Parents often realize the fact that the child has otitis even before the doctor’s arrival – the child is very restless, capricious, tries to reach ears with the little hands.
In order to explain the causes of otitis and give any significant, workable and understandable recommendations for otitis media treatment, let’s first see into brief information on how the human ear works. Even if we know the operation principles of any device, we cannot always understand why the device is broken. The same applies to our ears and we’ll explore now the physiology of the human ear to understand why it hurts and what to do. Here are some medical terms and theoretical information on this topic below.
Otitis is an inflammation of one of the ear divisions.
This definition helps us logically understand that the human ear consists of several departments, and each one has its own specific functions and diseases.
Outer ear is the only visible ear department. The pinna is associated in our perception with the organ of hearing, although it has the least importance for the very possibility of hearing (among all ear departments). The task of the pinna is to capture the sound vibrations and send them into the ear canal which ends with the eardrum. Behind the eardrum there’s the beginning of the middle ear.
The function of the middle ear is to conduct sound waves. Right behind the eardrum there is the tympanic cavity – a very limited space that amplifies and processes the audio signals in a certain way. In the tympanum there are very little sound bones called very ingeniously – a hammer, anvil and stirrup. The hammer handle is very firmly attached to the eardrum. The eardrum vibrates under the influence of sound waves, these vibrations are transmitted through the chain of bones and the stirrup base is in a special opening of the temporal bone behind of which there’s the inner ear.
The inner ear is a complex canal system; it is located in the temporal bone and forms the very hearing organ called cochlea because of its specific shape of channels that resembles a snail. The channels are filled with the fluid and so-called hair cells. A certain frequency of a sound causes vibrations of certain hair cells which, in turn, convert mechanical vibrations into nerve impulses. The impulses are perceived with the auditory nerve and transferred into the special brain nuclei.
Considering the above information, physicians therefore diagnose three types of otitis – otitis externa, otitis media and otitis interna.
Otitis externa doesn’t have any “ear” particularities – it is obvious that an inflammatory process may appear as on the ear skin so in any other part of the skin – a variety of acnes, boils, etc. Ulcers (often called boils) in the ear canal are not easy to be treated, for it is difficult to reach them in this part of the ear.
Otitis interna (channel systems – also called “mazes”) is fortunately not very frequent phenomenon but always very serious. Otitis interna is usually not a primary disease but a complication of otitis media or of an overall severe infectious disease.
In most cases, any ear canal discharge, pain in one or in both ears, and (or) impaired hearing are caused by otitis media.
The very otitis media is one of the most common diseases especially in children. In 99% of cases, physicians mean otitis media when saying: “Your child has got otitis”. So, when using hereinafter the term “otitis”, let’s bear in mind an inflammation of the middle ear.
Middle ear, as we already know, is the tympanic cavity, inside of which there are bones. The normal function of the middle ear is possible only when the pressure in the tympanic cavity equals the atmospheric one – eardrum and bones vibrate adequately.
A special channel, Eustachian tube, which connects the throat and the tympanic cavity, maintains the proper pressure level. When we swallow the tube opens, the middle ear is being ventilated and the pressure there is balanced.
Middle ear inflammation does not appear for any apparent reason. The change of pressure in the tympanic cavity is the root cause. Why does this happen? First, when the pressure on the eardrum is changed – when diving or rising (lowering) during air travel, for example. Secondly, and this is the most common cause, when various inflammatory diseases of the nose and throat appear, when the patency of the Eustachian tube is disordered.
In short, otitis is not an independent disease, and is almost always a complication of inflammatory diseases of the nasopharynx, primarily – acute respiratory viral infections.
Every adult knows well that any viral disease of the nasopharynx causes an increased mucus secretion. Multiple sniffing, particularly active one (it doesn’t matter whether inward or outward the nose), promotes penetration of mucus into the Eustachian tube; moreover, bacteria and viruses that cause acute respiratory diseases, often cause inflammation of the Eustachian tube mucosa. Both these factors deteriorate ventilation of the tympanic cavity. In these conditions, surface cells of the tympanic cavity start releasing inflammatory fluid. At this stage, specific symptoms of otitis media already appear – ear pain, impaired hearing. Later on (sometimes in a few hours but more often in 3 days), the bacteria enter the tympanic cavity (through the same Eustachian tube) and start multiplying – otitis becomes purulent. Pain increases, the body temperature rises, the pressure in the tympanic cavity often increases so that there is a rupture of the eardrum and purulent begins to emerge through the hole in the ear canal.
