OVERVIEW

What is otitis media?

Otitis media refers to inflammation of the middle ear, which includes the Eustachian tube, tympanic cavity, tympanic sinus, and mastoid air cells.

Depending on the cause, otitis media can be classified into suppurative otitis media, secretory otitis media, and other types. Different types of otitis media present varying clinical symptoms and require distinct treatment approaches.

• Suppurative otitis media: Typically caused by pyogenic bacterial infections. Acute symptoms include ear pain, ear discharge, and may be accompanied by systemic symptoms such as fever and chills^[1]. Prompt infection control, drainage, and addressing the underlying cause are essential. If inflammation persists, it may develop into chronic suppurative otitis media, characterized by recurrent discharge and hearing loss.
• Secretory otitis media: Often results from dysfunction of middle ear ventilation or may occur after radiotherapy for head and neck tumors^[1]. Common symptoms include hearing impairment, ear pain, tinnitus, and ear fullness. As it is a leading cause of hearing loss in both children and adults, early intervention—through medication or surgery—is crucial, with generally favorable outcomes.

Is otitis media common?

Otitis media is a prevalent condition in otolaryngology, particularly among children. Secretory otitis media is more frequent in winter and spring, affecting approximately 1 in 100 children^[2]. With worsening environmental pollution and lifestyle changes, its incidence has been rising annually^[3].

Which department should I visit for otitis media?

Otolaryngology (ENT).

SYMPTOMS

How to know if you have otitis media?

The main symptoms of otitis media include hearing loss, a feeling of fullness or blockage in the ear, ear pain, and intermittent tinnitus. Symptoms may vary slightly depending on the type of otitis media.

Symptoms of suppurative otitis media

In the acute phase, severe throbbing ear pain may occur, accompanied by a noticeable feeling of fullness in the ear. After perforation of the eardrum, pus may discharge from the ear. Systemic symptoms such as fever, chills, loss of appetite, diarrhea, and vomiting are also common.

Symptoms of secretory otitis media

The primary symptom is hearing loss, which may vary with changes in body position—improving when the head is tilted forward or toward the unaffected side. Mild ear pain and a sensation of fullness may also occur. It’s important to note that infants and young children, due to limited ability to express discomfort, often show no obvious symptoms. If an infant exhibits poor responsiveness to sounds, irritability, or frequent ear tugging, or if a child has difficulty concentrating or does not respond when called, these signs should be taken seriously.

CAUSES

What are the causes of otitis media?

The causes vary depending on the type of otitis media:

• Suppurative otitis media: Caused by bacterial infections, such as Streptococcus pneumoniae or Staphylococcus. It may occur when water enters the ear during swimming or bathing and is not promptly removed, creating conditions for bacterial growth. It can also result from the spread of inflammation from sinusitis or tonsillitis to the middle ear.
• Secretory otitis media: The exact cause is not fully understood, but it is generally associated with eustachian tube dysfunction, infections, and immune factors.

Is otitis media contagious?

It is generally not contagious between people.

Who is most commonly affected by otitis media?

Otitis media is most common in children, primarily due to the following reasons:

• Children have shorter, wider eustachian tubes with a lower tympanic orifice, making it easier for infections in the throat to spread to the middle ear^[1].
• Children's immune systems are not fully developed, making them more susceptible to bacterial and viral infections^[1].
• During breastfeeding, improper positioning may allow milk or stomach contents to enter the middle ear through the eustachian tube, triggering inflammation^[1].

DIAGNOSIS

What tests should patients with otitis media undergo?

Generally, a complete blood count, otoscopy, hearing test, and ear CT scan are required. None of these tests cause significant discomfort.

• Complete blood count: Helps identify the type of pathogen causing the inflammation through blood analysis. Fasting is not required.
• Otoscopy: Allows examination of the external ear and eardrum to detect signs of otitis media.
• Hearing test: Assesses whether hearing is impaired, determines the nature and severity of hearing loss, and aids in treatment planning and efficacy evaluation.
• Ear CT scan: Provides a clear view of the middle ear structure to detect abnormalities and assess the extent of the disease.

TREATMENT

How to treat suppurative otitis media?

