When I diagnose acute otitis media or secretory otitis media after examining the ears, parents often ask with amazement how such a young child could have otitis media. The daily clinic volume is huge and the consultation time is short, so there is no way for each parent to explain in great detail. I apologize to those parents who have not been able to explain in detail. Xiong Qi, Department of Otolaryngology, Guangzhou Women’s and Children’s Medical Center
Otitis media is divided into purulent otitis media (pus flowing out of the ear canal) and non-purulent otitis media (no pus flowing out). Secretory otitis media, also known as exudative otitis media, catarrhal otitis media, mucus otitis media, etc., is the most common and most frequent type of non-suppurative otitis media, with an incidence of about 70% in children aged 2-5 years.
I. How does otitis media occur?
The normal middle ear is an air-containing cavity, and the fluid produced will flow through a tube to the nasal cavity, which is called the eustachian tube. As shown in the diagram, when the eustachian tube is not open, middle ear fluid accumulates and cannot be discharged into the nasal cavity through the eustachian tube, gradually forming middle ear effusion, or secretory otitis media. Therefore, the eustachian tube is not open and is the culprit of secretory otitis media.
What are the causes of eustachian tube opacification?
The most common cause is acute upper respiratory tract infection, i.e., cold. Bacteria and viruses in the air are first inhaled and filtered through the nasal cavity before being inhaled into the lungs, so it is the organ of the respiratory system that is most exposed to bacteria and viruses and is also the most sensitive. The nasal cavity has a self-purification system. When a large number of bacteria and viruses adhere to the nasal turbinates, the blood flow to the turbinates increases to secrete mucus to kill the bacteria and viruses and reduce the amount of bacteria entering the lungs, which is the first line of defense for the respiratory system. However, the increased blood flow in the nasal cavity makes the turbinates congested and swollen, nasal congestion, congestion of the eustachian tube, and obstruction of the eustachian tube. The second common cause is adenoid hypertrophy, where the adenoids open at the opening of the eustachian tube to the nasal cavity, and the oversized adenoids block the opening of the eustachian tube leading to atresia. Third, there is retrograde infection. This is also more common in children than in adults.
As shown in the diagram, the shape of the eustachian tube is basically horizontal in children, while in adults there is an angle, and the presence of this angle causes bacteria from the nasal cavity not to enter the middle ear easily. Children, on the other hand, are more prone to otitis media due to nasal infections such as rhinitis and sinusitis. The eustachian tube gradually develops closer to the adult stroke angle after the age of 7, so the incidence of otitis media decreases after the age of 7. In addition, the immaturity of the muscles of the eustachian tube in children and the fact that the contraction and drainage of fluid are not yet complete also contribute to the high incidence of otitis media in children. Children with cleft lip and palate also have a high incidence of secretory otitis media due to malformations in the development of the eustachian tube.
What are the manifestations of secretory otitis media?
1 Early on, there is a sudden onset of severe pain, which usually lasts for several hours and can be relieved automatically, often at night (when lying down). (As an aside, when I was on duty, I often had children with earache come to the emergency room in the second half of the night, and many of them were no longer in pain by the time they arrived at the hospital, but of course there was no shortage of those who were still in pain. (The parents are very nervous to ask for immediate treatment can only eat painkillers, but painkillers are usually not recommended for children, and it takes a while for painkillers to take effect, maybe when they take effect the child has long stopped hurting, at this time the child most needs only parental reassurance.)
2 The tympanic membrane is obviously congested in the early stage, and the doctor can see the congested tympanic membrane with an electro-otoscope
As shown above, the left tympanic membrane is obviously congested, while the right tympanic membrane is normal. Of course, the pictures given are the most typical and need the doctor’s experience to see them, most of the time they are not so typical.
3 In the middle stage of otitis media, the pain has dissipated, but some children may still have persistent or intermittent vague pain or mild discomfort, and those with speech may also report stuffy, buzzing, and swollen ears.
4 In children with prolonged otitis media effusion, there is no obvious discomfort, and some of them only show mild hearing loss, such as poor response to verbal conversations, the need to repeat listening, decreased attention in class, increased volume of speech, increased volume of watching TV, and inaudible answering of phone calls.
Why does middle ear infection cause ear pain? Why does the eardrum become congested?
Early middle ear exudate contains a lot of inflammatory factors (leukotrienes, prostaglandins, etc.), which will simply be the substances that cause pain, while these inflammatory factors stimulate the tympanic membrane causing it to become congested.
In summary, the causes of otitis media are mainly related to several factors, such as: cold, rhinitis, sinusitis, adenoidal hypertrophy, immature middle ear, etc. The early manifestation of otitis media is ear pain, which is relieved after a few hours.
The treatment of otitis media will be further written later.
This article is published with the authorization of Dr. Xiong Qi.