The above theoretical information helps easily answer the question: “Why do children suffer from otitis media significantly more often than adults?” The main factors are as follows:
1. eustachian tube of a child is much narrower than the one of an adult, thus its patency is deteriorated easier;
2. children often suffer from colds and viral diseases;
3. children cry and sniff more actively;
4. adenoids, which compress the Eustachian tube, appear much more often in children.
The main symptoms of otitis are impaired hearing, ear pain, and (rarely) discharge from an ear. And if a child had a cold before, the diagnosis is absolutely obvious then. At the same time it is much harder to diagnose otitis in babies, because a baby can’t complain about either pain or impaired hearing. But parents shouldn’t forget about the possibility of otitis media in any case, for motiveless, at the first glance, anxiety, irritability, sleep disturbance, and crying must remind parents about otitis.
There is a pointed eminence on the external auditory canal opening called tragus. If a child has otitis, pressure on the tragus will cause significantly increased pain and shrill cry. Every parent can check this symptom, and he should immediately visit the doctor if the child cries.
To prevent otitis, you should not let thick mucus plug the Eustachian tube – it is not as easy as it might seem at first glance. It is important to remember that the liquid discharge from the nose is not dangerous; but what to do not to let the mucus thicken? You should know the factors that promote drying up of mucus:
1. fluid deficit in the body (the child hence should drink more);
2. high body temperature (timely use antipyretics, of course, in accordance with the doctor’s recommendations);
3. dry and warm indoor air (use warm clothes, but the air temperature should not be above 18-20°C, ventilate the room, do wet cleaning frequently, remove things that accumulate dust).
Another important way to prevent otitis is moderation when blowing the nose (the situation is common – a mother holds a handkerchief in a hand, there’s the child’s nose under the handkerchief, and the mother’s actions are commented with the urgings: “Come on, blow your nose stronger!”)
The otitis media can be diagnosed exactly only by a doctor who will examine the tympanic membrane (such inspection in the medical language is called otoscopy). Otoscopy lets the doctor determine the type of otitis media – catarrhal (there is inflammatory fluid but without pus yet) or purulent one; as well as clarify the amount of accumulated fluid in the tympanic cavity. All this information significantly affects as the choice of remedies so the treatment duration.
Very often vasoconstrictive nasal drops are used (yes, right into the nose) that allow to reduce the swelling of the Eustachian tube mucous membrane – these medications are contraindicated to treat an ordinary viral runny nose but are mandatory if otitis is suspected to be. Antiseptic solutions are applied locally (into the ear canal). Sometimes, if the ear pain is severe, anesthetic drops as well as anti-inflammatory hormones are applied.
Antibacterial medicines play a special role in the otitis media treatment (antibiotics, sulfonamides, etc.). Their usage has some peculiarities – the medicine must not only affect the bacteria that have caused otitis, but to penetrate also into the tympanic cavity well.
These therapy methods must not be regarded as guidance no way. It should be remembered that proper and timely treatment of acute otitis media is quite fast and almost never results in impaired hearing. Treatment delay and self-medication can have serious consequences – at the best otitis media becomes chronic, at the worst – serious complications from total hearing loss to purulent meningitis are possible.
You should not be upset very much if there’s suppuration from an ear – if the treatment is proper, instead of the tympanic membrane rupture there will be a small scar that almost never leads to hearing loss later on.
If you have suspected otitis, you must immediately visit an otolaryngologist. If this isn’t possible (the doctor is away), you can use vasoconstrictive nasal drops on your own, naftizin for example; apply also otinum drops, which, besides anti-inflammatory action, are able to dissolve earwax. It is highly desirable that the ear is warm (dry heat – cotton wool, a scarf or a hat), but do not apply a hot water bottle. These activities will help save the time needed to get to a doctor.