Acute suppurative otitis media

• Systemic treatment: Early use of antibiotics to control infection, such as penicillins and cephalosporins^[1]. This can effectively prevent tympanic membrane perforation.
• Local treatment:
  • Before tympanic membrane perforation: 1% phenol glycerin ear drops can be used to reduce inflammation and relieve pain. If the treatment effect is limited and the tympanic membrane bulges significantly, an acute tympanotomy can be performed to drain pus from the ear, which helps reduce inflammation. After systemic and local symptoms improve, the perforation may heal^[3].
  • After tympanic membrane perforation: Antibacterial solutions are often used as ear drops to effectively eliminate pathogens. It is important to clean the pus from the external auditory canal before administering ear drops^[3].
• Etiological treatment: If conditions such as rhinitis, sinusitis, hypertrophic tonsils, adenoid hypertrophy, or nasopharyngeal tumors are present, these underlying causes of otitis media should be actively treated.

Chronic suppurative otitis media

• Drug treatment: When ear drainage is unobstructed, antibiotic solutions or a combination of antibiotics and corticosteroids are often used as ear drops. The external auditory canal must be thoroughly cleaned of pus before administering ear drops. During acute episodes, systemic antibiotics may be used^[2].
• Surgical treatment: Generally, small tympanic membrane perforations may heal on their own after the ear stops discharging pus. If they do not heal, tympanoplasty may be required^[1].

How to treat secretory otitis media?

Secretory otitis media can lead to hearing loss and affect quality of life. In infants and young children, it may even impair language development and balance function, so prompt medical attention is necessary once detected.

• Etiological treatment: Actively treat nasopharyngeal conditions such as cleft palate, adenoid hypertrophy, and nasopharyngeal cancer to eliminate mechanical obstruction of the Eustachian tube^[1].
• Drug treatment:
  • Antibiotics: Mostly used during the acute phase, especially for secretory otitis media caused by upper respiratory tract infections.
  • Corticosteroids: Corticosteroids can reduce inflammatory exudation. However, long-term systemic use of corticosteroids should be avoided due to potential side effects such as osteoporosis^[1].
  • Mucolytics: These can help drain middle ear effusion and improve Eustachian tube ventilation^[2].
• Surgical treatment: If conservative treatment is ineffective, timely surgical intervention may be necessary to improve middle ear ventilation and drainage and eliminate effusion^[1].

Can otitis media heal on its own?

Otitis media cannot heal on its own and requires active treatment.

Can otitis media cause deafness?

Generally, otitis media will cause some degree of hearing loss. With timely and standardized treatment, hearing can usually be restored. Otherwise, complications such as tympanic membrane perforation, disruption of the ossicular chain, or scarring that restricts ossicular movement may lead to irreversible hearing loss.

DIET & LIFESTYLE

Do patients with otitis media need to avoid certain foods in their diet?

Diet has little relation to otitis media, so no specific restrictions are necessary. However, a healthy diet benefits everyone:

• Focus on eating more fruits and vegetables;
• Maintain a balanced mix of meat and vegetables;
• Diversify staple foods by incorporating whole grains alongside rice and noodles;
• Use less salt and high-sodium seasonings when cooking;
• Limit intake of pickled vegetables and cured meats;
• Avoid alcohol as much as possible.

What should otitis media patients pay attention to in daily life?

• Reduce ear cleaning frequency and avoid excessive force or deep insertion to prevent eardrum damage.
• When blowing the nose, avoid pressing both nostrils simultaneously; alternate pressing one nostril at a time.
• Minimize headphone use and keep the volume low when using them.
• Limit swimming, especially when ear issues are present, to avoid worsening infections.

PREVENTION

How to prevent otitis media?

• When bathing or swimming, try to avoid water entering the ears. If water gets in, promptly dry it with clean, soft tissue.
• If you have conditions like rhinitis, sinusitis, adenoid hypertrophy, or tonsillitis, actively treat them to prevent recurrence.
• Avoid catching colds, wash hands frequently, and stay away from crowded, poorly ventilated public places during flu season.
• Boost immunity by maintaining a regular schedule, balanced diet, and physical exercise.
• Quit smoking and avoid exposure to secondhand smoke.

What to do if you feel blocked after water enters the ear?

A blocked sensation after water enters the ear is usually caused by two scenarios, each requiring different handling methods.

One is when water accumulates deep in the ear canal or on the eardrum, causing a blockage. Tilt your head to the affected side and jump lightly to "drain" the water. The blockage usually disappears immediately, and any remaining moisture can be left to dry naturally.

The other is when excessive earwax in the canal expands after absorbing water, leading to blockage. This typically requires a doctor's intervention for professional cleaning or ear irrigation, as self-treatment is often ineffective and may cause injury.

If the blockage occurs after diving, it may not just be water—pressure differences could also cause secretory otitis media. This is often accompanied by ear pain and requires medical attention.