitis media, the doctor inserts a device called an otoscope into the ear canal to examine the eardrum. “In case of otitis, the eardrum appears opaque even though it is normally transparent. In some cases, you can see the liquid through it. On otoscopy, we also see that the eardrum has changed shape. Under the pressure of the liquid, it bulges outwards.explains Dr. Juvanon.
This examination, which can be carried out at the general practitioner’s office, is not easy to perform on a child who is in pain, especially if a blockage of earwax obstructs the ear canal. In this case, Dr Juvanon advises consulting an ENT doctor, who is better equipped than a general practitioner. “Using a micro-aspirator, the ENT aspirates the secretions: earwax or pus”, explains Dr. Juvanon.
Why should acute otitis media be treated?
A simple otitis heals spontaneously, without antibiotic treatment, within a few days. But repeated episodes must be taken seriously because, by damaging the eardrum, “they can lead to permanent deafness in the long term”, notes Dr. Juvanon. He also recalls that: “before the advent of antibiotics, 10% of ear infections transformed into mastoiditis, with a risk of abscess behind the ear or even brain abscess. » Today, these very serious complications have practically disappeared.
How to treat acute otitis media?
In case of otitis, the doctor prescribes antibiotic treatment (amoxicillin or cephalosporin). “Ideally, you should wait 48 hours after the diagnosis of ear infection before prescribing an antibiotic because some ear infections heal spontaneously. But, in practice, this deadline is not often respected. observe Dr Juvanon.
If this first treatment is not enough to cure the otitis, it is sometimes necessary to pierce the eardrum using a lancet to let the pus drain, which will quickly relieve the pain. During this paracentesis, a fluid sample is taken. The analysis will make it possible to precisely identify the germ responsible for the infection and to adjust the treatment. This paracentesis, which can be painful, has left bad memories in some people. But Dr Juvanon is reassuring: “Today, it is practiced less and less because the antibiotics prescribed as first-line treatment are generally effective. »
Is an ear infection contagious?
“Otitis becomes contagious from the moment the ear starts to run. The pus contains microbes that can contaminate those around you,” replies Dr. Juvanon. In the absence of effusion, it is not the otitis which is contagious but the infection which is the cause (cold, nasopharyngitis, etc.).
Acute otitis media: what risk of recurrence?
Among children, recurrences of ear infections are very common, particularly among children under three years old in the community. The problem is that by increasing the number of antibiotic treatments, we risk selecting resistant germs. Better to take some preventive measures.
Against ear infections, what possible prevention?
First advice for parents who smoke: quit smoking. Exposure to cigarette smoke irritates the respiratory tract which, indirectly, promotes ear infections.
Some children suffer from gastroesophageal reflux disease (GERD). “When stomach fluid rises into the throat, it causes inflammation which promotes inflammation of the ear,” explains Dr. Juvanon. A effective treatment of GERD reduces the risk of ear infections.
Must also teaching children to blow their noses. This nasal hygiene protects them, to a certain extent, from ENT infections.
Finally, the placement of a “yoyo”, under anesthesia, relieves the child for several months. Concretely, this transtympanic aerator “allows permanent ventilation of the middle ear. It reduces the number of ear infections in children at risk. specifies the ENT doctor.
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