Otitis media

Otitis media

ICD-9: 382.9


Otitis media is an accumulation of fluid within the structure of the middle ear. The condition is subclassified into either serous or suppurative according to the composition of the accumulating fluid. In serous otitis media, the fluid is comparatively clear and sterile, secreted from the membranes lining the inner ear. In suppurative otitis media, the fluid is the product of pus-producing bacteria. The pressure from the accumulating fluid, in either form of the condition, may be sufficient to occasion temporary hearing loss. Both serous and suppurative forms of the disease may occur as acute or chronic conditions. Otitis media is most common among children.

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Acute serous otitis media may occur spontaneously or following an upper respiratory tract infection. It also may be occasioned by rapid changes in atmospheric pressure, such as occur during flying or diving, or by allergic reactions. The chronic form of serous otitis media may develop from the acute condition, or it may result from the overgrowth of adenoidal tissue or chronic sinus infections. Suppurative otitis media is caused by the introduction of pyogenic microorganisms into the middle ear, usually Haemophilus influenzae, S. pneumoniae, or Moraxella catarrhalis. The condition often follows the flu or colds and may be induced by overly forceful nose blowing. Swimming in contaminated water also may result in a middle ear infection.

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Variations in the structure or function of the eustachian tube may strongly predispose an individual to the development of otitis media. Narrowing or constriction of the eustachian tubes may interfere with the normal drainage of secretions from the middle ear. Conversely, those with eustachian tubes that are shorter, wider, or more horizontally placed than normal may be more prone to infectious forms of otitis media.

Signs and Symptoms

The symptoms vary with the severity of the infection. A person with serous otitis media usually experiences only a sensation of fullness or pressure in the affected ear, along with varying degrees of hearing impairment. Suppurative otitis media, on the other hand, is usually manifested by pain in the affected ear and is often accompanied by general symptoms of infection such as fever and chills. Both conditions may cause dizziness.

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Diagnostic Procedures

Examination of the affected ear with an otoscope reveals bulging of the eardrum. Often the eardrum has a cherry-red discoloration. Fluid bubbles may be discernible behind the eardrum. The individual’s white blood cell (WBC) count is usually elevated in cases of suppurative otitis media.


Antibiotics are ordered to control suppurative otitis media, and analgesics may be prescribed to relieve pain and discomfort of either form. However, many primary care providers are opting not to use antibiotics except in the most severe cases. Decongestants may be ordered to promote drainage. In severe cases, drainage may be accomplished by needle aspiration; by surgical incision of the tympanic membrane, a procedure called myringotomy; or by surgery to correct the eardrum, called tympanoplasty. For chronic forms of otitis media, the acute attacks must be treated as previously described, but surgery, such as myringoplasty and tympanoplasty, may also be necessary. In some cases, especially in children, tubes are inserted surgically into the tympanic membrane to equalize pressure between the atmosphere and the middle ear. In most cases, the tubes are removed after 6 to 18 months, or they may fall out on their own.

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Complementary Therapy

Stollery Children’s Hospital at the University of Alberta published research data from studies indicating that complementary therapy may help children with ear infections. Most of the studies, however, had significant limitations that made it difficult to offer advice based on their conclusions, whether positive or negative.

Client communication

Stress the importance of taking all the antibiotics even when client is feeling well. Followup care is needed especially in cases when the infection recurs. Instruct in preoperative and postoperative care that may be necessary. Children especially need to understand procedures and special care.


The prognosis for an individual with either form of acute otitis media usually is good, given the individual receives prompt treatment. Chronic otitis media, however, may lead to scarring, adhesions, and severe ear damage with hearing loss.

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Prompt treatment of any URI infection and otitis media is recommended.