Otitis: symptoms, causes, diagnosis and treatment

Pain and fever, if present, can be relieved by using paracetamol and ibuprofen-based painkillers.

Depending on the part of the organ involved, one can distinguish between external otitis, otitis media and chronic otitis media.

Otitis media is inflammation of the middle ear, i.e. the tympanic cavity or eardrum cavity that contains the ossicle chain (hammer, anvil, stirrup).

Acute otitis media is a bacterial or viral infection of the middle ear mucosa generally accompanied by an upper respiratory tract infection.

Chronic otitis is defined as all those forms of otitis that are protracted over time (>6 months) with predominant involvement of the middle ear portion and may extend to neighbouring areas.

Chronic otitis media is a chronic inflammation of the middle ear.

The presence or absence of otitis symptoms is related to the stage of the disease, possible involvement of the mastoid bone and the presence or absence of a tympanic perforation.

Otitis externa, also known as swimmer's otitis, is an inflammation of the external auditory canal, the canal that connects the auricle with the eardrum.

In particular, otitis externa affects the lining epithelium of the external auditory canal.

It is often caused by contact with water polluted with bacteria or irritants, but can also be generated by small wounds on the walls of the ear canal that may occur as a result of normal hygiene.

The symptoms commonly associated with otitis externa are

Otorrhea is the discharge of material from the ear that often smells bad.

A hearing loss is the decrease in hearing, or buzzing, whistling, throbbing, dizziness, pain and rarely paralysis of the facial nerve.

In rare cases, acute or chronic exacerbated otitis media can lead to serious complications, e.g. endocranial (meningitis, brain abscess, cerebral venous sinus thrombophlebitis, etc.).

Chronic forms are characterised by recurrent episodes of otorrhea, or by constant and slowly worsening hearing loss, which often only partially respond to medication.

This occurs because the middle ear and nasopharynx are connected by a duct known as the Eustachian tube, whose job is to balance the air pressure inside the ear with that outside and facilitate the drainage of mucus from the middle ear.

In the event of an upper airway infection, germs present in the secretions of the nasopharynx can reach the middle ear and initiate the infection.

In other cases, obstructions and/or changes in the Eustachian tube cause the infection.

Otitis media is a typical disease of children, particularly common between 6 and 15 months of age.

Almost all pre-school children suffer from it at least once and just under 50% will have at least three episodes of otitis within the first three years of life.

Very often, fluid may be present in the ear of children with otitis media.

In this case we speak of otitis media with effusion, a form that affects about 90 per cent of preschoolers.

When otitis media is not adequately treated, an aggravation of the clinical picture with perforation of the eardrum, impaired hearing and severe tinnitus is possible.

Otitis media is caused by the action of bacteria or viruses and is affected by subjective factors such as age, immune status and local factors.

These include adenoid hypertrophy, Eustachian tube insufficiency, sinusitis or chronic rhinitis.

The bacteria that most commonly cause this condition are: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

The propagation and development of germs can take place via the Eustachian tube or the lymphatic-haematic route.

Other possible triggers of otitis media are:

In children with repeated (or recurrent) otitis media, it may be necessary to insert a small tube (ventilation tube) into the eardrum to facilitate drainage of the collected fluid.

In the case of enlarged adenoids that generate recurrent episodes of otitis media, their removal through surgery may be considered.

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Serious complications of otitis media are not frequent. However, very young children (in whom the body's defence system is underdeveloped) are at risk of local, regional or endocranial complications such as:

This condition is characterised by high fever, swelling and pain behind the ear, headaches and hearing loss.

Usually, it resolves by administering antibiotics but, in some rare cases, it may be necessary to resort to cholesteatoma surgery, chronic inflammation of the middle ear associated with abnormal skin growth with erosion of bone structures.

A surgical approach is necessary

Although it is not possible to prevent otitis media in children, certain behaviours can help reduce the risk of infection

In the case of chronic otitis, complications occur very rarely thanks to pharmacological treatment.

From an aetiological point of view, the pathogens involved in otitis externa are mainly bacteria and viruses (especially herpes viruses), and in some cases some mycetes.

Acute otitis externa, typical of children, is often a consequence of eczema or purulent otitis media, responsible for the progressive maceration of the skin lining the external auditory canal.

Otitis externa can be facilitated by certain elements such as cold, humidity, dryness of the ear canal or accumulation of earwax. In the case of allergy-induced otitis externa, the elimination of anything that may cause the allergy (e.g. hearing aids, ear plugs, earrings) is recommended.

If, after a few days of treatment with painkillers, symptoms persist and/or worsen, the doctor may decide to prescribe antibiotics.

Antibiotic treatment is recommended, in the doctor's opinion, especially in children under the age of 6 months and/or adults with other illnesses.

If an otitis externa caused by fungi is established (diagnosed), the doctor may decide to administer so-called antifungal drugs.

Several elements can play a preventive role with respect to the occurrence of otitis externa:

In some forms of chronic relapsing otitis, it may be necessary to complete the diagnosis with radiological investigations (CT petrous cavity).

This is done in order to better define the extent of the inflammatory phenomenon and any damage that cannot be detected in order to exclude the involvement of important structures such as the labyrinth (seat of the balance organ), the cochlea (seat of the hearing organ), the facial nerve (cranial nerve responsible for the movement of the facial mimic muscles), and the meninges (the membrane lining the brain tissue).

The treatment of chronic forms is usually surgical and depending on the type, previously indicated, an indication is given for a specific surgical procedure.

In simple chronic forms (with tympanic perforation), the eardrum is reconstructed with fascia from the temporalis muscle or with cartilage taken from the auricular pavilion.

In exudative forms, incision of the eardrum and placement of a drainage tube usually solve the problem.

In atelectasis forms the eardrum together with the ossicles are reconstructed and cartilage and titanium or Teflon ossicular prostheses are used.

In cholesteatoma forms, a mastoidectomy and reconstruction not only of the eardrum but also of the cavity with fibro-muscular flaps (closed, open and open obliterative tympanoplasty) is usually performed.

With the application of new endoscopic surgical techniques, it is now possible in many cases to perform the operation without any external cuts.

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